In the behavioural part of CBT, people learn new behaviour that counteracts their limiting beliefs.

People with anxiety disorders tend to overestimate threats and underestimate their coping ability. They tend to engage in various avoidant behaviours to prevent feeling distressed and overwhelmed. These behaviours could include leaving a crowded party because they sense a panic attack coming on, self-medicating with alcohol or drugs, or even refusing to leave the house. 

Avoidance provides short-term relief from overwhelming emotions. Over time avoiding perceived threats strengthens the underlying self-limiting beliefs because the person never gives themself a chance to discover if these beliefs are true. They believe that the danger is too big and their ability to cope is too small, and their world becomes smaller over time.

So, a crucial part of CBT is to help people feel better by changing their avoidant behaviours.  

The first step in changing avoidant behaviour is to make a Fear Hierarchy. A Fear Hierarchy lists things you avoid because they trigger you in some way, causing anxiety or other feeling your wish to avoid. When making a list rank the items from least to most distressing.

For example, someone with social anxiety might have this as a fear hierarchy:

  • Checking Facebook
  • Introducing themself to someone 
  • Going to a social gathering
  • Giving a speech

Each item can be broken down into smaller, incremental steps. Going to a social gathering can be broken down into:

  • Talking about going to a social gathering
  • Standing outside a social gathering, listening 
  • Going to a social gathering with a friend and staying for 15 minutes
  • Going to a social gathering and staying for at least an hour

The second step is to expose yourself to each item on your fear hierarchy. Start with the least distressing item and repeat it several times until the anxiety level goes down. For each item, remember to work through the incremental steps, you don't need to dive straight into the deep end. Move on to the next least distressing item and keep repeating until you work through your list.

Over time you will create new beliefs that replace the old beliefs. This is very effective for confronting fears and creating a feeling of safety and security, which results in feeling less anxious.

Box Breathing

Breathing exercises are another common behavioural component of CBT that helps to reduce both feelings of distress and avoidant behaviour.

In Box Breathing, you take a deep breath in, fully expanding the lungs and belly, pause, blow it all out slowly, and relax. Repeat a few times until the tension dissipates. 

Questions to Ask Yourself

What are some situations that I avoid which limit my life?

What feelings do I experience if I think about doing those things?

Do I use alcohol or drugs to self-medicate and help me avoid facing certain things?

Am I missing opportunities that I would like to participate in because of my fears or avoidant behaviour?

CBT Part 1 Conclusion