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Insider Secrets From a Top Cognitive Behavioral Therapist

Tips to help you worry less, sleep better and face your fears after 50

As told to

Eric Spitznagel,

AARP

Published March 24, 2026

illustration featuring Dr. Kevin Chapman in a blue suit, surrounded by scenes of cognitive behavioral therapy (CBT) in action.

Licensed clinical psychologist Dr. Kevin Chapman shares his cognitive behavioral therapy (CBT) tips, including how to play a fear out until it becomes “boring” — and manageable.

Amber Day

If you’re lying awake at 3 a.m. worrying about money or dreading your next medical appointment, you’re not alone. It’s estimated that between 10 and 20 percent of older adults experience anxiety, according to the American Association for Geriatric Psychiatry. And much of it is undiagnosed.

But the fix may be simpler than you think. Cognitive behavioral therapy (CBT), an action-oriented form of talk therapy, teaches you to spot unhelpful thoughts, test them against the facts and build better habits. It’s helped more than half of adults over 60 eliminate their anxiety disorder entirely, according to a 2025 meta-analysis in The American Journal of Geriatric Psychiatry.

The results are lasting, too: A study that followed up with subjects in a randomized, controlled trial found that around 70 percent of older adults treated with CBT were still getting relief from their symptoms 10 years later — nearly twice the rate of traditional talk therapy.

Dr. Kevin Chapman, a psychologist and founder of the Louisville, Kentucky-based Kentucky Center for Anxiety and Related Disorders, which is diplomate-certified by the Academy of Cognitive and Behavioral Therapies, has built his career on making these powerful CBT techniques feel approachable and doable. Winner of the Anxiety and Depression Association of America’s 2019 Jerilyn Ross Clinician Advocate Award, which honors a clinician “who exemplifies excellence and outstanding advocacy for patient education and care, training and research,” Chapman shares insider advice that can help you sleep through the night, quiet the worry spiral and feel steadier facing whatever comes next.

You set the agenda, and I follow your lead

Structure is not rigid in CBT. It’s reassuring, collaborative and the reason progress shows up faster. One of the quickest ways to lower anxiety in the room is to make the plan together. At the start of every session, I tell clients, “Anything important to you can go on this agenda,” and I let them go first. After we capture their priorities, I add my items based on the symptoms they want help managing. We always end with a quick review and clear next steps so they know exactly what to practice at home.

The real work happens outside the therapist’s office

CBT has “high external validity,” which is just a fancy way of saying the skills actually work in your real life. You spend about 1 percent of your waking week with me and the other 99 percent out in the world. Homework is how you carry the tools into your day so the brain gets multiple reps between sessions. The practices that I teach you, that you bring into your everyday life, cement what you learned so that when we meet again we can build, not restart. Most people find that reassuring, because it puts progress squarely in their hands.

CBT may take longer than medication, but the results outlast it

Antidepressants or anti-anxiety medications typically work faster in the early weeks — that’s just the truth. But studies show that as therapy gets moving, CBT typically catches up and then outperforms medication on staying power, because you’re learning skills your brain can reuse without a prescription. When you stop or taper off medication, the drug leaves your system and the symptoms can return. When CBT ends, the understanding of why you were anxious — and what to do about it — stays with you. For most anxiety and related problems, you’ll notice momentum within six to eight sessions, and you’ll leave with a plan you can run on your own. Many people also choose to combine CBT with medication early on, then taper meds as skills take hold.

Your brain uses your past experiences against you

illustration of an older adult woman in a red suit walking confidently toward a wooden podium on a stage

If a past presentation went poorly, your brain might tell you that all presentations will go poorly. CBT teaches you to recognize these thoughts for what they are: testable predictions, not proven truths.

Amber Day

I often use Chick-fil-A as an example with clients. I walk in and I know what I want; I don’t need to read the menu because I’ve been there before and my brain has learned the pattern and automated the decision.

Your brain does the same thing with negative experiences. If a presentation went badly once, your brain files that away as “presentations = danger.” Now, as you walk into your next presentation, your brain automatically thinks, “This will be a disaster.” Not because it’s analyzing the current situation, but because it’s pattern-matching to the past.

Your brain is treating that automatic thought like a fact when it’s actually a hypothesis based on limited, outdated data. CBT teaches you to recognize these thoughts for what they are: testable predictions, not proven truths. You learn to ask, “What’s the evidence for this thought right now, in this specific situation?”

Are you catastrophizing or fortune-telling?

illustration of an older adult man lying wide-awake in bed at 3 a.m. His partner is asleep next to him

CBT can help you tackle your life worries by getting to the root of an issue and working through it.

Amber Day

Almost every anxious thought fits into one of two buckets: fortune-telling and catastrophizing. With fortune-telling, you’re making a scary prediction about the future as if it were a fact — telling yourself, for instance, that you’ll get bad news from an upcoming medical test before the results are even in. With catastrophizing, you’re inflating the stakes and assuming the worst-case outcome — a headache becomes a brain tumor, a tense conversation with your adult child means the relationship is permanently broken.

