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Let's Talk About CBT

Cognitive Behavioural Therapy: what it is, what it's not and how it can be useful.


Mar 19, 2020

This is an understandably stressful time and it's normal to feel worried. What can we learn from CBT for health anxiety that might help us with feelings of anxiety during the pandemic? In this short bonus episode, Dr Lucy Maddox interviews Dr Jo Daniels from Bath University, about things we know are likely to help. 


Show Notes and Transcript

Podcast episode produced by Dr Lucy Maddox for BABCP

Read an article by Dr Jo Daniels on how to stop anxiety about coronavirus spiralling out of control here:

Another article about panic here:

And this about how it's normal to feel worried:

BBC piece on protecting your mental health at this time:


Photo by Kelly Sikkema on Unsplash


Lucy: Hi, I’m Dr Lucy Maddox and this is Let’s Talk About CBT. This is a podcast brought to you by the British Association for Behavioral and Cognitive Psychotherapies.  

This is a bit of an unusual episode. I’ve come to Bath University to interview Dr Jo Daniels who has experience in researching health anxiety in relation to medical conditions. There’s obviously a great deal of worry around at the moment, understandably, in relation to coronavirus 

I’ve come to ask Jo about how we can look after our psychological wellbeing as well as our physical health. The information that Jo talks about is based on cognitive behavioural therapy principles for anxiety. Obviously there’s no evidence base for this in relation to coronavirus in particular, but really health anxiety in relation to any physical illness has some very similar features, so we hope that this advice can be helpful.  

Jo: My name is Jo Daniels and I’m a senior lecturer in clinical psychology and also a clinical psychologist working in health.  

Lucy: Could you say a bit about the work that you’ve done that’s relevant to our reactions to the coronavirus pandemic? 

Jo: The research that I’ve done so far is focused on health anxiety and distress in medical conditions. I do some work in the emergency department and think about why people keep coming back in and it’s usually to do with anxiety rather than pain. I’ve also worked in health anxiety in complex conditions such as Addison’s disease, chronic fatigue syndrome, also stroke, looking at how important anxiety is in both emotion and physical experience.  

Lucy: Fab. I mean it’s really understandable that people are feeling worried at this time because there’s loads of stuff around about Covid-19 and about what we should be doing about it. What advice would you have about how we can avoid spiralling out into panic about what’s happening? 

Jo: I think the first thing to say, which feels quite important, is it’s very, very normal to have a fear response, to feel anxious because this is a threat really and that’s the way that our brains are interpreting it, as a threat. Important to just accept that we’re all a little bit worried at the moment and we’re really in it together.  

In terms of the things that we can do help ourselves, it’s a digital age, so a lot of people are accessing various sources of media and information at the moment. Thinking about where the notifications are essential, thinking about the sources of information that we access, where some of the new stories are designed to be alarmist.  

Keeping perspective is really, really important and we can do that in a number of ways. So keeping in touch, especially if we’re moving into having to be at home, we need to be in touch with people to keep perspective and also to keep ourselves happy.  

Also trying to stay calm. It’s really important that we go about our normal daily business as much as we can. Things are going to change over the next few months, but normality is really important. So ensuring that we do the same things that we normally do and don’t adapt too much because sometimes when we do that, we start to do things that are actually counterproductive.  

Lucy: So like a balance between following the advice that’s out there, the sensible advice on reputable websites, but doing as much as we can to keep our routine and keep in touch digitally with people that we care about?  

Jo: Exactly. It’s really important to be vigilant, but not hyper vigilant. If you look for trouble, that’s what you’ll find.  

Lucy: What does hyper vigilance mean, just in case people don’t know that?  

Jo: That’s when we’re really paying extra attention to things. You see that a lot in health anxiety and at the moment I think a lot of us may be doing that, looking for signs of coronavirus 

The interesting thing is, is that actually if we become quite anxious; we will product physical symptoms in our body that may mimic it. So things like chest pain, you can get a bit of chest pain or dizziness, nausea, feeling a bit hot, all of those physical sensations can be anxiety or they can be something like coronavirus, which is another reason why it’s important to stay calm. As obvious as it sounds, to keep breathing.  

Lucy: I find that really interesting because if I get anxious or worried, I normally feel like I get quite short of breath. Is that quite a common symptom that you would say?  

Jo: Yes, definitely. We see hyperventilating even if it’s at moderate level you might not even notice in anxiety. Some shallow breathing and again, that sends signals to the brain that there is a threat and it does trigger off, it can trigger off a ‘fight or flight’ response, or an anxiety response. And there is a lot that we can do to help ourselves at this time, but panicking and anxiety is not helpful.  

Lucy: Could you say a bit more about ‘fight or flight’ response, I expect people would have heard about that, but just a bit more detail? 

Jo: So fear is a very normal response and that fear response is ultimately designed to keep you safe, it’s a survival mechanism. We can receive incoming information that triggers off a ‘fight or flight’ response that actually isn’t a real threat to us. It’s designed to deal with threats such as seeing a scary lion chasing us in the African plain, but actually we still get an anxiety response, a ‘fight or flight’ response when we send a text message to the wrong person, for example.  

What happens then is we have a lot of hormones released around our body and people might be familiar with breaking into a sweat or hyperventilating a little bit or palpitations. Many, many symptoms are essentially designed so that we can fight really hard or run really fast just to keep us safe.  

Lucy: But not very helpful to run away from a mobile phone when we send a wrong text message.  

Jo: No, not really, that’s where it doesn’t work very well, ‘fight or flight’ response because we haven’t evolved, if you like, to be able to distinguish between what’s a real threat and what’s being perceived as something like a social threat where a ‘fight or flight’ response actually can be quite unhelpful and actually stressful.  

Lucy: It’s tricky with this isn’t it, because it is a real threat and at the same time there’s a quite a lot of panic around which might be unhelpful.  

Jo: Yes, exactly and that again brings on further symptoms associated with anxiety. So it’s really important to, as much as we can, give our bodies and our brains the message that actually there is a threat, but we can deal with it in a pragmatic way.  

Lucy: If someone has an existing mental health problem, any advice about how to stop that being exacerbated? 

Jo: I think it’s a difficult time for people who have got anxiety already because they’re already going to be quite sensitive to anything else that can be perceived as a threat.  

The same applies really, so trying to maintain distance from the difficulty, just following the sensible precautions, making sure that you’re in contact with the people who care about you, both friends and family, but also GP as well, if things are escalating a little bit and it becomes unmanageable or you become preoccupied. It’s really important to put into place strategies that you know that work.  

Lucy: So still that balance between making sure you’re accessing information about what to do, but not over checking, either symptoms in yourself or over checking websites that might be showing quite scary stories.  

Jo: That’s right. We know that panic breeds panic. So if we see other people panic buying, then we’re more inclined to do that as well. So just trying to, again, take a step back when we feel ourselves becoming anxious and trying to retain that perspective.  

Lucy: One of the things that’s so tricky about this is that there’s a lot of uncertainty around about what’s going to happen and what we’re going to be advised. 

Jo: We are mostly intolerant of uncertainty and that in itself can be problematic in the sense that this will perpetuate anxiety, that’ll keep anxiety going. Rather than the actual illness itself, or the fear of the illness, it’s the uncertainty of, “Will I catch it? Will I be able to manage it? Will I be badly affected? 

Lucy: And actually it can get us checking online news a lot more can’t it, to see what are we being advised on a moment-to-moment basis.  

Jo: That’s right and that’s the problem sometimes with anxiety. Even mild anxiety, because some of us who may not be usually prone to anxiety, will feel a little bit anxious at this time, for understandable reasons. But some of those strategies we use are counterproductive. I don’t know of any good examples of where people have Googled their symptoms and come off feeling better.  

So check that checking behaviour, it can make us feel better momentarily, but really serves to increase our anxiety and of course then we get stuck in a loop feeling like because that anxiety was reduced for a moment by checking, that we keep doing it. But of course, it really serves to increase our anxiety. 

Lucy: What are some things that we can do that would be more helpful than checking online?  

Jo: One of the things we can do, given that we are experiencing mild levels of ‘fight or flight’ response, that fear response, is to try and get rid of some of that adrenaline. Exercise is really important, not only does it get rid of that adrenaline, it also allows us to keep perspective and keep fit at the same time.  

But also just making sure that we keep in touch, check reliable sources and just follow the guidance. There are a lot of busy people who have got a lot of knowledge in this area who are giving very sound advice. So just keep up to date with what the precautions are.  

Lucy: And how do we know that these things are helpful? 

Jo: Thankfully we know a lot about anxiety, so for many, many years there’s been lots of research, lots of empirical data-based studies which have supported the development of models of anxiety. And anxiety is the same applied in different settings.  

Whilst anxiety in mathematical conditions may not present the same, it’s very, very similar. Those principles which are underpinned by cognitive behavioural approach we’ve seen work in other situations where people experience anxiety, and in that sense there’s no difference here. People tend to do the same kinds of things when they’re anxious and we know that the same kinds of things will help.  

Lucy: So to sum up, follow the advice on the government websites. Try to look after yourselves and other people by managing some of the anxiety response that’s going on as well.  

Jo: That’s right.  

Lucy: Have you got anything that you would like to add at all?  

Jo: I think what feels essential is that where we can, we respond to this in a compassionate and community focused way. We’re going to be in this together as a community, so it’s really important that we look out for our neighbours, those who are vulnerable to us and express some understanding towards those who do feel anxious, who are finding it difficult.  

Lucy: I hope you found that as helpful as I did. And if by the time this podcast is out we have moved into a phase where we’re having to stay at home a bit more, I hope you can remember those tips of trying to keep a routine as much as possible, following advice, but also trying not to get too preoccupied. Jo described this as having some kind of normality within an abnormal situation.  

If you’re stuck at home and you want to listen to some more podcasts, there’s plenty of episodes of Let’s Talk About CBT to keep you company.