Why Anxiety Keeps Going: The Vicious Cycle

When to use ‘Why Anxiety Keeps Going: The Vicious Cycle’

‘Why Anxiety Keeps Going: The Vicious Cycle’ is an interactive cognitive behavioural therapy (CBT) worksheet, most often used in CBT for generalised anxiety (GAD).

It is designed to be used within therapy rather than as a standalone self-help tool: a therapist introduces it, works through it collaboratively, and helps make sense of what it surfaces. You can preview the full worksheet above, then assign it digitally for clients to complete between sessions on any device — or download it as a print-ready PDF.

How it works

Most people work through it in around 9 minutes. It moves through six short steps:

1. Why does anxiety stick around? — When something makes us anxious, it is natural to want the feeling to stop. So we avoid the thing, or we find ways to get through it that…
2. Avoidance brings relief, then keeps you stuck — When you avoid something that scares you, the anxiety drops almost straight away. That relief feels good, so your brain learns that…
3. Safety behaviours do the same thing — Sometimes you cannot avoid a situation, so you find small ways to feel safer while you are in it. These are called safety behaviours:…
4. Which of these do you do? — Safety behaviours are very common and completely understandable. Tick any that you notice yourself doing when you feel anxious.
5. The vicious cycle — Put together, this forms a loop. You notice a threat, anxiety rises, you avoid or use a safety behaviour, and you feel relief. But because…
6. How the cycle breaks — The way out is to let the feared thing be tested. When you stay in a situation, or drop a safety behaviour, and the disaster does not…

Completed on the Formulate platform, your client's answers are saved automatically and shared straight back to you, so you can review them before the next session rather than waiting for a paper copy to come back.

The CBT approach behind it

In common with other CBT methods, ‘Why Anxiety Keeps Going: The Vicious Cycle’ works by mapping how the parts of a problem connect and keep it going (formulation). The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going — and practical, testable ways to change it.

Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.

Evidence & sources

This worksheet is grounded in established cognitive behavioural therapy theory and practice. Key sources include:

• Salkovskis, P.M. (1991). The importance of behaviour in the maintenance of anxiety and panic: A cognitive account. Behavioural Psychotherapy, 19(1), 6-19.
• Clark, D.M. (1999). Anxiety disorders: Why they persist and how to treat them. Behaviour Research and Therapy, 37(Suppl. 1), S5-S27. doi:10.1016/S0005-7967(99)00048-0
• Clark, D.M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461-470. doi:10.1016/0005-7967(86)90011-2