CBT for Anxiety | Challenging Cognitive Distortions

I couldn’t sleep worrying about the presentation I had the next day. I was too anxious to fall asleep and I couldn’t stop thinking about the disaster the presentation was going to be. I could vividly imagine my embarrassment.

I met with my cognitive therapist and showed her my Stress Log exercise. We decided together that it would be best to challenge the automatic negative thought: “Tomorrow’s presentation will be a disaster.”

She helped me identify the cognitive distortions in my thinking and explained the importance of challenging them so I don’t feel so anxious.

I know there are many more layers of complexity to this, but I don’t need to get overwhelmed right now and this seems to be a good clear start. I know that I shouldn’t care so much, even if the presentation was a disaster. I know I have a deep conviction that I need to make my parents proud and my dad’s recent heart attack takes the whole career success pressure to a whole other level. But I agreed with my therapist to tackle things one step at a time. We’ll start by questioning this thought that was causing me to feel so anxious and preventing me from falling asleep: “Tomorrow’s presentation will be a disaster.”

Here’s a picture of this Thought Challenge exercise:

CBT for Anxiety - Challenging Cognitive Distortions

CBT for Anxiety – Challenging Cognitive Distortions

After talking about the evidence in favor and against the idea that the presentation would be a disaster I came up with a more balanced thought. I also understood that I have a tendency to this kind of distorted catastrophic thinking in which I picture the worst case scenarios. Similar catastrophic cognitive distortions have had a lot to do with my panic attacks, when I think I am dying or having a heart attack.

I believe that if I catch myself thinking this way and correct the distorted thinking on the spot, then I won’t feel so anxious.



Stress Log Example | Presentation Anxiety

I just couldn’t fall asleep. My mind was going on and on about the presentation tomorrow. I had worked hard at preparing it, but I still had the feeling it would be a big mess. Or better said, I was feeling anxious because I was thinking the presentation was going to be a disaster.

I kept picturing myself standing in front of a crowd, blanking when asked a question or hearing some negative comment. I could see myself flushing, having a panic attack in front of everybody.

Doing a Stress Log Exercise helped me clearly distinguish my feelings from the negative thinking that was causing these feelings.

Here is a picture of this Stress Log example, dealing with presentation anxiety:

Stress Log Example | Presentation Anxiety

Stress Log Example | Presentation Anxiety

You can also practice your CBT skills using the Stress Log tool at


Therapy Homework Online


Distorted Thinking

I need to correct my distorted thinking. Next time I have a panic attack I don’t want to start thinking I am dying. Now that I am not in the middle of a panic attack I know they are not life-threatening. But how do I get my thinking trained to interpret my shortness of breath and pounding heart in a less scary way?

My CBT therapist tells me I can train my thinking, just like I can train my body to ride a bike or play tennis. Working on catching myself as I let my emotions distort my thinking is a first step. A second step is to get used to having a rational approach to any physical symptom, in particular during a panic attack.

This Thought Challenge exercise is like the second part of a Thought Record. I’ve selected the scariest negative thought from my Stress Log to challenge.

Panic Attack Thought Challenge

Correcting distorted thinking during panic attacks

Read more about Cognitive Distortions on Don’s Blog.

My First Stress Log

When I’m having a panic attack my thinking is completely distorted. I “feel” like I’m dying so I’m certain I’m dying.
Even if it makes no sense to think that way, I still do, because rationality is not part of a panic attack.

I guess it made some sense to worry I might be having a heart attack the first time I had a panic attack. After all my heart was pounding and I felt terrible shortness of breath, What makes less sense is that every time I have a new panic attack I still think I’m dying. I’ve been to the ER and to see a cardiologist and they’ve done plenty of tests. By now I am quite confident that my general health is quite good. I know these are episodes of anxiety and that they are not dangerous. But still, when I’m having an attack the thoughts of imminent death still become prominent in my mind.

Since I am seeing a CBT therapist I’ve started practicing CBT techniques to correct my thinking in general, but specially when I am having a panic attack. I’ve been doing Stress Log exercises and Though Challenge exercises. A Stress Log is similar to the first part of a thought record. I describe the situation and then I report my feelings (usually panic!!) and the negative thoughts that go through my mind while I’m feeling stressed out or having a panic attack. Clearly separating what are feelings from what are thoughts is already helping me. It is a lot better to say “I feel very anxious because I think I am dying” than to say “I feel like I’m dying”. When I say that I think that something is the case it is already obvious that this is just a possible belief or interpretation that can be challenged. When I say “I feel like I’m dying” I leave no room for questioning my interpretation of what’s going on.

I’ll tell you more about challenging negative thoughts in my next blog. For now I want to share with you my first Stress Log:

Panic Attack First Stress Log Exercise

Panic Attack First Stress Log Exercise


CBT for Panic Disorder

I know it was pretty obvious that I was having panic attacks, not problems with my heart. But I still ended up in the emergency room. Thank god I managed not to make a big scandal at work. I just told them I was feeling sick and had to go home. By the time I got to the ER I was already feeling much better, but they still did a thorough evaluation and told me there was nothing wrong with my heart. I’d had a panic attack.

I read about panic attacks and learnt that if you keep having them out of the blue you might have panic disorder. If you start fearing having more panic attacks and you start avoiding things or places (like elevators) then you definitely have panic disorder.

It turns out panic disorder is very common and there are many different treatments available. I was, at first, very tempted to take a medication and not waste time seeing a therapist. But I have to be honest with myself. This is obviously happening to me because my dad had a heart attack, or maybe because of the pressure at work. The thing is that I really want to know why I am having these attacks. So I’ve been trying to find a therapist.

There are different therapeutic approaches to treating panic disorder. I chose a therapist that practices CBT (cognitive behavioral therapy). CBT seems to be the kind of therapy that works best and the fastest for panic disorder. Here’s some more information on how CBT can help anxiety: CBT for anxiety.

I’ll be in touch to let you know how my therapy is going.


Since I had that first panic attack in the elevator at work I have not been able to get in an elevator again.

I did try a couple of times. I was very nervous, but I knew I had to try. I got in the elevator and tried to stay put. I couldn’t stand it. I can’t even explain how or why, but I knew that if that elevator door closed and I was still inside I was certain to die. I saw the door closing and without any hesitation I reached out, stopped it from closing and ran out of it.

The next day I stood by the elevator door waiting for it to open. My heart started pounding so hard that I didn’t even dare go inside.

Since then I’ve been walking up the stairs 17 floors up and down every day. I started bringing luch from home so I don’t have to go out at lunch time. I need to do something about this!

My First Panic Attack

Part of me knew it was impossible I was having a heart attack. I’m 24 and healthy and it is my father who just had the heart attack, not me! I know very well heart attacks are not contagious.

But I surely felt like I was having one. The pressure in my chest was unbearable. I felt so cold and like I was not really there. It felt so much like I was dying. I was too scared to think whether this was likely to be a heart attack or not. I couldn’t stop thinking about how my parents would react to the news of my death, how I was leaving them alone, childless, no longer having a daughter to be proud of.

I’m ashamed to even consider it was “just my nerves”. And it’s not like I was worried about my dad’s heart attack or even thinking about it at the time. All I had in my mind going in that elevator was how I needed to work hard and efficiently to get up to date at work and make sure my absence had no negative consequence in my productivity. Now I’m really worried my mental health will get in the way of me having a successful career.