Introduction
Cognitive Behavioral Therapy (CBT) has long been the gold standard for treating anxiety disorders. Backed by decades of research, CBT helps clients recognize distorted thoughts, challenge unhelpful beliefs, and change behaviors that reinforce fear (Hofmann et al., 2012; van Dis et al., 2020).
Yet even with CBT’s proven effectiveness, many clinicians find that some clients relapse, plateau, or continue to struggle with deeper existential questions. This is where the Deconstructing Anxiety model, developed by Todd Pressman, PhD, offers a complementary lens. Instead of focusing primarily on thought patterns, it works to identify the root fear beneath all forms of anxiety.
Together, CBT and Deconstructing Anxiety can provide clinicians with a powerful, integrated toolkit for helping clients move from symptom management to deeper healing.
How CBT Approaches Anxiety
- Core Principle: Thoughts, feelings, and behaviors are interconnected. Changing one can shift the whole system.
- Techniques: Cognitive restructuring, behavioral experiments, exposure therapy.
- Strengths: Highly structured, evidence-based, widely applicable across diagnoses.
- Limitations: May not always address existential concerns or deeply rooted fears that drive symptoms.
Example: A client with social anxiety practices exposure tasks to speak up in groups, learning that feared outcomes rarely occur. Yet they still carry a deep fear of rejection that surfaces in subtle ways.
How Deconstructing Anxiety Approaches Anxiety
- Core Principle: Beneath every form of anxiety lies one of five “core fears”: abandonment, loss of identity, loss of meaning, loss of purpose, or fear of death.
- Techniques: Progressive questioning to uncover the core fear, structured exercises such as The Alchemist and The Warrior’s Stance, reframing defenses.
- Strengths: Addresses root causes, integrates existential and transpersonal dimensions, helps clients find meaning and freedom.
- Limitations: Less widely researched than CBT, and may be unfamiliar to some clinicians.
Example: A client with the same social anxiety is guided to uncover that their core fear is loss of love (abandonment). By recognizing this, they begin to understand why exposure is so distressing — and why addressing the root fear leads to lasting change.
Similarities Between CBT and Deconstructing Anxiety
- Both are structured and give clients clear tools.
- Both emphasize the role of defenses (avoidance in CBT, chief defenses in DA).
- Both encourage clients to face what they fear — CBT through exposure, DA through “doing the opposite” of defenses.
Key Differences
| CBT | Deconstructing Anxiety |
|---|---|
| Focuses on thoughts and behaviors | Focuses on root fears and defenses |
| Evidence-based with decades of research | Integrative, emerging model with growing clinical use |
| Goal: reduce symptoms | Goal: uncover meaning and transform fear |
Why Clinicians Benefit From Using Both
CBT gives clients effective tools for daily symptom management. Deconstructing Anxiety helps them uncover the existential roots of those symptoms. Together, they create a bridge between short-term relief and long-term transformation.
Conclusion
For clinicians, integrating CBT and Deconstructing Anxiety offers a unique opportunity: address immediate symptoms while guiding clients to the deeper fears at the heart of their suffering.
👉 Ready to learn how to integrate these approaches in practice? Join Dr. Todd Pressman for a 3-hour training on Sept. 20, 2025: [Register Here]
