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How to Use Cognitive Behavioral Therapy to Overcome Stress, Anxiety, and Cognitive Distortions

Stress and anxiety tend to go hand-in-hand with migraine. The pain, fatigue, nausea, and uncertainty regarding treatment outcomes often feel like too much to handle. Thankfully, while we can’t control our illness, we do have control over our thought patterns, which may be increasing the stress and anxiety we feel. Changing cognitive distortions is one big way we can reduce stress and anxiety and increase hope. Cognitive behavioral therapy can help us do this.

Cognitive behavioral therapy (or CBT) is a form of therapy that focuses on changing negative thought patterns into positive, healthy ones by focusing our attention on our negative thoughts and asking us to question and refute them. It then teaches us how to replace the thoughts with more accurate, more adaptive thoughts. The idea is that by continually questioning, refuting, and replacing a distortion, it begins to lose its power over us and we begin thinking in new ways.

Unlike traditional therapy, CBT works exclusively in the present, so you don’t have to expend valuable time and energy working out why you started engaging in a particular cognitive distortion. Instead, you work solely on recognizing and then changing the distortion. Best of all, you can practice CBT at home on your own.

Step 1: Pay attention to your thought patterns and how they affect you. A journal can help with this. Write down what you think and how you act for a day, a week, or a month (whatever makes you more aware of yourself without overwhelming you). Make special note of how your actions and thoughts make you feel.

Step 2: Write down negative thoughts instead of accepting them as truth. Once you’ve gotten used to identifying your thoughts, it’s time to tease out the maladaptive ones. Any time you hear yourself saying or thinking something negative that falls in line with one of the cognitive distortions, pause. Don’t accept it. Instead, write it down.

Step 3: Focus on the thought. Ask yourself if the thought expressed on the page is helpful or unhelpful to your mental well being. Most importantly, is it even true?

Step 4: Refute and replace it. If you find the thought is unhelpful and inaccurate, as most cognitive distortions are, refute the distortion, and then replace the negative thought with a positive one. This is the most important step for changing your thought patterns. If you stop at step three, nothing will change. In fact, you may feel worse because you’re bringing extra attention to the negative thought without altering it. Don’t do that! Instead, follow the examples below.

Example 1. If you’ve been engaging in all-or-nothing thinking, you may have the thought that because you were unable to do one thing – bake cookies for your child’s bake sale or meet a deadline at work – you’re a complete failure. To combat this, remind yourself of a time when you succeeded despite the obstacles of illness, and then offer yourself some compassion by saying something like “Considering the amount of pain I’m in right now, it’s amazing that I managed to get anything done. I’m proud of myself for [fill something in here, washing the dishes, making the bed, answering a work email, etc.].” By refuting the distortion with a reminder of something you did get done and replacing “I’m a failure” with “I’m proud of myself,” you’ve taken the first steps toward eradicating all-or-nothing thinking from your mind’s arsenal of tricks.

Example 2. If you’ve been personalizing everything, you may have the thought that your best friend’s neglectful attitude toward you is your fault. (Perhaps he or she hasn’t been able to get together for the past month or so.) You may be compounding this by jumping to conclusions (“He/She doesn’t want to be my friend anymore because I’m sick”) and/or overgeneralizing the neglect (“I can’t even keep my best friend; everyone is going to abandon me now.”)

Instead of continuing to think these thoughts, stop. Ask yourself if you have any evidence that your friend’s inattention to you is your fault. Has he/she said something specific? If not, brainstorm other reasons why your friend might be out of touch. Did she get a new job? Does he have small children? How’s your friend’s marriage doing? Once you’ve entertained some other reasons why your friend isn’t hanging out, tell yourself your friend’s absence isn’t your fault. This should take care of the other thoughts as well.

If you’re still feeling anxious, however, go ahead and refute and replace the overgeneralization too. Remind yourself of a time in childhood when you lost a close friend, and yet stayed friends with other people. Then say, “I have a supportive network around me, no matter what.” (Additional examples of negative migraine-specific thoughts and their replacements can be found in my book, Finding Happiness with Migraines: A Do It Yourself Guide.)

That’s it! There are additional layers to CBT, but following these four steps will start you on the path to increased positivity, better functionality, and reduced stress.


This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


  • Leynal
    3 years ago

    I want to try CBT for my anxiety related to migraines. I’m wondering if we are supposed to be trying to extinguish the negative thoughts or just write them down and notice them

  • Sarah Hackley moderator author
    3 years ago

    I’m glad you’re wanting to give CBT a try. Many people – myself included – have found it very helpful. Generally, you want to go with the steps outlined above, in order. How long it takes to progress from one step to the next is up to the individual. I would focus first on identifying the negative thoughts and writing them down though, and then move to questioning them and starting to replace them with positive ones. Eventually, you’ll retrain yourself to think the positive ones before – and more frequently – than the negative ones. I hope that helps!

  • Camassia
    5 years ago

    Thank you for this article. I’m just starting to work on controlling my negative thoughts about migraine and other aspects of life. Recently I read an article on Medscape about how fearing pain and a migraine attack keeps you in the same hypervigilant state that could actually trigger an attack. I have a long history of anxiety (also health anxiety) and panic attacks while migraine symptoms are very recent – no family history either. To me it is possible that my tendency to obsess about my health, the constant anticipatory anxiety and worrying about the slightest change in my body can lead to an overactive CNS and amplifying sensations such as pain, etc. Having realized that, I’m now working with an acupuncturist who also does counselling and looking into CBT with a therapist. The acupuncturist believes my chronically tight muscles in my upper back are from constant anxiety. She said relaxation won’t happen just from the needles unless I work on myself as well. I do believe long term stress/anxiety is what triggered the onset of migraine at the age of 50.

  • Sarah Hackley moderator author
    5 years ago

    Thank you for reading! I hope you begin to feel better soon. – Sarah

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