Breaking Free from Anxious Thoughts: A Real-World Example of Cognitive Restructuring
When anxiety strikes, our minds can spiral into worst-case scenarios that feel incredibly real and threatening. But what if there was a way to step back and examine these thoughts more objectively? Cognitive behavioural therapy offers powerful tools for doing exactly that, and seeing them in action can be eye-opening.
When Thoughts Run Wild
Consider someone who had a negative interaction with colleagues two years ago. What started as a simple workplace conflict has evolved into persistent worry about retaliation, damaged reputation, and even physical harm. The person finds themselves stuck in a cycle of rumination, constantly checking for signs of threat and meeting each intrusive thought with intense fear.
This is where cognitive restructuring becomes invaluable. Rather than accepting these anxious thoughts as facts, the technique involves systematically examining them for evidence and accuracy.
The Power of Evidence Testing
The process begins by identifying the specific worried thoughts. In this case, three main fears emerged: that former colleagues might seek revenge, that the person's reputation is permanently damaged, and that years of building a good life could be destroyed randomly.
For each fear, the person methodically searched for supporting evidence. The results were telling. For the revenge scenario, there was literally no evidence to support it. Two years had passed, the colleagues had their own careers in teaching, and there was no indication they were dangerous people.
The reputation concerns also crumbled under scrutiny. The incident was old news, most people in the person's current circle weren't even aware of it, and those who were hadn't changed their behavior. The colleagues had a pattern of difficult behavior with multiple people, which actually made their opinions less credible.
What Would a Friend Say?
One particularly effective technique involves imagining what a trusted friend would say if they heard these worries spoken aloud. In this case, the imagined friend's response was blunt but helpful: "Dude, let it go. That's crazy. These people aren't thinking about you. You're not living in a movie."
This outside perspective helps break through the emotional intensity that makes anxious thoughts feel so compelling. It provides a reality check that our internal critic often can't deliver.
Finding the Path Forward
The final step involves identifying concrete actions to take. Rather than continuing to ruminate and check for threats, the solution became clear: let it go and continue working toward career goals without alteration. The person recognized that seeking external validation, whether positive or negative, was keeping them trapped in the cycle.
Why This Approach Works
This type of structured thought examination works because it forces us to move from emotional reaction to logical analysis. Anxiety often makes us treat our thoughts as facts, but when we actually look for evidence, we frequently discover our fears are built on shaky foundations.
The technique also helps distinguish between what we can and cannot control. While we can't control others' opinions or actions, we can control our own responses and choices. This shift from external to internal focus often provides immediate relief.
Practical Takeaways
If you find yourself caught in similar thought spirals, consider these strategies:
Ask yourself what evidence actually supports your worried thoughts. Be specific and factual rather than emotional in your assessment.
Consider how much time has passed since the triggering event. Old conflicts often lose their power and relevance over time.
Think about what someone who cares about you would say about your concerns. Sometimes an outside perspective can provide clarity that's hard to achieve alone.
Focus on what you can control rather than what you can't. You can't control others' actions or opinions, but you can control your own responses and life choices.
Remember that not everyone will like or respect you, and that's perfectly normal. Building a good life doesn't require universal approval.
Moving Forward
The person in this example ultimately recognized that continuing to give power to these old conflicts was more damaging than the original incident itself. By challenging their thoughts systematically and focusing on what they could control, they found a path toward letting go and moving forward.
This process isn't about pretending problems don't exist or adopting false positivity. It's about developing a more accurate and balanced perspective on challenging situations. When we can see our thoughts clearly rather than through the lens of anxiety, we often discover that our fears are much less substantial than they initially appeared.
The goal isn't to never have anxious thoughts again, but to develop the skills to examine them critically and respond more effectively when they arise. With practice, this type of cognitive restructuring can become a natural part of managing life's inevitable challenges.
Gkintoni, E., Vassilopoulos, S. P., & Nikolaou, G. (2025). Next-generation cognitive-behavioral therapy for depression: Integrating digital tools, teletherapy, and personalization for enhanced mental health outcomes. Medicina, 61(3), 431.
Learning to Handle Emotions First: The Key to Overcoming Social Anxiety
New research reveals that improving emotion regulation skills during therapy helps predict better outcomes for people with social anxiety disorder.
When Marcus started online therapy for his social anxiety, he had no idea that learning to manage his emotions would be more important than tackling his fear of public speaking directly. Like many people with social anxiety, Marcus assumed therapy would focus mainly on challenging his anxious thoughts and gradually facing feared situations. What surprised him was discovering that his ability to handle difficult emotions in general turned out to be a crucial factor in his recovery.