Start by labeling which bucket a thought belongs to — out loud if it helps. Then ask, “What’s the real evidence for this prediction?” and “What’s a more likely outcome I’d bet money on?” If it’s catastrophizing, follow up with, “If the worst happened, what would I do first?” Getting quick at spotting fortune-telling and catastrophizing gives you a simple, repeatable way to deflate anxiety before it runs the show.

The most powerful question is ‘So what?’

When you’re waiting for test results or bracing for something scary, the best question isn’t “Will this be OK?” It’s “So what if it isn’t?” It sounds almost rude, but it’s actually the fastest route out of catastrophizing. Walk the fear all the way to its ending.

Say you’re terrified of getting a vaccine and passing out. Instead of pushing the thought away, follow it: “I get the vaccine and pass out. I wake up a few minutes later. The staff hands me apple juice and sits me back up. Then nothing.” Keep asking “and then what?” until the ending is genuinely boring. The scene loses its power not because you resolved it but because your brain finally saw the whole movie, and the monster wasn’t that scary.

Some other questions that help: “Am I 100 percent sure this bad outcome will happen?” “What’s the actual evidence?” “Have I survived something like this before?” Each question is a small crowbar prying the thought loose from certainty.

CBT teaches you to be a realist, not an optimist

CBT is not about replacing negative thoughts with positive ones. It’s about replacing thoughts that contain thinking traps — the fortune-telling and catastrophizing we covered earlier — with more flexible, accurate alternatives. We’re not asking you to become an optimist. We’re teaching you to become a realist.

That difference matters. When you think, “I made a mistake in that presentation; I’m a complete failure,” CBT doesn’t counter with, “I’m amazing! That presentation was perfect!” That’s toxic positivity, and your brain knows it’s a lie. Instead, CBT asks you to examine the evidence. “I made a mistake. That was uncomfortable, but one mistake doesn’t define my overall competence. Most people probably didn’t notice. I can learn from this.” Your brain can accept that. It can’t accept a cheerful fiction.

Staying stuck in grief can trigger clinical depression

Grieving is a normal, natural response to loss, but if we stay in grief we’re not responding adaptively, and it can trigger depression. Mourning is taking the grief and starting to process the inevitable negative emotions attached to the loss. Then you’re able to take a step back, gather your resources, champion the memories and move forward. The sadness dissipates when you do that.

There’s no such thing as ‘productive worry’

What people often call “productive worry” is not worry at all; it’s planning. Planning has an end point and a next step: “If I do X, Y and Z, the problem moves forward.” Worry never lands the plane. If you find yourself circling the same fears without getting anywhere, that’s your signal to shift gears. Write down one concrete step you can take today, decide when you’ll do it, and set a time limit. The act of converting worry into a task breaks the loop.

Worry and rumination are twins with different time zones

Worry circles the future; rumination circles the past. The worrier thinks, “This cold snap is going to knock out our power.” The ruminator thinks, “We lost power in last year’s cold snap — I should have been more prepared.” Both are repetitive, fear-driven loops that leave you more stuck than when you started. If you’re unsure which one you’re doing, ask yourself: “Do I have a concrete next action and a finish line I’ll recognize?” If not, you’re stuck in a loop, not solving a problem. The fix is the same either way — convert it to a plan, or if the issue genuinely can’t be resolved right now, set it aside for your daily worry window and return to the rest of your life.

Imagining the worst-case scenario can actually make it less scary

Worry is a form of avoidance, not of action but of the fear itself. When something scares us, we tend to think about it just enough to spike our anxiety and then quickly change the subject, reach for our phone or ask someone to reassure us that it’ll be fine. That momentary escape feels like relief, but it teaches your brain that the fear is too dangerous to look at directly. So the anxiety keeps coming back.

The fix is counterintuitive: You have to actually go there. Worry exposure means deliberately sitting with the worst-case scenario and making it as vivid and detailed as possible — not fleeting flashes of dread but a full, slow walkthrough. Say you’re terrified of a health scare. Instead of pushing the thought away, you lean in: What would the doctor’s face look like? What would you do first? Who would you call? What would the next week look like?

It sounds like torture. But when you stop escaping the thought and just stay with it, something unexpected happens: Your brain gets bored. The fear loses its charge. Anxiety is like a fire alarm that won’t stop going off; worry exposure is how you walk over, open the door and show your brain there’s no smoke.

Your brain confuses discomfort with danger

Avoidance feels like a fix because it brings instant relief, but it quietly trains your brain to overreact the next time. As I tell patients, your brain keeps receipts. When you dodge a trigger, your nervous system learns, “That must have been dangerous,” so the next encounter comes with louder alarms and more sprint-for-the-exits urges.

