Cycle of anxiety worksheet
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Clients often come to therapists struggling with anxiety, but they may not be aware of the cycle of anxiety.
This guide to the cycle of anxiety provides mental health therapists with a worksheet for clients that explains the anxiety loop or the anxiety avoidance cycle, and helpful tips for breaking the anxiety cycle.
What is the cycle of anxiety?
Cognitive behavioral therapy (CBT) works on the premise that our perception of events influences our feelings and behavior.
While anxiety can be a helpful response to a perceived threat, in the CBT cycle of anxiety, anxiety is a malfunction of a person’s internal alarm system. The person misreads the threat of danger and their ability to cope, experiences anxiety-related symptoms, and engages in anxiety-related behaviors to counteract the physical effects of their anxiety.
Over time, this cycle creates a self-perpetuating escalation of anxiety, which is explained in detail below and in the anxiety avoidance cycle worksheet that therapists can download at the top of this article.
Trigger or stressful event
The trigger is typically an actual or imagined situation that a person perceives as a danger or a threat.
Negative thoughts
The mind generates irrational and unhelpful thoughts (also called cognitive distortions), such as “I can’t cope,” “I’ll have a panic attack,” or “I don’t feel safe.”
Physical symptoms
The body activates the fight-or-flight response, releases stress hormones, and experiences symptoms such as increased heart rate, sweating, shaking, nausea, digestive upset, and tension throughout the body.
Avoidant behaviors
The person might avoid the situation, procrastinate, seek reassurance, and use substances.
Short-term relief
The anxiety-related behaviors might provide momentary relief, but they ultimately reinforce this cycle of anxiety.
It can also be helpful to share an anxiety spiral diagram with clients so they can visualize the cycle of anxiety.
The anxiety avoidance cycle
The cycle of anxiety is also known as the anxiety avoidance cycle or the anxiety procrastination cycle because the process involves avoidant behaviors in which the person aims to neutralize their anxiety.
Examples of avoidant behaviors might include:
- Drinking to numb anxiety
- Skipping a social event due to social anxiety
- Avoiding a public speaking opportunity
- Staying away from places that may remind you of a traumatic event, like avoiding a town or city
- Leaving an essay or work task to the last minute
- Avoiding a doctor's appointment in fear of receiving bad news
- Ignoring a friend or partner’s phone calls to avoid a difficult conversation
- Not checking bank accounts or avoiding opening bills due to anxiety about your financial health
- Avoiding household projects because of overwhelming anxiety about completing the task
- Delaying finishing a product or completing a work project out of fear of not being good enough
Breaking the anxiety cycle
There are several ways to break the anxiety avoidance cycle, such as:
Identify triggers
Clients can use either an anxiety triggers worksheet or a trauma triggers log to increase awareness of the situations, events, and people that contribute to their anxiety.
CBT thought logs
Clients can use a thought record to notice negative thought patterns and cognitive distortions to help break the anxiety avoidance cycle.
Apply cognitive restructuring techniques
Strategies like examining the validity or reliability of the thought, finding evidence for and against the negative thought, and evaluating alternative thoughts and explanations to find a more helpful response can help break the cycle of anxiety.
Gradual exposure
Clients can practice exposing themselves to the situations that cause anxiety as an experiment and collect evidence to support or refute the original fears and anxieties.
Strengthen coping strategies
Coping strategies include:
- Learning distress tolerance and emotional regulation skills, such as deep breathing, Opposite Action, STOP skill, cope ahead, wise mind, mindful breathing, radical acceptance, and safe place visualization
- Using anxiety coping cards or coping worksheets as physical reminders to practice the skills learned in therapy
Build resilience
The process of identifying triggers, restructuring thoughts, using coping strategies, and not acting on fears and anxieties can break the cycle of anxiety and increase the capacity to cope with stressful situations.
Sources
- Jerath, R., & Beveridge, C. (2021). Harnessing the Spatial Foundation of Mind in Breaking Vicious Cycles in Anxiety, Insomnia, and Depression: The Future of Virtual Reality Therapy Applications. Frontiers in psychiatry.
- Patriarca, G. C., Pettit, J. W., & Silverman, W. K. (2022). Implementing Cognitive-Behavioral Therapy in Children and Adolescents with Anxiety Disorders. Klin Spec Psihol = Clinical Psychology and Special Education.
- Sokol, L., & Fox, M. G. (2020). The Comprehensive Clinician’s Guide to Cognitive Behavioral Therapy. PESI.
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