Marcus's experience reflects findings from a study that followed 46 people with social anxiety disorder through nine weeks of internet-based cognitive behavioural therapy and continued tracking their progress for over two years afterward. The research revealed a fascinating pattern: people who improved their emotion regulation skills during therapy were more likely to see their social anxiety symptoms decrease in the weeks and months that followed.
Understanding Emotion Regulation
Emotion regulation refers to the various ways we monitor, evaluate, and manage our emotional responses to different situations. It's not about suppressing or avoiding emotions, but rather developing healthy skills for dealing with them when they arise.
People with good emotion regulation can:
- Recognize and understand their emotions as they occur
- Stay focused on their goals even when experiencing distress
- Control impulsive behaviors when upset
- Access effective strategies for managing difficult emotions
- Accept their emotions without judgment
- Maintain emotional clarity rather than feeling overwhelmed
For people with social anxiety disorder, emotion regulation can be particularly challenging. They may struggle with intense feelings of fear, embarrassment, or shame in social situations, and often lack effective tools for managing these overwhelming emotions.
The Social Anxiety Connection
Social anxiety disorder affects millions of people worldwide, causing intense fear and avoidance of social situations due to worry about being judged, embarrassed, or rejected by others. People with this condition often experience physical symptoms like racing heart, sweating, trembling, or blushing, which can further increase their anxiety and self-consciousness.
Research has consistently shown that people with social anxiety tend to have more difficulties with emotion regulation compared to those without the condition. They may rely heavily on strategies like emotional suppression (trying to hide their feelings) or avoidance, which can provide temporary relief but often make the problem worse over time.
The Study Design
The researchers recruited participants with social anxiety disorder from northern Sweden through social media advertisements. All participants met the criteria for social anxiety as their primary diagnosis and were generally functioning well in their daily lives, though many had additional mental health conditions.
What made this study unique was its comprehensive approach to measurement. Rather than just looking at before and after therapy results, the researchers tracked participants at seven different time points over 28 months:
- Two baseline measurements (11 weeks apart before therapy began)
- Mid-treatment (4 weeks into therapy)
- Post-treatment (after 9 weeks)
- 6-month follow-up
- 12-month follow-up
- 28-month follow-up
This extensive timeline allowed researchers to see not just whether therapy worked, but how the relationship between emotion regulation and social anxiety symptoms evolved over time.
The Internet-Based Therapy Program
Participants received a nine-week internet-based cognitive behavioural therapy program that had been proven effective in previous studies. Each week, they worked through online modules containing educational materials and homework assignments based on CBT principles.
The program followed a structured approach:
Weeks 1-4: Cognitive Focus
- Learning about social anxiety and its patterns
- Practicing cognitive restructuring (challenging anxious thoughts)
- Conducting behavioral experiments to test problematic beliefs
Weeks 5-9: Behavioral Focus
- Introduction of exposure exercises (gradually facing feared situations)
- Continued practice with cognitive techniques
- Integration of skills learned throughout therapy
Throughout the program, participants had weekly contact with clinical psychologists who provided written feedback and guidance through the secure online platform.
Key Findings
The study revealed several important patterns that have significant implications for understanding and treating social anxiety:
Emotion Regulation Improves First: One of the most interesting discoveries was the timing of improvements. Participants showed the largest improvements in emotion regulation during the first half of therapy (weeks 1-4), while the biggest reductions in social anxiety symptoms occurred during the second half (weeks 5-9).
This pattern suggests that developing better emotion regulation skills may create a foundation that allows people to benefit more fully from exposure exercises and other anxiety-specific interventions later in therapy.
Individual Changes Matter Most: The research used sophisticated statistical methods to separate individual-level changes from group-level patterns. The results showed that when individuals improved their emotion regulation skills, they were more likely to see subsequent reductions in their social anxiety symptoms.
Importantly, this relationship worked in one direction: better emotion regulation predicted later improvements in social anxiety, but early improvements in social anxiety didn't predict later emotion regulation gains. This suggests that emotion regulation may be a key mechanism through which therapy helps people overcome social anxiety.
Long-Term Benefits: The positive effects of therapy lasted throughout the entire 28-month follow-up period. Participants maintained their gains in both emotion regulation and social anxiety symptoms, suggesting that the skills learned during the relatively brief nine-week program had lasting benefits.
