Cognitive behavioral therapy directly addresses anxiety

Q. I'd like to learn more about cognitive behavioral therapy. How is it used to treat anxiety?

A. Cognitive behavioral therapy, or CBT, is the leading form of therapy for anxiety. It attempts to correct ingrained patterns of negative thoughts and behaviors. Some studies indicate that it is as effective or more effective than medication.

Cognitive behavioral therapy has roots going back a century. The ideas and techniques of CBT came together in the 1960s and 1970s. It is one of the forms of “talk therapy” that has been studied in scientific trials and found to be effective.

In contrast with other forms of talk therapy, CBT does not focus on events in your early life, your relationships with family or your dreams. Instead, it directly addresses your fears and apprehensions.

As the name suggests, CBT has two parts. Cognitive therapy helps you change negative patterns of thinking. Behavioral therapy works to change your reactions in situations that trigger anxiety.

Negative thoughts and behaviors tend to crop up when you're under stress. So the first step in CBT is to help you recognize when you're stressed.

Your therapist will ask you to record your thoughts and anxiety levels in certain situations. Then, you and the therapist will discuss your thoughts. You'll evaluate how realistic they are. And you'll work together to substitute more productive thoughts.

The therapist might also challenge you to consider what would happen if your fears came true. Would that outcome actually be so bad?

The behavioral component of CBT has two main strategies. The first involves having you face your fears directly. The reasoning is that avoiding anxiety-causing situations reinforces fears or false beliefs. In real-life situations, you can practice substituting more realistic thoughts for your negative ones. With repeated exposure, you should become desensitized to fear-provoking situations.

The other main strategy is teaching practical skills to help you feel more in control. For example, say you become extremely anxious when you have a lot to do. You may learn about setting goals and managing time. If you're uneasy in social situations, you may be coached in social skills.

We have more information on anxiety in our Special Health Report, “Coping With Anxiety and Phobias.” Learn more about it on my website,

Practitioners of other forms of talk therapy, such as psychoanalysis, sometimes complain that CBT has been given more recognition than is justified by the scientific evidence. Nevertheless, one of the most prestigious awards given for medical and biological research, the Lasker Award, was bestowed on Dr. Aaron Beck in 2006 for his role in developing CBT.

For many people with anxiety, two treatments are better than one. In particular, many doctors recommend both CBT and medication. This dual approach can offer longer-lasting results than either medication or therapy alone.

Some of my patients who suffer from anxiety are reluctant to take any kind of medication — despite the fact that medications definitely can help. For them, CBT has been a very welcome option.

• Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: