CBT to Combat COVID-19 Anxiety - DIY Series

By Jacob Weissman

Cognitive-Behavioral Therapy, or CBT, is one of the most popular and effective therapeutic strategies. For the unfamiliar, CBT is based on the central premise that our emotions are caused by underlying thoughts. According to CBT, an effective way to bring about emotional change is by tackling these underlying thoughts. If the underlying thoughts can be changed, then a change in emotion will naturally follow.

The concept of reframing describes one process of changing these thoughts. Reframing involves uncovering the thought behind the negative emotion. Once the thought has been uncovered, it can then be analyzed and adjusted. The great thing about reframing is you can start the process at home with nothing more than pen and paper. This makes it an excellent technique for battling anxiety while under lockdown.

We will walk you through each step of the reframing process. Each step will then be followed by an example to help you get an idea of how reframing looks in action. The example we use is geared specifically towards reframing anxiety about Covid-19, but reframing can be used to combat many other kinds of anxiety and negative emotion as well.

Step 1: Uncovering the Thought

The process of at-home reframing starts by writing about the emotions you are feeling, and the thoughts that you believe are related. Many times, the most useful way to begin is by describing what was happening when you first noticed the current negative emotion. You will likely uncover something about the experience which caused you to begin thinking. These thoughts are likely related to the emotion you began experiencing. Starting out, don’t worry about getting it “right”. Even if you can’t pinpoint the exact thought your first time, this process will still be beneficial. More than anything, reframing is about teaching yourself a way to evaluate your thoughts and emotions. Learning the process of this evaluation is more important than initial accuracy.

Step 1 Example:

Jill notices that she suddenly feels very anxious, so she decides to sit down and write about it. Jill starts by considering what happened right before she felt anxious. Jill realizes that it was after watching a news report about an outbreak of Covid-19 in a New York Retirement Community that she first started to feel anxious. Jill realizes that the thought behind her anxiety was something like “Coronavirus is making everyone sick. It’s everywhere. If I get it, I’ll become very sick, and I’ll probably die.”

Step 2: How Realistic is the Thought?

After uncovering the thought, you then want to analyze the thought. This analysis should be focused on comparing your thought to reality. Anxious feelings tend to have catastrophic thoughts behind them. These thoughts usually aren’t warranted based on reality. This step is about focusing the mind on the unrealistic nature of the anxiety. A great way to start this process is by asking yourself questions like: “Realistically, what are the chances that this would happen to me?”, or “What is my belief that this will happen based on?”. Write your own questions related to your specific issue. The questions should be designed to make you evaluate how realistic your thought is. Write your answers to these questions out using pen and paper. After answering these questions, write out one final question: “Is this thought realistic?”. Answer this question with YES or NO, followed by a brief explanation of your reasoning.

Step 2 Example:

Jill begins by writing out the question: “How likely am I to actually catch coronavirus and die from it.” Jill is 40 years old, and she knows that coronavirus tends to be most dangerous for people over 65. For children, young adults and middle-aged adults, coronavirus tends to me much milder. Jill writes this out underneath her question. Jill knows she is in good health. She has been taking vitamin C and D actively and goes for a walk around her neighborhood at least three times a week. Jill jots down that she is unlikely to die from coronavirus because of her age and the health precautions she takes. After this, Jill looks up the infection statistics for her local area. Around one million people live in her city; Jill sees that 5,000 people have been infected and under a hundred people in her city have died. She notes that both the infection and death numbers in her local area are .5% and .01% - much lower than she thought.

Jill then writes out her original thought: “Coronavirus is making everyone really sick. It’s everywhere. If I get it, I’ll become very sick, and I’ll probably die.”

Directly below this she writes, “Is this thought realistic?”

Jill’s answer: “NO, this thought is not realistic. Coronavirus is making people sick, and it is widespread in certain areas, but not everywhere. Most of the people dangerously effected by the virus are over the age of 65 or in bad health. I am 40 years old and in pretty good health. If I get the virus, I might become sick, but I’m very, very unlikely to die from it.”

Step 3: Adjusting the Thought

The final step in this process challenges you to build a new thought, based on what you came up with in Step 2. Ask yourself, “How can I make my original thought more realistic?” Write out a new version of your original thought that is in line with reality. Try to make this thought succinct enough to remember. This is your adjusted thought. Write out the thought and repeat it to yourself until you have it memorized. Using paper and pen, rather than a computer or tablet, may be especially important for this step. Research suggests that handwriting is more effective than computer-writing when it comes to memorization.    

Step 3 Example:

Jill starts by writing out her original thought, “Coronavirus is making everyone sick. It’s everywhere. If I get it, I’ll become very sick, and I’ll probably die.”

Jill crosses this thought out with her pen, and writes down a new thought, adjusted for reality.

“Coronavirus is making people sick, but most severe cases are in people 65+. It is not widespread everywhere. If I get it, I might get sick, but probably only mildly. I will not die from coronavirus.”

Jill shortens the thought, so that it is easier to memorize:

“I’m under 65 and in good health. If I catch coronavirus, I will be ok. I will not die.”

Jill writes this thought down until she has it memorized. Now, whenever Jill finds herself feeling anxious about coronavirus, she replaces her negative thoughts with this reframed one. After two weeks of doing this, Jill finds that she no longer feels as anxious about coronavirus. Jill might still need some help, but she has come a long way in combatting Covid-19 with just the power of her own mind. This makes Jill feel more hopeful and in control of her life, despite the troubles of Covid-19.

The reframing process is now complete, but make sure not to end here. For long lasting emotional change, it is important to use this process actively, building up a repertoire of reframed thoughts and increasing knowledge about the thought-based roots of your negative emotions. Once you have this repertoire, make sure to interject the reframed thoughts whenever you notice yourself thinking one of the old, unrealistic thoughts. Doing this overtime will help you break the negative thought-negative emotion pattern you are stuck in.


If you or someone you know could use help with anxiety - please visit Journey’s Bridge Counseling.