Anxiety disorder often occurs in combination with depression and substance abuse. People with anxiety disorder may have problems with excessive worry, obsessional traits, behavioral rituals, significant shyness, depressive symptoms, or substance abuse. Anxiety disorders can be divided into several types:

1. Panic disorder. This is characterized by a rapid onset where the person experiences a severe anxiety episode accompanied by physical symptoms that are often suggestive of cardiac, endocrine or neurological disorder. People with panic disorder become frightened of the panic itself and its symptoms. They become fearful of situations involving crowds, driving, being closed in, being far from home alone, waiting in lines, etc. Panic episodes can last from five minutes to over 30 minutes. CBT and/or medications such as selective serotonin uptake inhibitors (SSRIs) can be effective treatments for panic disorder.
   
   
2. Social phobia. This is extremely common and is characterized by excessive anxiety or distress in nearly all situations in which the person is subject to attention, social scrutiny, or social appraisal. Because social anxiety is so common it is often minimized or ignored and may go untreated. People with social anxiety may avoid public speaking, asking or answering questions in a group, use of public restrooms, etc. Social phobia can be treated with CBT and with social skills training and medication.
   
   
3. Obsessive-compulsive disorder (OCD). Obsessions are recurrent, disturbing thoughts that intrude on a person's normal thinking. These thoughts often involve fears of harm that may come to self or others. Common are recurring and unrelenting thoughts about germ contamination, about making mistakes, and thoughts of a violent or sexual nature. Compulsions are repetitive behaviors such as washing, counting, checking, repeating that are performed in a specific manner. People with compulsions are often able to hide them from others, but usually cannot control them. CBT and medication can be effective treatments for OCD.
   
   
4. Specific phobia. This is a marked fear of specific objects or situations. People with specific phobias avoid these objects or situations. They may often not feel impaired because they are so used to their avoidant behavior. Phobias about height and claustrophobia are among the most commonly treated phobias and other phobias such as snake and spider phobias are very common but often are not treated. CBT for phobias is extremely effective.
   
   
5. Generalized anxiety disorder (GAD). This is best described as excessive worry. People with this disorder often realize that they worry too much and they constantly struggle with ways to control it. They may experience restlessness, sleep problems, difficulty with concentration, fatigue and irritability. General anxiety disorder can occur by itself, but it is often accompanied with depression or other anxiety disorders (see above). Medication is the first line treatment for GAD.

Panic Disorder
The first goal of treating panic disorder is to help the person with panic attacks be less fearful of them. This can be done through cognitive restructuring. Cognitive restructuring focuses on helping the person realize their misconceptions about the attacks (i.e., "I may be dying", "I am having a heart attack", "I'm going to have a stroke", "I'm going to faint", "I'm losing my mind"). The person acknowledges that nothing terrible has occurred as a consequence of the panic attack and can begin to reassure themselves through a series of self-statements ("I am not going to die", "This is just a panic attack and I will be fine in a little while", etc.) The person is taught to reduce their fear of the attack itself.

The second goal of treating panic disorder is to reduce the person's fear of the physical symptoms associated with the panic or anxiety. To do this CBT uses the technique of exposure and desensitization. For example, a person who is fearful of fainting is exposed to the physical symptoms (dizziness, lightheadedness, shortness of breath, nausea, etc.) These symptoms can be induced by hyperventilation. The person is taught to stay calm when feeling these symptoms and is encouraged to practice calming themselves when the symptoms appear.

The third goal of treating panic disorder is to help the person face the person, situation, or event that is feared by exposing them to the situation and preventing them from fleeing. So, if a person is afraid of heights, then the solution is to be in a high place. The exposure is done gradually to allow the person to relax and become used to the situation before moving to the next level (i.e., a higher place).

Obsessive Compulsive Disorder (OCD)
Cognitive restructuring is not very helpful for persons suffering from OCD. Exposure therapy is the most effective CBT. The person is directly exposed to the situations that trigger obsessions or compulsive rituals. In addition, they must not be allowed to perform any rituals used to prevent harm that they anticipate as a result of the exposure. This is called response prevention. Exposure and response prevention are used together in the behavioral treatment of OCD. For example, a person who is afraid of germ contamination and compulsively cleans their bedroom is exposed to their fear by being required to touch objects in the room, the floor, toilet seats, under the bed, etc and must resist all urges to wash or engage in any other "decomntaminating" or anxiety reducing rituals in response to the exposure. Often at least 20 hours of actual exposure and response prevetion are necessary for improvement to occur.

Social Phobia
Cognitive restructuring can help people with social phobia by helping them focus on the distorted expectations of negative social outcomes and overly critical self-evaluation that is common with social phobia. The person is shown how to identify negative thoughts (i.e. "It would be terrible if I said the wrong thing", "I know they think I am ugly."). The person is gradually encouraged to participate in social situations. This repeated exposure and cognitive restructuing will eventually reduce social anxiety.

Specific Phobia
This is the simplest of the anxiety disorders to help using CBT. Graded exposure to the feared object or situation generally leads to desensitization.