Anxiety/Panic/Obsessive-Compulsive Disorder | Cognitive Behavioural Therapy

Generalized Anxiety Disorder (GAD)

Being ‘anxious’ is not a single phenomenon. Anxiety is manifested in three different symptoms: physical aspects (ex. chest pains, difficulty in breathing, blurred eye sight), cognitive aspects (ex. negative thinking – “everyone will think that I am weird”), and behavioural aspects (ex. murmuring, avoidance). Anxiety and fear are completely normal reactions that signal us when we face danger, but when excessive, they cause mental and physical pain that prevents proper care and disrupts everyday lives.

Social Anxiety

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) defines social anxiety as “Persistent, intense fear or anxiety about specific social situations because they believe they may be judged, embarrassed or humiliated. They avoid anxiety-producing social situations or endure them with intense fear or anxiety.”

The social situations that cause anxiety vary greatly by people.

-Conversation with unfamiliar person or someone with authorities
-Situations where they receive attention, such as giving a speech or having to be assertive
-Drinking or eating in front of others

To be diagnosed with social anxiety, one must meet the following criteria:

– The fear is considered excessive and most people would not find the same situation fearful.
– Avoids anxiety-inducing situations or endures them despite tremendous pain.
– The anxiety disrupts important aspects of their daily lives (ex. school, work) or they are very uncomfortable with the fact that they have anxiety.

Panic Disorder

Panic disorder is very common, and it appears regardless of a person’s social status, education level, occupation, or personality type. The intensity of panic disorder differs by people, but a considerable number of people experience panic attacks sporadically or without specific causes. However, not all sporadic panic attacks lead to panic disorder.

The main aspects of panic disorder are:
(1) One or more episodes of sudden and intense fear or unpleasantness
(2) Recurrence of panic attacks and alterations in daily lives due to consistent fear, anxiety, or panic attacks.

Common symptoms of panic disorder:

-Heart palpitations – racing of heartbeat or being overly aware of one’s heartbeat
-Chest pains or unpleasantness
-Shortness of breath
-Dizziness, trembling, and lightheadedness
-Sweating and/or chills
-Stomach pain and/or nausea
-Fear of death

Obsessive-Compulsive Disorder (OCD)

OCD, a type of anxiety disorders, is characterized by repetition of unwanted thoughts and/or behaviors. OCD encompasses obsessive thoughts and compulsive behaviors. Obsessive thoughts cause anxiety and pain; therefore, in order to avoid and alleviate them, people with OCD engage in compulsive behaviors repeatedly.

Common Symptoms of OCD:

-Pain caused by repeated occurrence of unwanted thoughts
-Seeking constant reassurance due to having difficulty with uncertainty
-Washing hands frequently
-Needing things to be in order
-Cleaning excessively


Phobia is defined as being extremely afraid of a particular object or situation that is unlikely to cause harm, and trying one’s best to avoid it. People suffering from phobia immediately become anxious when exposed to the fear-inducing stimulus, and in extreme cases, it might lead to panic attacks.

Phobia is categorized as below based on the source of one’s fear:

– Animals: Fear of animals or insects. It usually begins in childhood.
– Natural environment: Fear of heights, water, or storms, such as acrophobia and hydrophobia.
– Body-based: Fear of blood, injections, or receiving medical procedures.
– Situational: Fear of enclosed spaces such as public transportations, planes, elevators (Claustrophobia)
– Others : Fear of suffocation, vomit, or sickness. In the case of children, being fearful of loud noises or costumed characters such as clowns.

Anxiety/Panic/Obsessive-Compulsive Disorder Treatment Program at the Tree Group

Cognitive Behavior Therapy CBT

At the beginning of CBT for anxiety/panic/obsessive-compulsive disorders, the therapist helps the clients to study scientific explanations behind each symptom and theoretical reasons behind the treatment method in order for them to face and acknowledge their difficulties objectively. Additionally, the therapist identifies cognitive processes, behaviors, and problems in their surroundings that augment anxiety in order to establish safe and effective methods to modify them, while also preparing for exposure therapy.

After establishing techniques for exposing the clients to anxiety-inducing elements and situations, the sessions focus extensively on exposure therapy. By doing so, the clients practice using alternative behaviors during situations that cause anxiety, panic attack, and compulsive behaviors. As the clients learn and practice various cognitive and behavioral skills that help manage anxious feelings, cognitive behavior modification process takes place to eliminate any problems that trigger anxiety and to cope with such situations effectively.

At the final stages of treatment, the therapist closely examines the remaining problems and their causes while concluding exposure therapy and establishes countermeasures to prevent future recurrence.

The Tree Group