Cognitive Therapy Techniques: 5 Steps to Stop Worrying


Worry and stress seem to be an increasingly problematic part of modern life. Virtually constant connection to the 24-hour news cycle and social media provide a continuous source of anxiety-inducing thoughts. Financial and career uncertainty has upsurged despite a decade of consistent economic growth. Increased pressure to do more with less at work has created an expectation to multitask, dividing our mental focus in ways that breed anxiety. Now more than ever we need simple, effective ways of taking care of our minds to keep worry at bay.

If you struggle with persistent anxiety, it is likely that excessive worry is largely to blame. Although sometimes worrying feels beneficial, protecting us from being unprepared or caught off guard, for many people it causes more problems than it solves. There are numerous ways cognitive behavioral therapy (CBT) can reduce excessive worry. One powerful technique is through evaluating the worry to determine whether it is productive or unproductive. By determining a worry is unproductive, it is easier to intentionally let it go.

There are several questions you can ask yourself to evaluate your worry. After going through these questions, you’ll probably have a better idea whether the worry is helpful, or just background noise that only serves to increase your anxiety:

1. What are you predicting will happen, and what is the likelihood it will actually happen? Identify in detail what you are most concerned will happen. If it’s giving a speech, it may be people laughing at or heckling you. If you’re worried about a difficult interaction with someone, you may fear someone will yell at you or reject you in some way. If the concern is about making a mistake at work, you may fear being fired. Whatever the situation, consider what it really is that you are most afraid of. Oftentimes, just specifically identifying what we fear can help us realize our anxiety may be unfounded.

Once you identify the perceived threat, make some evidence-based predictions about how likely the threat is. How many times have you experienced this worst-case scenario before? (Does the person you’re thinking about often yell at others? Is it common for you or someone else to be laughed at during speeches? How often are people fired at your work, and when they are, what sorts of/how many infractions lead to their firing?) Would there be steps you could take to reduce the likelihood of your fear coming true? Could you for instance, craft a sensitive way of being assertive in your feared interaction? How could you influence the outcome more in your favor? Given the situation you fear, is this a plausible outcome? (For instance, do you really think people will heckle you at a professional conference?)

2.What are the best case scenario and most likely scenarios? Some people are already experts at identifying the worst-case scenario. In fact, they’re so good at it they forget to consider other possibilities. It is helpful to also consider the best-case scenario, which is often equally as plausible as the worst-case. Finally, after identifying the extremes, consider what the most likely scenario is. Usually our minds drift toward the more extreme potential outcomes, when in reality, the extremes happen less often. If you have difficulty identifying the most-likely scenario, it may be helpful to find a scenario that has some degree of negative outcome paired with some degree of positive outcome. For instance, “I’ll give the speech and there will probably be some people who are bored and some people who are really interested.”

3. How many times have you made this prediction and it came true? Another way to consider the usefulness of your worry is to actually count how many times the worst-case scenario has happened. If you’ve driven on the freeway 100 times in the past year and have never gotten into an accident, those odds indicate your worry may be disproportionate. Even if you have been in an accident your level of worry may have made it feel like it was a 50% chance, and thus causing unnecessary fear. 

4. If the worst-case were to happen, what would you do to cope with it? People generally end their worrisome predictions right at the worst moment. You may find it helpful to think about what would happen next, specifically, what you would do to get through the difficult situation. If you do fail the test, you might be disappointed for the rest of the day, curl up on the couch with a pint of ice cream and watch T.V. Then you’ll probably get back on the horse by finding out what you did wrong and altering your study strategy so you pass the next time. Although failing an important exam is unpleasant, you probably have a lot you could do to deal with it effectively. Consider that too!


5. What are the costs and benefits of worrying about this? Finally, examine how effective it is to worry about this situation. Some degree of worry may be helpful in motivating you to prepare. Too much, on the other hand, may paralyze you and become a self-fulfilling prophecy. And some things, no matter how much you worry about them, you don’t have any control over. In these latter two instances, the worry is self-defeating. It is unproductive worry. When you identify a worry as unproductive, you can tell yourself “Thinking about this is of no use to me now. Let it go.” Then immediately refocus your mind on what’s actually going on around you. By rehearsing this behavior, intentionally letting go of worries again and again, you learn to become less consumed by anxiety and worry.

This technique comes from a cognitive behavioral therapy protocol for generalized anxiety. CBT for generalized anxiety has been found to be 70%-80% effective in significantly reducing anxiety symptoms, as compared to a 30% effectiveness rate of traditional talk therapy (Durham, 1995). CBT for anxiety works best with the help of a trained cognitive-behavioral therapist. If you or someone you know has problems managing anxiety, click here for more information about CBT for Anxiety


Durham, R.C. (1995). Comparing treatments for generalized anxiety disorder: Reply. British Journal of Psychiatry, 166, 266-267.

CBT Treatment for Chronic Depression


Most people who suffer from depression experience depressive symptoms for a limited duration, on average, 20 weeks. This is what is considered acute depression, meaning an episode of depression lasting a discrete period of time. However, some who experience acute depression go on to have symptoms that endure for an extended period, lasting many months or years. This is considered chronic depression. Chronic depression lasts at least six months, in which more days than not significant depressive symptoms are present. Research has shown that chronic depression can be more difficult to treat, requiring a longer course of treatment and different interventions than acute depression. Cognitive Behavioral Assessment System of Psychotherapy (CBASP) is the only treatment model developed specifically for people with chronic depression (Shatzberg et al., 2005). It is the subject of the largest study on psychotherapy in history, and has shown to be significantly more effective than other treatments for chronic depression. 

According to the CBASP model, maltreatment and trauma experienced early in life can derail normal psychological development, and sometimes results in early-onset chronic depression. Such maltreatment can take many forms, from physical abuse to perceived invalidation. Alternatively, an out-of-control mood state later in life can also undermine psychological functioning in people with no history of neglect or abuse. Significant life events such as the onset of chronic illness, loss, and divorce can trigger such a mood state and result in lasting feelings of sadness and despair. Research has shown CBASP therapy is one of the few treatments than can effectively treat both early- and late-onset chronic depression.


Through CBASP treatment, people learn to objectively examine the consequences of their interpersonal behavior in specific kinds of interactions. Through this process, patients learn to become more perceptually connected to their environment, observing where their behavior is working against them and identifying behavior more consistent with their desired outcome. It is this process that, over time, helps people move from persistent feelings of helplessness to an increased sense of mastery and contentment. These gains are accomplished through a technique known as situational analysis.

In situational analysis, one’s attention is repeatedly directed to the effect of one’s behavior on others as well as the effect of one’s own interpersonal behavior on the therapist. Working through the situational analysis over time, the interpersonal trauma the patient brings to treatment is healed by separating those elements of the patient’s past she is projecting onto the present.

CBASP treatment has been shown to be highly effective in people whose depression symptoms do not respond to traditional talk therapy or to antidepressant medication. If you or someone you know is struggling with chronic depression, click for more information about cognitive behavioral treatment of depression

Shatzberg, A.F. et al. (2005). Medication or therapy is effective when the other is not. Archives of General Psychiatry, 62, 513-520.

All material provided on this website is for informational purposes only.  Direct consultation of a qualified provider should be sought for any specific questions or problems.  Use of this website in no way constitutes professional service or advice.