That’s the core mix-up: Discomfort isn’t danger. A racing heart, shaky hands, a rush of heat — these are signs of arousal, not proof of catastrophe. One of the most powerful skills in CBT is learning to sit with that discomfort on purpose, in small, planned steps, until the body calms itself and the fear shrinks. The more you practice staying, the faster your brain learns, “This feels rough, but I’m safe,” and the cycle starts to unwind.

You don’t need to tackle your fears in order

Traditionally, we create a hierarchy with the most distressing situation at the top and start with something moderately distressing. But studies have suggested that varying exposure intensity — skipping around the hierarchy rather than moving through it step-by-step — may be just as effective as traditional gradual exposure, with some evidence that it helps prevent the return of fear at follow-up.

If someone’s afraid to drive on the interstate, you stick to interstate driving but vary everything else: time of day, which interstate, with or without someone in the car. The key is introducing unpredictability into the exposure. When you work through a hierarchy in perfect order, your brain learns, “I can handle this specific situation in this specific order.” But real life doesn’t present fears in neat, graduated steps.

Variable exposure teaches your brain something more powerful: “I can handle uncertainty.” You might tackle a moderately difficult exposure one session, then jump to something harder the next, then drop back down. This unpredictability actually mirrors how feared situations show up in the real world, making the learning more durable.

You don’t need years of therapy — you might just need more sessions per week

For exposure-based CBT, momentum beats mileage. Instead of stretching treatment over many months, stack your sessions closer together so skills compound. Twice-weekly exposure builds confidence faster, reduces drop-off and keeps the learning window open between visits. That’s especially helpful for conditions like OCD and PTSD, where people often see meaningful gains in roughly eight to 16 weeks when they show up consistently and do the homework. Think of it like physical therapy for your fear system: shorter intervals, more reps, better muscle memory. The frequency matters more than the grand total. When you practice exposures regularly, your brain updates quickly, and relief arrives sooner than most people expect.

Decades of anxiety doesn’t mean years of treatment

illustration showing a smiling older adult woman driving an RV through a sunny landscape

Decades of anxiety don't necessarily require years of treatment. One of Dr. Chapman's patients had agoraphobia (a fear of leaving home), but after nine sessions she was able to buy an RV for traveling and move west to be with her son.

Amber Day

I had a 75-year-old woman with agoraphobia, a fear of leaving home, that she’d lived with longer than I’d been alive. [After] nine sessions she was not only leaving her neighborhood, but she was able to buy an RV for traveling and [moving] west to see her son.

Most people assume decades of anxiety mean years of treatment. The research shows the opposite. How long you’ve suffered doesn’t predict how long recovery takes. What predicts recovery is simpler and more in your control: your willingness to do the work. Motivation and adherence to the treatment plan matter infinitely more than whether your anxiety started last month or 40 years ago. The 75-year-old recovered faster than many 25-year-olds I’ve treated, not because her anxiety was less severe but because she showed up, did every exposure assignment and didn’t let discomfort stop her.

That’s the secret nobody tells you: Anxiety doesn’t care how long it’s been around. It only cares whether you’re willing to stop accommodating it.

Depression treatment is about feeling better, not feeling less sad

The key feature of depression is anhedonia, a fancy term for lack of pleasure. Most people do not say they want to feel less depressed; they say they want to feel better. That is why we aim to grow positive emotionality rather than only shrink negative feelings. We build a short list of realistic “feel-better reps,” including pleasure activities and mastery of activities that restore a sense of accomplishment, such as cooking a simple meal, tidying one drawer or walking to the mailbox. You practice one or two every day, even when you do not feel like it, so your brain relearns to expect good moments and starts noticing them again.

Avoidance feels good now, but always makes you feel worse later

When someone says “I don’t feel like doing anything today,” I ask what happened last time they followed that feeling. Most people remember a familiar loop: They stayed home, ignored calls, skipped invitations and ended the day heavier with shame. That’s avoidance working exactly as designed. It gives you brief relief, then charges interest later. Your emotions have short- and long-term consequences, and avoidance always tips the balance toward feeling worse tomorrow. The fix is small action, not a pep talk. Pick one 10-minute task that nudges life forward — walk to the mailbox, return a single text, start a sink of dishes — and do it before you judge your mood. When you interrupt avoidance with action, your brain learns that doing something tiny now beats feeling stuck all day.

Two questions tell you when you need professional help

Feeling sad after a setback or loss is part of being human. Depression is different, and two simple questions help you tell the difference. First, is the experience causing significant personal distress — do you feel troubled by how intense or unshakable the symptoms are? Second, is it impairing at least one area of your life — are work, relationships, friendships or daily obligations slipping because you can’t keep up? If the honest answer to either is yes, it is time to talk with a professional. That does not lock you into years of treatment. It simply opens the door to skill-based help, a clear plan and relief that arrives faster than most people expect.