How Cognitive Behavior Therapy (CBT) Helped Me Cope with Anxiety while Hiking the Inca Trail

2/13/2025

Below a blue sky, white clouds, and a mountain range lie the ruins of Machu Picchu. A man and a woman pose with their backs to each other and their arms stretched wide. Using Acceptance and Commitment Therapy helped them get to this moment.

One of my bucket list items for a long time was to hike the Inca Trail - the famous 4-day hiking trail in the Andes mountains of Peru. My parents were born and raised in Peru, and I’ve traveled frequently to Lima to visit extended family, and visited Cuzco as a kid, and then again in college. But I had not ventured to do the Inca Trail before because I could not wrap my head around no access to real bathrooms or showers for 4 days! Once I realized I could cope with that – I knew this was an adventure I wanted to experience.

This past summer, I was lucky enough to go on this awe-inspiring hike – surrounded by the beauty of the Andes for four days, and ending the trail in Machu Picchu. I knew the hike would be physically challenging, but what caught me by surprise, was how this experience also challenged me mentally and emotionally. I actively used coping tools that I discuss with my patients in session, and was grateful that they helped me enjoy this incredible and awe-inspiring hike.

A group of people from a hiking tour pose for a picture. Most of them wear green zip-up hoodies, green baseball caps, and hiking shoes. One wears a chef's uniform, one wears a knitted hat, and two more are wearing their own gear. Behind them is a mountain. Using mindfulness in this moment can help combat anxiety.

While on the hike, we'd sometimes pass other hikers, and other times they would pass us. Our tour guide from Wayki Trek encouraged us constantly to focus on our steps – to not worry about how much time was left until our next stop or whether we were leading our small group of hikers, or toward the back of our group. It sounded like great advice – but while on the hike – it was easier said than done!

Especially on parts of the hike that were very steep, and I had to take breaks every 4 to 5 steps – I found myself getting stuck in worry and negative thinking:

💭 Am I walking fast enough?
💭 What if I get too tired and can’t make it to the end of the hike?
💭 I’m already tired today, how am I possibly going to hike again tomorrow?
💭 My heart is beating so fast - is this normal?

When I caught myself in these worry loops, I tried to take a beat, and use tools from Cognitive Behavior Therapy (CBT) and Acceptance and Commitment Therapy (ACT), to cope with these thoughts.

CBT and ACT Strategies To Better Manage Worry and Anxiety

Two people in coats, backpacks, and knitted hats smile at the camera. Behind them is a red sign reading

1. Labeling the thoughts as worry and as separate from me.
These worry cycles can feel so compelling and real! The first step in trying to cope with the worry is simply labeling the thoughts as thoughts: “I notice I’m having the thought that… I’ll be too tired to continue tomorrow."

2. Challenge worries with facts and objectivity.
This can be really hard in the moment, but it’s worth a try. When using this key CBT strategy to cope with anxiety, I tried to think like a scientist and look for evidence that could help me figure out whether my worry was likely or not. A few facts I brought to mind were:

✅  I trained for this hike, and am likely physically fit enough to endure this challenge.
✅  I’ve experienced fatigue before and have been able to recover and continue.

A person in a coat, a knitted hat, and large sunglasses smiles at the camera. Behind her are beautiful mountains below a blue sky. She's been using Acceptance and Commitment Therapy tools to be able to climb this mountain.

3. Tolerate Uncertainty
No matter how much evidence you have – there will always be some level of uncertainty. In CBT, we learn to practice tolerating uncertainty – while also noticing the universality of uncertainty.

➡️  The facts show that it is likely that I will be able to complete this hike – but I can’t know that for certain. There is a chance that I might get too tired, or injured, to continue on.
➡️  Every hiker who goes on this trail – on any trail really – has to also face that uncertainty.
➡️  Part of going on hikes means tolerating some uncertainty about the possibility that you may not be able to complete it.

4. Choosing values-aligned actions.
Values are the things that are most important to us. Identifying your own values is something we work on extensively in ACT – and importantly – we get very specific about values-aligned actions.

I value exploring and spending time in nature, and so the values-aligned action in this moment was clear: To explore and savor the beauty of this amazing hike. I chose to take a beat to catch my breath, and then take the next step, and enjoy the next view.

