CBT techniques for anxiety: 10 step-by-step exercises, with worksheets and a 4-week plan

If you live with anxiety, you have probably heard that cognitive behavioural therapy (CBT) is one of the best treatments for it. But most articles about CBT techniques for anxiety stop at the names: cognitive restructuring, exposure, relaxation. How to actually do each one, which kind of anxiety it suits, and how strong the evidence behind it is usually gets left out.

This guide fills that gap. For each technique you'll find practical steps, an example and the most common mistakes. A table shows where to start if your main problem is panic attacks, constant worry or social anxiety. At the end there are ready-to-use worksheets and a four-week plan to get going. Every figure comes from published research or clinical guidelines, listed at the bottom of the page.

How well does CBT work for anxiety? The numbers

Anxiety is the most common mental health problem in the world. According to the World Health Organization, about 470 million people (5.8% of the world's population) had an anxiety disorder in 2023, and only about one in four of them (27.6%) received any treatment. In Australia, 17.2% of people aged 16 to 85, about 3.4 million people, had an anxiety disorder in the previous 12 months.

The good news is that anxiety is treatable, and CBT is one of the most thoroughly researched psychological treatments for it. The WHO recommends psychological treatments based on CBT, including exposure therapy, for anxiety. This table summarises the key evidence:

Study	What was tested	Result
Carpenter et al., 2018	41 randomised trials, 2,843 patients; CBT vs placebo	Moderate effect on core symptoms (Hedges' g = 0.56); odds of responding about three times higher (odds ratio 2.97); large effects for generalised anxiety and OCD, small to moderate for panic and social anxiety
Loerinc et al., 2015	87 studies reporting CBT response rates	On average 49.5% responded by the end of treatment and 53.6% at follow-up
Andrews et al., 2018	64 trials of internet-delivered CBT for anxiety and depression	Large effect (g = 0.80); in head-to-head comparisons, about as effective as face-to-face CBT
Cuijpers et al., 2010	21 studies, 810 people; guided self-help vs face-to-face therapy	No meaningful difference, either at the end of treatment or at follow-up up to a year
Fincham et al., 2023	20 trials of breathwork measuring anxiety	Small but significant effect (g = 0.32)

What do these numbers mean for you? CBT isn't magic, but its evidence is stronger than for most treatments. "Response" in these studies means improvement that passes a strict threshold, so a 50% response rate doesn't mean the other half don't change at all. What improves your odds is choosing the right techniques for your type of anxiety and practising them regularly. Those two things are what the rest of this guide is about.

The anxiety cycle: why anxiety doesn't just go away

CBT rests on a simple idea: anxiety is made of parts that keep each other going. A situation (say, a crowded train) triggers a thought that predicts danger ("if I feel sick here, no one will help me"). Your body reacts with a racing heart, tension and dizziness, and those sensations feel like proof that something is wrong. Then you do something to feel safer: you get off, you avoid that situation next time, or you use a "safety behaviour" such as carrying water or checking your pulse.

That behaviour calms you down in the short term, and that is exactly the problem. Your mind concludes, "Good thing I got off, or something terrible would have happened." The danger prediction is never tested, and next time the anxiety comes back stronger. David Clark described this cycle in his cognitive model of panic (1986), and most modern CBT protocols for anxiety build on it.

Each technique below targets one link in this cycle. Some work on thoughts, some on the body, and the most powerful ones work on behaviour.

10 CBT techniques for anxiety, step by step

You don't need to start all of these at once. Check the table on which technique suits which type of anxiety first, and begin with the two or three closest to your problem.

1. The anxiety diary (self-monitoring)

Before you change anything, you need to see how your anxiety works. Self-monitoring is the first step in almost every CBT protocol because it reveals patterns you can't see from the inside: which situations, thoughts and actions keep the anxiety going.

1. Whenever your anxiety rises above 40 (on a scale of 0 to 100), take two minutes to write it down.
2. Record five things: time and place, how intense the anxiety was, the thought in your mind, the sensations in your body, and what you did.
3. At the end of the week, review the diary. Which situations keep coming up? Which thoughts? What have you been avoiding?