Reliable Measurements: The study confirmed that both emotion regulation difficulties and social anxiety symptoms could be measured reliably over time, giving confidence in the accuracy of the findings.
Why Emotion Regulation Matters
The findings help explain why some people respond better to social anxiety treatment than others. People who develop better emotion regulation skills during therapy may be better equipped to:
Handle the discomfort of exposure exercises: Facing feared social situations is inherently uncomfortable. Better emotion regulation skills help people tolerate this discomfort and stay engaged with therapeutic exercises.
Recover from setbacks: Social anxiety treatment involves ups and downs. People with good emotion regulation skills may bounce back more quickly from difficult experiences and maintain their motivation for change.
Apply skills in real-world situations: Managing social anxiety in daily life requires the ability to regulate emotions as they arise. People who develop these skills during therapy are better prepared to handle challenging social situations independently.
Break cycles of avoidance: Social anxiety is often maintained by patterns of avoidance. Better emotion regulation provides alternatives to avoidance when facing difficult emotions.
Practical Implications
For people considering treatment for social anxiety, this research suggests several important points:
Emotion regulation skills are learnable: The study showed that people with social anxiety can significantly improve their emotion regulation abilities through cognitive behavioral therapy, even in an online format.
Early therapy work matters: The cognitive exercises and skills taught in the first half of therapy may be more important than they initially appear. These foundational skills create the groundwork for later success.
Individual progress varies: The research emphasized that changes happen differently for each person. What matters most is individual improvement relative to one's own baseline, not comparison to others.
Online therapy can be effective: The internet-based format proved highly effective, offering hope for people who may not have access to in-person therapy or prefer the convenience and privacy of online treatment.
Long-term benefits are possible: The lasting effects seen over more than two years suggest that relatively brief interventions can create enduring positive changes.
The Treatment Timeline
Understanding when different changes typically occur during therapy can help both therapists and clients set realistic expectations:
Early Phase (Weeks 1-4): Focus on building emotion regulation skills through cognitive techniques, psychoeducation, and behavioural experiments. People may notice improved ability to manage emotions even before social anxiety symptoms significantly decrease.
Later Phase (Weeks 5-9): Introduction of exposure exercises, building on the emotion regulation foundation established earlier. This is typically when the most significant reductions in social anxiety symptoms occur.
Follow-up Period: Continued practice and application of skills in real-world situations, with benefits typically maintained or even continuing to improve over time.
This research contributes to a growing understanding that adequate mental health treatment often involves addressing general emotional and coping skills rather than focusing solely on specific symptoms. The findings suggest that:
Emotion regulation may be a common pathway through which various therapies work: Even though this study focused on social anxiety, the principles may apply to other conditions where emotion regulation difficulties play a role.
Therapeutic interventions may have sequential effects: Different components of therapy may work in a specific order, with some skills providing the foundation for others to be effective.
Individual-level monitoring is valuable: Tracking how individual clients are progressing in their emotion regulation skills during therapy could help therapists identify who may need additional support or different approaches.
The researchers noted several directions for future investigation:
More frequent measurements: Using techniques like ecological momentary assessment (smartphone-based tracking) could provide more detailed information about how emotion regulation and social anxiety interact day-to-day.
Component analysis: Future studies could examine whether specific emotion regulation skills are more important than others for social anxiety treatment outcomes.
Different populations: Testing these findings with more diverse groups of people could help determine how broadly the results apply.
Intervention development: The findings could inform the development of new treatments that more explicitly target emotion regulation skills as a pathway to reducing social anxiety.
For people struggling with social anxiety like Marcus, this research offers both practical insights and reason for optimism. The study demonstrates that social anxiety is highly treatable, that online therapy can be just as effective as traditional approaches, and that the benefits of treatment can last for years.
Perhaps most importantly, the research helps explain why therapy works: by teaching people better ways to handle difficult emotions, treatment creates a foundation for facing fears and building confidence in social situations. Rather than viewing emotion regulation and social anxiety as separate issues, this study shows they're intimately connected, with improvements in one leading to benefits in the other.
The findings suggest that people don't need to choose between addressing their emotions or tackling their social fears directly. Instead, working on emotion regulation skills first may actually make it easier to face social challenges later. For the millions of people affected by social anxiety, this research points toward more effective, accessible, and hope-filled approaches to recovery.
