Anxiety is one of the most common human experiences. Almost everyone has felt their heart race before an important meeting, worried about the future, or replied to conversations in their mind late at night. Also, psychologists are not immune to anxiety and its negative consequences as well. I remember my final exam on anxiety disorders—it was from one of the most challenging courses in my Master’s in Clinical Psychology program. A few minutes before the exam, everyone was anxious, and several extremely worried students were trying to memorize possible therapies and relaxation techniques. You can see the irony there.
If anxiety is so detrimental, common, and even the specialist struggles with their specialty, why do we have anxiety? A certain level of anxiety can actually be helpful. It can motivate us to prepare for a presentation, study for an exam, or double-check an important decision. In these situations, anxiety functions as a signal that matters. However, anxiety becomes more difficult when the mind begins to overestimate danger and underestimate our ability to cope with it. This is where psychological models such as Cognitive Behavioral Therapy (CBT) offer a useful way to understand what is happening.
How CBT Explains Anxiety
One of the central ideas in CBT is that anxiety often comes from two mental processes happening at the same time:
- Overestimating the probability or severity of danger
- Underestimating our ability to handle the situation
When these two patterns combine, even relatively ordinary situations can start to feel overwhelming. Once I had a client, who had a minor bruise on his arm and thought that he would lose it.
For example, imagine someone preparing a presentation at work. Their mind might generate thoughts such as:
- “I’m going to mess this up.”
- “Everyone will notice if I make a mistake.”
- “If this goes badly, it will damage my reputation.”
These thoughts increase the perceived probability of something going wrong. At the same time, the person might underestimate their ability to cope:
- “I won’t know what to say if I get stuck.”
- “I won’t recover if I make a mistake.”
- “I won’t be able to handle the embarrassment.”
The combination creates a powerful sense of threat. The body responds with physical anxiety, faster heartbeat, muscle tension, racing thoughts, even though the situation may not actually be dangerous.
In CBT, these thoughts are known as automatic thoughts. They often appear quickly, feel convincing, and are rarely questioned at the moment. It’s a reflex of thinking; it happens so unconsciously is like wearing blue lenses and viewing the world more dangerous and the self-less competent that they are.
Learning to Question Automatic Thoughts
One of the most helpful CBT skills is learning to slow down and examine these automatic thoughts more carefully. Instead of accepting them as facts, we can begin to treat them as mental hypotheses that can be tested.
A few simple questions can help create some distance:
- What evidence supports this thought?
- What evidence might contradict it?
- Am I predicting the future without certainty?
- If a friend had this worry, what would I say to them?
- What is a more balanced way of looking at this situation?
For example, the previous client thought how many times a simple bruise didn’t led to any serious consequence, it takes a much more severe injury to cause such a result and then thought on the advance technology and well-educated doctor that would provide a solution. the thought “I’m going to lose my arm”, was changed to ‘My arm is going to be probably fine’. It’s simple process didn’t evaporate the anxieties, but it reduced severity as it happens many times, a series of small steps causing a change.
The goal is not to replace every negative thought with unrealistic optimism. It’s a common misconception I see in my practice. Once, another client had a serious conflict with their loved partner; his reaction was ‘everything will be fine’. As positive and nice as this comment might seem, it was more an act of avoidance and maladaptive optimism. Instead, the aim of CBT is to develop thoughts that are more accurate, balanced, and helpful.
I have seen individuals struggle at the beginning; it’s a common reaction. Imagine you are starting to go to the gym after a long time of being inactive; the start will be the hardest part. It’s important to remember in time of self-doubt and pity that practice makes perfect.
When Anxiety Shows Up as Rumination
Sometimes anxiety is not driven by one specific thought but by a pattern of thinking known as rumination. It involves repeatedly going over the same worries, scenarios, or questions in the mind without reaching a resolution. It might sound like:
- “What if I said the wrong thing earlier?”
- “What if something goes wrong tomorrow?”