Example: "Tuesday, on the train, 70. Thought: if I feel sick here, no one will help me. Body: racing heart, hot. What I did: got off one stop early."

Common mistake: only recording the feeling ("I was really anxious"). The thought and the behaviour matter most, because the techniques that follow work on those two.

2. Thought records and cognitive restructuring

Anxiety usually makes two errors: it overestimates the chance of danger and underestimates your ability to cope. Cognitive restructuring means treating an anxious thought as a hypothesis to check, not a fact. The aim isn't "positive thinking"; it is a thought that fits all of the evidence.

1. Write down the situation and your feeling, and rate how intense it is from 0 to 100.
2. Write the exact thought that went through your mind, for example "I'm going to faint", and how strongly you believe it (0 to 100%).
3. Name the thinking trap: catastrophising, mind-reading ("everyone thinks I'm useless"), fortune-telling or overgeneralising.
4. List the evidence for and against the thought. Facts only, not feelings.
5. Write a more balanced thought that takes all of the evidence into account.
6. Re-rate how intense your feeling is and how much you believe the original thought.

Example: "If I speak in the meeting, my voice will shake and everyone will see I don't know what I'm doing (belief: 85%)." Evidence against: last time my voice shook a little and nobody said anything; my manager said the presentation went well. Balanced thought: "My voice might shake a little, but most people focus on what I'm saying, and I know this topic well." Belief in the original thought afterwards: 40%.

A useful question for overestimated danger: "Out of the last hundred times I've had this thought, how many times did it actually happen?" There is a ready-made thought record worksheet further down this page.

Common mistake: turning thought records into endless mental debate or a way to get reassurance. If you need to feel "completely sure" after every record, it has probably become a safety behaviour (technique 7).

3. Decatastrophising: worst, best, most likely

When your mind fixes on the worst-case scenario, it usually freezes the film at the scariest frame and never asks "and then what?". Decatastrophising plays the film to the end.

1. Write out the worst thing that could happen, in full.
2. Write out the best thing that could happen.
3. Write out the most likely outcome, based on your past experience.
4. If the worst did happen, how would you cope? Who or what would help?
5. Ask how much it would matter in a week, a month and a year.

Example: "My test results are late." Worst: a serious illness. Best: the lab is busy. Most likely: an admin delay, like last time. If it were the worst: I would make a treatment plan with my GP, and my family would be there for me.

Common mistake: trying this at the peak of anxiety. It works better once you've calmed down a little.

4. Worry time and problem solving

This technique is mainly for generalised anxiety disorder (GAD), where worry fills the whole day. The idea is not to stop worrying but to contain it in time and place. In a small trial, 53 people who worried a lot spent two weeks with a daily 30-minute "worry period" at a fixed time and place. Their worry, anxiety and insomnia dropped more than in the comparison group. The study was preliminary, but the method is a standard part of many CBT programs for GAD.

1. Set a fixed 20 to 30 minutes each day for worrying, in the same place, and not close to bedtime.
2. Whenever a worry comes up during the day, jot it down in one sentence and tell yourself, "I'll save this for worry time." Then bring your attention back to what you're doing.
3. In worry time, read the list and sort each worry into one of two groups: practical (something you can act on, like an unpaid bill) or hypothetical ("what if I get sick next year?").
4. For practical worries, problem-solve: define the problem precisely, list five possible solutions without judging them, weigh the pros and cons, choose one and decide on its first small step.
5. Let hypothetical worries go without searching for an answer. Accept that you can't be certain about the future; tolerating that uncertainty is a skill that grows with practice.
6. When the time is up, stop, even if some worries are left.

Common mistake: scheduling worry time right before bed, or spending it googling symptoms.

5. Graded exposure with a fear ladder

Exposure means approaching the situations you fear, step by step and without escaping, so your brain gets new information. In the Carpenter meta-analysis, treatments built mainly on exposure showed larger effects than purely cognitive ones (although the difference wasn't statistically conclusive). Research by Michelle Craske and colleagues shows that the goal of exposure isn't for anxiety to drop to zero. The goal is to learn that what you predicted didn't happen, or that you coped if it did.