Garke, M. Å., Hentati Isacsson, N., Kolbeinsson, Ö., Hesser, H., & Månsson, K. N. (2025). Improvements in emotion regulation during cognitive behavior therapy predict subsequent social anxiety reductions. Cognitive Behaviour Therapy, 54(1), 78-95.
Your Body Knows Best: How Learning to Listen to Internal Signals Can Help Overcome Social Anxiety
Research reveals that tuning into bodily sensations in healthy ways improves online therapy outcomes for social anxiety
Sarah's heart would race every time she walked into a crowded room. Her palms would sweat before job interviews, and she could feel her face burning red whenever someone looked at her during meetings. For years, Sarah tried to ignore these physical sensations, convinced they were signs of weakness or evidence that everyone could see how anxious she was. She had no idea that learning to pay attention to these bodily signals in a healthy way could actually be the key to overcoming her social anxiety.
Sarah's experience reflects findings from new research that examined how "interoceptive awareness" (the ability to sense and understand internal bodily signals) plays a role in treating social anxiety disorder. The study discovered that people who learn to tune into their bodies in adaptive ways show dramatically better outcomes when receiving online cognitive behavioral therapy.
Understanding Interoceptive Awareness
Interoceptive awareness refers to our ability to perceive, interpret, and respond to signals from inside our bodies. This includes awareness of heartbeat, breathing, muscle tension, stomach sensations, and other internal cues that constantly provide information about our physical and emotional states.
Most people aren't consciously aware of how much their bodies are "talking" to them throughout the day. Your heart rate increases slightly when you see an attractive person. Your breathing changes when you're concentrating. Your stomach tightens when you're stressed. These signals can provide valuable information about our emotional state and help guide our responses to different situations.
However, people with anxiety disorders, particularly social anxiety, often have complicated relationships with these bodily sensations. They may either ignore them completely or become hypervigilant about them in unhelpful ways.
The Social Anxiety Connection
Social anxiety disorder affects how people perceive and react to social situations, often involving intense fear of being judged, embarrassed, or rejected by others. What makes this research particularly relevant is that people with social anxiety frequently use their bodily sensations as evidence for their fears.
Someone with social anxiety might think: "My heart is racing, so everyone must notice how nervous I am" or "I can feel myself blushing, which proves I'm making a fool of myself." This creates a vicious cycle where physical sensations increase anxiety, which in turn creates more physical sensations.
The research identified several different aspects of interoceptive awareness:
Noticing: The basic ability to detect bodily sensations when they occur.
Attention Regulation: The capacity to intentionally focus on or shift attention away from bodily sensations as needed.
Self-Regulation: Using awareness of bodily signals to manage emotions and stress.
Not Distracting: Avoiding the urge to ignore or push away uncomfortable physical sensations.
Not Worrying: Reducing the tendency to catastrophize or worry excessively about normal bodily sensations.
Body Listening: Using bodily signals as information to guide behaviour and decisions.
Trusting: Having confidence that bodily sensations provide reliable and useful information.
The Online Therapy Revolution
The study examined these concepts within the context of internet-based cognitive behavioural therapy (ICBT), which has emerged as a highly effective and accessible alternative to traditional in-person therapy. This is particularly important for people with social anxiety, who may find the prospect of attending face-to-face therapy sessions intimidating.
The researchers worked with 47 people diagnosed with social anxiety disorder who participated in a three-month online group therapy program. The treatment included video conferences with licensed therapists and focused on key components of cognitive behavioural therapy: developing a better understanding of anxiety patterns, attention training, behavioural experiments, cognitive restructuring, and relapse prevention.
What made this study different was its focus on measuring how participants' relationships with their bodily sensations changed throughout treatment and whether these changes predicted better outcomes.
Remarkable Results
The findings were both encouraging and illuminating. The online therapy program produced significant reductions in social anxiety symptoms, with large effect sizes that indicate meaningful, real-world improvements in participants' lives.
But perhaps more interesting were the discoveries about bodily awareness:
Improved Regulation Skills: Participants showed significant improvements in their ability to regulate attention toward bodily sensations and use bodily awareness for emotional self-regulation.
Baseline Predictors Matter: People who started treatment with lower tendencies to distract themselves from bodily sensations and less worry about physical symptoms showed better treatment outcomes.
Change Predicts Success: Participants who developed better attention regulation and self-regulation skills during treatment experienced greater reductions in social anxiety symptoms.
The Power of Prediction
One of the most valuable aspects of this research was identifying factors that predict who will benefit most from treatment. The study found that certain patterns of interoceptive awareness at the beginning of therapy could predict how well someone would respond to treatment.
