1 The cognitive behavioural model of anxiety
Pathological anxiety sustains itself through a three-part vicious circle: automatic catastrophic thoughts such as “I am going to faint” or “everyone is judging me”, intense physical sensations including rapid heartbeat, chest tightness and dizziness, and avoidance or reassurance-seeking behaviours. CBT targets these mechanisms directly, helping the brain relearn that feared situations are not dangerous.
2 Therapeutic tools: cognitive restructuring and graded exposure
Therapy uses Beck’s thought records to identify cognitive distortions, such as overgeneralisation and jumping to conclusions, and develop more realistic alternative thoughts. Behaviourally, therapist and patient build a graded exposure hierarchy: the person gradually faces anxiety-provoking situations without escaping, allowing the neurobiological mechanism of habituation to reduce anxiety naturally.
3 Clinical conditions in which CBT excels
International bodies recommend CBT as a first-line treatment for panic disorder with or without agoraphobia, social anxiety, generalised anxiety, specific phobias involving driving, transport or animals, and obsessive-compulsive disorder (OCD), using exposure and response prevention (ERP).
4 Brief, collaborative and practical therapy
Structured over 12 to 20 sessions, CBT involves close face-to-face collaboration in which the patient takes an active role, trying concrete exercises between sessions. This approach provides lasting tools, enabling the person gradually to become their own therapist and prevent future recurrences.
5 Between-session exercises and objective measurement of progress
Between CBT sessions, the patient commits to self-observation tasks and behavioural exercises recorded in a journal. This active practice greatly increases therapeutic effectiveness: over the weeks, the person objectively measures the decline in their anxiety scores.