Key Anxiety Coping Strategy: Focus on the Present Moment

Dr. Eli Penela sits on a rock next to a llama. They're on a mountain with foliage and ta fog of clouds is behind them. She is practicing mindfulness and taking in the view.

Focusing on the present moment is something that I always keep in my back pocket when worry thoughts come to visit. Anxiety and worry make our brains focus on the future – on the things that can go wrong, on the things you may not be able to cope with.

But how can you train your mind to focus on the present moment? Keeping these three tips in mind helped me stay on track:

1. Be Patient and Kind with Yourself
When I noticed that my mind began to wander again to the worries (e.g., Why is my heart beating so fast? How far away is the next stop?) – my knee-jerk reaction was often to be self-critical: You are trying to stay in the present moment – but there you go again with the worries! Instead of jumping to self-criticism though – I worked to maintain a gentle and compassionate tone with myself: “Gosh, this staying present focused stuff is really hard work. Let me try again to label that worry, and then come back to the present moment. I’m feeling really anxious right now, so of course this is tough!”

2. Use Visualizations to Come Back to the Present
Visualizations can also be a powerful tool when trying to stay focused on the present moment. When a worry thought popped up that took me away from the present moment – I would pick one key word from the worry – maybe “tired” for example – and then "place it" outside of my mind and body:

I visualized the written word (or an image related to that word) – and then place it on a cloud. I would then imagine the cloud floating past me.

I might also visualize the word and put it on one of the trees I was passing on my walk, and then keep walking past the tree/past the thought. Kindness is key, so even if I had to keep using the visualization again and again as different worry thoughts came to visit, I would remind myself that this I hard work, and kindly redirect my attention back to the present moment.

Two people wearing orange shirts hike up a trail of rocks surrounded by foliage on the left and a cliff face on the right. One of them turns towards the camera and smiles. She is able to use coping strategies for anxiety to continue on her path.

3. Focus on your senses.
When anxiety rears its ugly head, tune into each of your senses and zoom in on the details as you ask yourself. Here’s what that sounded like:

👀 What can I see? I can see the blue sky, the snow-capped mountains, and my own brown hiking boots.
👂 What can I hear? I can hear the sound of my own footsteps on this dirt path, and the sound of a stream in the distance.
👐 What can I feel? I can feel the cool wind on my face, and my feet snug in my boots.
👃🏼 What can I smell? I can smell dew in the air and a nutty smell from my granola bar
👅 What can I taste? I can taste refreshing water in my mouth, as I take sips from my water bottle.

At the end of the 4 days of hiking, I was exhausted – and so grateful. Yes, worry thoughts showed up often on this hike, and I relied on CBT and ACT strategies to handle these thoughts, and not allow them to keep me from enjoying this incredible experience.

Choosing to Focus on How to Respond To Anxiety

Below white fluffy clouds are mountains and the ruins of Machu Picchu. People are walking along the ruins while llamas rest in the grass. One of them is practicing Acceptance and commitment therapy.

Would I have preferred that these worry thoughts NOT be there at all during my hike? Of course! But unfortunately, we don’t really get to choose whether anxiety shows up or not.

Instead, what we DO get to choose is how we will respond to the worry thoughts that show up.

So this is where I focus my energy – on using these evidence-based tools to respond to the worry so that I can continue to live a values-aligned, meaningful life. If we focus on trying to make sure that anxiety or worry do not show up, we inadvertently give the anxiety power! We send the message to our body and brain that anxiety is dangerous, and that if it shows up, we cannot handle it!

However, if we instead focus on our energy on the response to anxiety, we feel empowered and resilient. We develop the belief through regular practice, that even when anxiety shows up – we know exactly what to do, and we can continue on with doing what we choose to do in our everyday, beautiful lives.

I hope you can use these same CBT and ACT coping tools to handle worry and anxiety next time it comes to visit.

Sometimes anxiety, worry, and/or OCD gets in the way of everyday life, and you might decide to work with a therapist to help you get back on track. If you’re feeling that way, I’d be honored to help guide you on your journey. I am a bilingual psychologist (English/Spanish) providing in-person therapy services in South Florida and therapy via tele-health to children and adults across 42 states. If you’re ready to take that step toward getting help for yourself, let’s talk soon.

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