I always psychoeducate my clients that anxiety, our built-in, natural survival mechanism, has helped humans stay alert and aware in dangerous situations. We have a built-in alarm system! However, in today’s world, chronic anxiety often emerges in response to stressors that are not life-threatening, leaving many people feeling trapped in a cycle of persistent worry. This amazing system that can alert us to danger is like a smoke detector. Blow out a candle or put a raging fire under a smoke alarm and, guess what, the alarm sounds the same. Our alert system has evolved the same way. While cognitive behavioral therapy (CBT) is frequently touted as the gold standard for treating anxiety, it may only provide a surface-level fix. Call it anecdotal, but I find that combining CBT and EMDR can be the most effective. It is a two-prong approach that addresses the root cause (EMDR) and then provides a tool (CBT) for future work. In fact, approaching anxiety solely through CBT can act as a band-aid, addressing the symptoms but not the root cause. I’ve seen it over and over again with clients who have been through years of CBT therapy saying, “I still get triggered,” or “even though I can identify I am catastrophizing, I cannot seem to stop, even after re-framing situations.”

In this blog, I will explore how integrating body-based approaches (like EMDR, Brainspotting, Flash-Technique, Mindfulness, even relaxation work) and ego state therapy, alongside an understanding of anxiety’s evolutionary origins, offers a more comprehensive solution. These methods help to heal the mind-body connection, creating more lasting relief. Then, CBT can become an effective tool for living a meaningful life.

Anxiety and Evolution: Why We Can’t Think Our Way Out of Fear: Cognitive Behavioral Therapy

To understand why CBT alone falls short, we need to acknowledge how evolution has shaped the experience of anxiety. Anxiety, at its core, is an adaptive mechanism, a signal designed to protect us from danger. Our ancient ancestors relied on this “fight-or-flight” response to survive threats like predators or hostile environments. As a result, the human brain evolved to prioritize safety over comfort. In complex, traumatic environments, especially during key developmental periods, fawning can even be a response (which emerges in later life as “people pleasing”).

The amygdala, the part of the brain responsible for fear responses, kicks into gear when we perceive danger, real or imagined. It’s essential to note that these responses are deeply rooted in our bodies. When someone experiences anxiety, their body reacts physiologically—racing heart, shallow breathing, muscle tension—all symptoms of preparing for survival. When a client walks into my office for the first time as an “anxiety sufferer,” usually we have to immediately deploy relaxation techniques, integrating bilateral tapping, slow breathing, imagination exercises, etc…and slowly the shoulders lower. This is most often followed by a yawn. Now we can get to work.

CBT primarily focuses on altering thought patterns to regulate emotions, which can be helpful for challenging irrational fears. However, because anxiety is a full-body experience, addressing it purely through cognitive strategies may only scratch the surface. Studies emphasize that body-centered therapies offer more sustained outcomes because they help the nervous system relearn how to respond to stress (van der Kolk, 2014).

Healing Through the Body: The Missing Piece

One of the most effective ways to address anxiety at its core is by focusing on the body. Breathing techniques, grounding exercises, and somatic therapy all work to regulate the autonomic nervous system, helping clients calm their physical anxiety responses. Research on mind-body approaches, such as mindfulness and breathwork, has demonstrated their ability to reduce stress, anxiety, and emotional dysregulation (Kabat-Zinn, 1990).

Incorporating breathwork allows clients to shift from a state of hyperarousal (fight or flight) to a state of calm. Studies have shown that breath-focused practices lead to decreased symptoms of anxiety and can even rewire the brain’s response to stress (Jerath et al., 2015). By teaching clients how to engage in mindful breathing or progressive muscle relaxation, we offer them tools to regulate their anxiety in real time. By then applying modalities, such as EMDR, we can allow the brain and body to finally re-wire the neural network (called neuroplasticity) to understand the root cause of the anxiety is no longer a danger, threat or something to perceive as “immediately” impactful.

Ego State Therapy: Integrating the Self

Another powerful approach to addressing anxiety at its core is ego state therapy. This method is based on the idea that we all have different parts, or “states,” within us that come to the surface in response to different situations. Anxiety can often be linked to internal conflict or fear between ego states, with one part of a person feeling vulnerable and another part stepping in to protect through hypervigilance or avoidance.

Ego state therapy encourages clients to access and engage with these different parts, fostering internal communication and healing. By working with the parts that hold anxiety, we can help soothe the nervous system and create a more balanced internal environment. This approach can be particularly effective when combined with breathwork, as clients can use mindful breathing to regulate specific ego states and bring a sense of calm to their entire being (Watkins & Watkins, 1997). IFS is all the rage these days but I find Ego State Therapy is more personal and less rigid. My clients agree.

A Comprehensive Approach to Anxiety Treatment

To achieve lasting relief from anxiety, it is essential to take a holistic approach that includes both mind and body. While CBT offers valuable tools for reframing thoughts, it often falls short in addressing the full spectrum of anxiety’s impact. By incorporating body-based practices, such as breathwork, and integrating ego state therapy, we can address anxiety at both a cognitive and physiological level. This comprehensive approach leads to deeper healing and more lasting results. I’ve seen this with my clients and the feedback from clients is that they agree with this approach.

References

1. van der Kolk, B. A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking.
2. Kabat-Zinn, J. (1990). Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. Bantam Books.
3. Jerath, R., Edry, J. W., Barnes, V. A., & Jerath, V. (2015). Physiology of long pranayamic breathing: Neural respiratory elements may provide a mechanism that explains how slow breathing shifts the autonomic nervous system. Medical Hypotheses, 85(6), 486-496.
4. Watkins, J. G., & Watkins, H. H. (1997). Ego states: Theory and therapy. W. W. Norton & Company.
5. Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. W. W. Norton & Company.