1. List 10 to 15 situations that make you anxious and give each a rating from 0 to 100.
2. Order them from lowest to highest. This is your ladder.
3. Start with a step rated around 30 to 40.
4. Before each practice, write down your prediction: "I think … will happen."
5. Stay in the situation long enough for your prediction to really be tested, and without safety behaviours (technique 7).
6. Afterwards, write down what happened and what you learned.
7. Repeat each step several times, at different times and in different places, before moving up. Variety helps the learning carry over to real life.

Example (fear of a panic attack in shops): a small local shop with a friend for five minutes (30); the same shop alone (40); a big supermarket at a quiet time (55); a big supermarket at a busy time (70); standing in a long checkout queue (85). The full ladder is in the worksheets.

Common mistake: escaping at the peak of anxiety, which strengthens the cycle; jumping too many steps at once; or distracting yourself the whole time. If your anxiety is linked to trauma, do exposure work with a therapist, not on your own.

6. Exposure to body sensations (for panic attacks)

In panic attacks, what you fear is the body sensations themselves: a racing heart, dizziness, breathlessness. The mind reads them as signs of a heart attack, suffocation or "going crazy". In this technique you create the same sensations on purpose, in a safe setting, so your body and mind learn that they are unpleasant but not dangerous.

Exercise	Sensation it creates	Duration
Spinning in a swivel chair	Dizziness	30 seconds
Shaking your head from side to side	Dizziness, light-headedness	30 seconds
Breathing through a thin straw	Breathlessness	60 seconds
Running on the spot or up stairs	Racing heart, puffing	60 seconds
Fast, deep breathing	Light-headedness, tingling hands	60 seconds

1. Try each exercise once and note how anxious you felt and how similar the sensations were to your panic attacks.
2. Pick the exercise that feels most similar.
3. Repeat it a few times a day. When you finish, wait for the sensations to fade on their own, without doing anything to calm down.
4. Once it no longer feels very frightening, move to the next exercise, then bring on the same sensations in real life, for example by drinking coffee or exercising.

Caution: if you have a heart condition, asthma or another breathing problem, epilepsy or high blood pressure, or you're pregnant, talk to your doctor before trying these exercises.

Common mistake: stopping as soon as the sensation starts. The key lesson ("this feeling isn't dangerous") only sinks in when you experience the sensation all the way through.

7. Dropping safety behaviours and avoidance

Safety behaviours are things you do to "prevent disaster": sitting near the exit, always carrying water or tablets, rehearsing sentences before you speak, avoiding eye contact, checking your pulse, googling symptoms, or asking family again and again, "are you sure it's nothing?". The problem is that when disaster doesn't strike, your mind credits the safety behaviour, not the fact that there was no danger. NICE guidance for social anxiety specifically recommends exercises that show the harmful effects of these behaviours.

1. Use your anxiety diary to list all your safety behaviours. Count asking others for reassurance too.
2. Pick one and drop it in a situation from the lower steps of your ladder.
3. Predict what will happen beforehand, and write down what actually happened afterwards.
4. Gradually drop the rest, so you experience the situation "unprotected".

Example: someone who grips their glass with both hands at parties so nobody sees their hand shake tries holding it normally in one hand. They discover nobody notices anything, or that even if their hand shakes a little, nobody cares.

8. Behavioural experiments

A behavioural experiment means testing an anxious belief in the real world, like a scientist. Unlike exposure, its aim is to test one specific prediction. It plays a central role in the cognitive models of panic and social anxiety, and NICE lists it as an essential part of CBT for social anxiety.

1. Write down the belief precisely and how strongly you believe it (0 to 100%).
2. Design an experiment that could show whether the belief is true.
3. Write your prediction: if my belief is true, what will I see?
4. Run the experiment and record the result carefully.
5. Ask what the result says about your belief, and re-rate how strongly you believe it.