Less Distraction Equals Better Outcomes: People who were less likely to distract themselves from uncomfortable bodily sensations at the start of treatment showed greater improvement. This might seem counterintuitive, but it suggests that those who are willing to experience their physical sensations (rather than avoiding them) are better positioned to learn from therapy.
Worry Less, Improve More: Participants who worried less about their bodily sensations at baseline also showed better treatment outcomes. This suggests that having a more accepting and less catastrophic relationship with physical sensations fosters better conditions for therapeutic change.
Skills Development Drives Recovery: Most importantly, people who developed better attention regulation and self-regulation skills during therapy experienced greater symptom reduction. This suggests that learning to work with bodily sensations in healthy ways is actually a mechanism through which therapy helps.
Why This Matters
These findings have important implications for understanding both social anxiety and how therapy works:
Bodies and Minds Work Together: The research reinforces that mental health isn't just about thoughts and behaviours; our relationship with physical sensations plays a crucial role in emotional well-being.
Avoidance Isn't Always Helpful: While avoiding uncomfortable sensations might provide temporary relief, the research suggests that people who are willing to experience their bodily sensations without excessive worry or distraction tend to benefit more from treatment.
Skills Can Be Learned: The fact that improvements in attention regulation and self-regulation predicted better outcomes suggests these are teachable skills that can enhance therapy effectiveness.
Online Therapy Works: The study provides strong evidence that internet-based group therapy can be highly effective for social anxiety, making treatment more accessible to people who might not otherwise seek help.
Practical Applications
For people struggling with social anxiety, this research suggests several potentially helpful approaches:
Notice Without Judgment: Instead of trying to ignore bodily sensations or interpreting them as signs of danger, practice observing them with curiosity rather than fear.
Use Sensations as Information: Physical sensations can provide valuable information about emotional states and environmental demands. Learning to "listen" to your body can improve decision-making and self-care.
Practice Regulation Skills: Developing the ability to intentionally focus attention on or away from bodily sensations as needed can enhance emotional regulation.
Avoid Excessive Worry: While it's normal to notice physical sensations during anxiety, catastrophic interpretations ("This racing heart means I'm having a panic attack") tend to make anxiety worse.
Consider Online Options: For people hesitant about traditional therapy, online cognitive behavioural therapy can be highly effective and more accessible.
The Bigger Picture
This research contributes to a growing understanding that successful mental health treatment often involves changing our relationship with internal experiences rather than simply eliminating symptoms. Instead of viewing bodily sensations as problems to be solved or avoided, learning to work with them skillfully can enhance overall well-being.
The findings also highlight the importance of individual differences in therapy. Not everyone starts treatment with the same strengths or challenges, and understanding these differences can help both therapists and clients optimize treatment approaches.
While this study provides valuable insights, the researchers noted several areas for future investigation:
Objective Measures: Future studies could incorporate physiological measures of interoceptive accuracy (like heartbeat detection tasks) alongside self-report measures.
Controlled Comparisons: Research comparing different treatment approaches could help determine whether interoceptive awareness improvements are specific to cognitive behavioural therapy or occur across different therapeutic modalities.
Targeted Interventions: Studies could investigate whether incorporating specific interoceptive awareness training into standard therapy protocols improves outcomes.
Broader Applications: The concepts might apply to other anxiety disorders beyond social anxiety, suggesting potential for wider therapeutic applications.
For people like Sarah who struggle with social anxiety, this research offers both hope and practical direction. The study demonstrates that online therapy can be highly effective, making treatment more accessible than ever before. More importantly, it suggests that learning to work with bodily sensations in healthy ways can enhance treatment outcomes.
Rather than viewing physical symptoms of anxiety as enemies to be fought or ignored, this research suggests they can become allies in the recovery process. By developing skills in attention regulation and self-regulation, people can transform their relationship with anxiety-provoking situations.
The findings reinforce that recovery from social anxiety isn't just about changing thoughts or behaviours; it's about developing a more integrated and skillful relationship with all aspects of experience, including the wisdom of the body. For the millions of people affected by social anxiety, this research points toward more effective, accessible, and holistic approaches to healing.
Sarah's racing heart and sweaty palms don't have to be signals of doom. With the right skills and support, they can become information that helps her navigate social situations with greater confidence and self-compassion. The research shows that this transformation is not only possible but predictable when people learn to listen to their bodies with skill and kindness.