- “Why do I always do this?”
Unlike problem-solving, rumination tends to go in circles. The mind tries to find certainty, but the process itself increases tension and mental exhaustion. I noticed a difference living in Greece and the Netherlands. It’s a common problem, particularly in the western world compared to others. Western individuals tended to be more oriented into the future, planning and comparing different probabilities. More commonly, self-reflection and organization become a reparative, unhelpful way of thinking.
In these cases, the challenge is not necessarily changing a specific thought but changing the relationship to thinking itself. In the rehab center in Thailand. They combined therapeutic techniques such as CBT with alternative approaches based on the mind body connection. This is where techniques focus on calming the nervous system and shifting attention can be particularly helpful. I have witnessed numerous clients expressing their gratitude about learning these techniques. They expressed that it gave them an antidote to uncontrollable anxiety.
Alternatives to Rumination
1. Mindfulness
Mindfulness involves gently bringing attention back to the present moment rather than becoming absorbed in mental loops about the past or future. A simple mindfulness exercise might involve focusing on the sensation of breathing, noticing sounds in the environment, or paying attention to physical sensations in the body. When the mind drifts back into worries, the goal is simply to notice it and return attention to the present moment. Over time, this practice helps people recognize that thoughts can be observed without needing to follow them.
You can also get creative with it. When I am getting overwhelmed, I like to walk and observe the colors and objects I see in the walk, or when I am inside, I like to take simple redundant activities and perform them mindfully such as take a shower and eat a meal.
2. Breathwork
Breathing patterns are closely connected to the nervous system. When we feel anxious, breathing often becomes faster and shallower. Slowing the breath can send a signal of safety to the body. One simple technique is slow diaphragmatic breathing:
- Inhale slowly through the nose for about four seconds.
- Allow the abdomen to expand.
- Exhale slowly for about six seconds.
Extending the exhale slightly longer than the inhale helps activate the body’s relaxation response. Practicing this for just a few minutes can reduce physiological tension and make anxious thoughts easier to manage.
3. Progressive Muscle Relaxation
I used to confuse progressive muscle relaxation (PMR), with a body scan. It’s a completely different exercise with origin in the USA, instead of Asia. It is interesting how different individuals explore similar solutions from unsimilar places. In more detail, PMR helps bring awareness to this tension and release it systematically.
The process typically involves:
- Tensing a specific muscle group (such as the shoulders or hands) for a few seconds.
- Slowly releasing the tension.
- Noticing the difference between tension and relaxation.
Moving through different muscle groups gradually allows the body to shift into a calmer state. When the body relaxes, the mind often follows.
Anxiety and Avoidance
In my clinical practice, I have seen a connection between anxiety and avoidance. A client was anxious about getting fired, so he avoided checking on his performance, another was anxious about her break-up, and she avoided having any conflict. When situations feel threatening, the natural reaction is to avoid them. Avoidance can provide short-term relief, but over time it tends to strengthen anxiety.
For example, the client who didn’t examine his performance score was missing important feedback, depriving himself from growing. Similarly, the client, who avoided conflicts, could unintentionally increase them and have to deal with a continuously more frustrated boyfriend.
CBT often focuses on the common phrase ‘face your fears, by gently reversing this pattern by encouraging gradual engagement with the situations that trigger anxiety. Taking small steps can help rebuild confidence and show the mind that the feared outcomes are often less likely or less catastrophic than imagined.
A final thought
Understanding how anxiety works is often the first step toward changing it. Learning to question automatic thoughts, recognizing patterns of rumination, and practicing techniques that calm the nervous system can all make a meaningful difference.
These skills do not eliminate anxiety completely. Anxiety is a normal and important emotion. My anxiety when I gave my last exam on anxiety motivated me and prepared me way better than apathy. That day, the students weren’t divided to anxious and not anxious, Instead, we were divided into having a healthy vs unhealthy relationship with anxiety