Example: Belief: "If I ask a question in class, everyone will think I'm stupid" (70%). Experiment: ask one short question in class and watch how people react; or ask three friends what they think when someone asks a question in a group. Result: the lecturer welcomed the question, and two classmates said afterwards they had wondered the same thing. Belief afterwards: 25%.

9. Shifting attention outward (for social anxiety)

In social anxiety, attention turns inward: "How does my voice sound? Am I blushing? What do I look like?" This self-focus increases anxiety and makes you miss what the other person is saying, which really does make the conversation more awkward. NICE includes "systematic training in externally focused attention" as part of CBT for social anxiety.

1. In a low-stakes conversation (with a shop assistant or a colleague), put all your attention on the other person's words, face and expressions.
2. Whenever you notice your attention has turned back to yourself, gently bring it outward again, without criticising yourself.
3. Run a small experiment: have one conversation focused on yourself and one focused outward, then compare which felt less anxious and which went better.

10. Applied relaxation and slow breathing

Applied relaxation means learning to release tension in your body quickly, then using that skill at the first signs of anxiety. NICE recommends it for GAD as an alternative to CBT (12 to 15 weekly sessions). Breathing exercises showed a small but real effect on anxiety in a meta-analysis of 20 trials.

1. Weeks one and two: once a day, for about 15 minutes, practise progressive muscle relaxation. Tense each muscle group (hands, arms, shoulders, face, stomach, legs) for five seconds, then release for 10 to 15 seconds and notice the difference.
2. Then: shorten the practice by skipping the tensing and only releasing, and link it to a cue word such as "relax".
3. Slow breathing: breathe in through your nose for about four seconds and out slowly for about six. Keep going for five minutes. The longer out-breath is the key part.
4. Apply it: during the day, watch for early signs of tension (raised shoulders, a clenched jaw) and use a few slow breaths and a release right there.

Common mistake: turning relaxation into a safety behaviour. If after every exposure you think "I was only fine because I did my breathing", the exposure loses its message. Use relaxation for everyday tension, not to escape every flicker of anxiety. If you like mindfulness, it complements these exercises well.

If these exercises are hard to do on your own, online CBT-informed counselling can help you build a plan that fits you and move through it step by step.

Which technique for which type of anxiety?

CBT protocols differ a little for each type of anxiety. This table shows where to start; the numbers are in order of priority. If you have more than one type, start with the one that disrupts your life the most. For an overview of the types, read anxiety disorders.

Type of anxiety	Main sign	Start with these techniques
Generalised anxiety (GAD)	Constant, hard-to-control worry about many things	4 (worry time), 2, 3, 10
Panic attacks	Sudden, intense fear of body sensations	6 (exposure to body sensations), 7, 8, 5
Social anxiety	Fear of being judged or embarrassed	9 (outward attention), 7, 8, 5
Specific phobia	Fear of a particular thing or situation, such as heights, flying or dogs	5 (fear ladder), 7
Health anxiety	Fear of illness, body checking and searching symptoms	7 (dropping checking and reassurance-seeking), 8, 2
OCD	Intrusive thoughts and compulsions to neutralise them	Exposure and response prevention (ERP), a specialised form of techniques 5 and 7

Technique 1 (the anxiety diary) is the starting point for every type.

Free worksheets

Copy these tables onto paper or print this page (Ctrl+P, or Cmd+P on a Mac). Each one includes an example row.

Thought record

Situation	Feeling and intensity (0–100)	Automatic thought (% belief)	Evidence for	Evidence against	Balanced thought	Feeling afterwards
Saturday morning, before a presentation	Anxiety 80	"My voice will shake and everyone will see I don't know what I'm doing" (85%)	My voice shook a little last time	Nobody said anything; my manager said it went well; I know the topic well	"My voice might shake a little, but the content matters more, and I'm prepared" (70%)	Anxiety 50

Fear ladder

Step	Situation	Expected anxiety (0–100)	My prediction	What actually happened?
1	Small local shop with a friend, 5 minutes	30	"If I get dizzy, I won't be able to get out"	I felt a bit dizzy, but I finished the shopping
2	The same shop alone, 10 minutes	40
3	Big supermarket at a quiet time, 15 minutes	55
4	Big supermarket at a busy time	70
5	Standing in a long checkout queue	85

Worry log

Worry	Practical or hypothetical?	Next step
My loan repayment is overdue	Practical	Call the bank at 10 am today
What if I lose my job next year?	Hypothetical	Save it for worry time, then let it go

A 4-week plan to get started

This plan is for mild to moderate anxiety, if you want to start on your own. It takes 20 to 30 minutes a day.

Week	Practice
Week 1	Anxiety diary every day; progressive muscle relaxation for 15 minutes a day; list your safety behaviours
Week 2	Thought records three times a week; start daily worry time (if worry is your main problem); keep up relaxation and slow breathing
Week 3	Build your fear ladder; three or four exposure practices on the lower steps; drop one safety behaviour
Week 4	Move up the ladder; run one behavioural experiment; compare this week's diary with week one

Don't expect your anxiety to be gone in four weeks. For a full course of treatment, NICE guidance for GAD usually recommends 12 to 15 weekly one-hour sessions. A sign of progress is doing things you used to avoid, even if you still feel a little anxious.

When self-help isn't enough

Self-help works well for many people, but it's better to work with a professional if:

• anxiety disrupts your work, study or relationships every day
• you avoid many places or activities, and your world has shrunk
• you rely on alcohol, drugs or non-prescribed medication to calm down
• you also have signs of depression
• your anxiety is linked to a traumatic experience
• you've practised regularly for several weeks without noticing a change.

Have a doctor check any new physical symptoms, such as chest pain or severe breathlessness, first. If you take medication, don't stop it without talking to your doctor.

If you live in Australia

• Talk to your GP. They can write a Mental Health Treatment Plan; with it, Medicare covers part of the cost of up to 10 individual and 10 group sessions each calendar year (the Better Access initiative).
• MindSpot offers free assessments and online CBT courses for Australian adults.
• The Centre for Clinical Interventions (WA Health) publishes CBT self-help guides and worksheets on worry, panic, social anxiety and health anxiety.
• Beyond Blue answers any time on 1300 22 4636.
• If you'd rather speak in Farsi, call TIS National on 131 450 and ask for a phone interpreter to connect you with these services.

Frequently asked questions

Sources

1. World Health Organization. Anxiety disorders: fact sheet. 2026.
2. Australian Bureau of Statistics. National Study of Mental Health and Wellbeing, 2020–2022.
3. Carpenter JK, et al. Cognitive behavioral therapy for anxiety and related disorders: a meta-analysis of randomized placebo-controlled trials. Depress Anxiety. 2018;35(6):502-514.
4. Loerinc AG, et al. Response rates for CBT for anxiety disorders: need for standardized criteria. Clin Psychol Rev. 2015;42:72-82.
5. Andrews G, et al. Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: an updated meta-analysis. J Anxiety Disord. 2018;55:70-78.
6. Cuijpers P, et al. Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? Psychol Med. 2010;40(12):1943-1957.
7. Clark DM. A cognitive approach to panic. Behav Res Ther. 1986;24(4):461-470.
8. Craske MG, et al. Maximizing exposure therapy: an inhibitory learning approach. Behav Res Ther. 2014;58:10-23.
9. McGowan SK, Behar E. A preliminary investigation of stimulus control training for worry: effects on anxiety and insomnia. Behav Modif. 2013;37(1):90-112.
10. Fincham GW, et al. Effect of breathwork on stress and mental health: a meta-analysis of randomised-controlled trials. Sci Rep. 2023;13:432.
11. Curtiss JE, et al. Cognitive-behavioral treatments for anxiety and stress-related disorders. Focus. 2021;19(2):184-189.
12. NICE. Generalised anxiety disorder and panic disorder in adults: management (CG113).
13. NICE. Social anxiety disorder: recognition, assessment and treatment (CG159).
14. Centre for Clinical Interventions (WA Health). Looking After Yourself: self-help resources.
15. MindSpot Clinic, Macquarie University.