What is CBT?

What is Cognitive-Behavioral Therapy?

Cognitive-Behavioral Therapy (CBT) applies established learning principles to modify troublesome patterns of thinking and behavior. A cognitive behavioral therapist assists you in understanding the causes of emotional discomfort (anxiety, depression, anger, etc.), ineffective action, and relationship problems, and in changing self-defeating thought and behavioral habits. Some cognitive-behavioral methods can be usefully applied as self-change strategies. You can use methods of self-relaxation, changing negative thoughts, increasing motivation with positive imagery, setting effective goals, and utilize problem solving instead of worrying on a daily basis with regular practice. However, if the troublesome thoughts, emotions, and behavior are intense and persistent, a therapist can greatly assist progress.

Cognitive-behavioral treatment uses Behavioral Techniques to help change unpleasant emotions such as depression, anxiety, and frustration by learning relaxation methods, using problem solving techniques, and developing graded action plans to overcome avoidance. Self-calming techniques promote relaxation, focused attention, and preparation for effective coping with stressful events. With calmer reactions and more effective planning, better results are possible with life’s challenges with a greater degree of comfort.

Cognitive Methods (procedures to make one aware of and able to modify habits of perceiving, thinking, remembering, and interpreting) are emphasized in this type of therapy because research shows that thoughts cause our emotions, to a great degree. Psychological upset is connected to negative habits of thought (thinking that is distorted, pessimistic, global, and excessively negative or defeatist), and these self-defeating habits are of particular interest as targets of change.

Michael stood by himself at the party feeling self-conscious and focusing on his pounding heart as he experienced a rapid train of thoughts: “I don’t have anything to say; They’ll think I’m dumb!; Oh, why did I come?”

Thoughts can be very rapid events–virtually reflexive, known as automatic thoughts, –and consequently a challenge to identify and change.

As Jim approached the group to give his speech he felt anxious,tense, with a dry mouth as he noted the flashing thought “Can’t do this!.”

Emotional and behavioral problems can result from faulty habits of thinking involving distortions about ourselves or circumstances.

When making a mistake at work, Melissa immediately catastrophized: “I’m stupid, I’ll never be good at this, I’ll lose my job!” Deep pessimism and depression immediately started interfering with her ability to problem solve and persisted to the next day.

Negative thoughts become stronger and more persistent if not changed, and lead to emotional upset, self-defeating behavior, and problems with others. They can reach a point of almost constant occurrence causing persistent anxiety, depression or anger and paralyzing effective action.

Cognitive-Behavioral Therapy is a skills based approach aimed at replacing negative thinking habits with more accurate, constructive, and optimistic ones that lead to:

  • Effective action
  • Rational thought
  • Persistence in the face of frustration
  • Sound problem solving
  • Interpersonal skill
  • Well-being
  • Purpose in life

Effective thinking skills and productive action are gradually strengthened with daily practice–just as an aspiring skater practices daily and progresses from awkward and shaky to skilled and graceful.

After using imagery desensitization and behavioral rehearsal methods for several weeks, Michael reminded himself of his new skills (“I can handle this”), instructed himself to initiate conversation, and though still having some mild anxiety, did enjoy his increased involvement and response from others at the company party.

Your CBT therapist actively assists you in identifying troublesome thinking and self-defeating behavior, and in learning the methods and skills to change them.

After understanding the importance of looking forward to frustrations as just normal challenges and learning to view problems in a systematic way, Melissa interpreted work frustrations: “Now wait a minute, this is just a problem, I’ve seen this before, and I can break it down into manageable steps. I can do this! Let’s see the first step is…….”

Characteristics of Cognitive-Behavioral Therapy are:

Research Based: Experimental studies have shown CBT to be effective for many problems and goals of importance for children, adolescents, and adults, and couples. These include:

  • Social Anxiety and Shyness
  • General Anxiety and Panic
  • Depression
  • Worry
  • Phobias and Obsessions and Compulsions
  • Increasing Effectiveness, Fulfillment, and Well-Being
  • Insomnia
  • Improving Relationships
  • Adjustment to Job and School Problems
  • Strengthening Esteem and Optimism
  • Child Behavior Problems
  • Anger, Guilt, Shame
  • Substance Abuse
  • Rational Thinking
  • Effective Communication

Systematic and Practical: CBT is a competence based approach aimed at objective evaluation of problem and skill deficit areas, in order to develop a step by step approach to problem solution and skill development. Relevant skills are those of thinking (such as, reducing anxiety causing worry, replacing catastrophizing tendencies, modifying deeply held views of ineffectiveness or unworthiness), and behaving (such as, carrying out action plans, reducing avoidance of important activities and goals, learning better communication skills). It takes a gradual, systematic, and practice based approach to problems.

Active: A cooperative approach involving mutual examination of issues in sessions, and systematic homework practice outside of sessions characterizes CBT. The therapist also serves the roles of consultant, teacher, and coach to bring into play knowledge about the areas of concern. Practice (called behavioral experiments) helps you test new, more constructive outlooks and action strategies.

Collaborative: This mutual approach to understand, solve, and develop constructive strategies and habits is known as collaboration.

Present & Future Oriented: While history is taken, it is used in the service of developing solutions to current day challenges for which new thinking and action strategies are needed.

Brief Duration: CBT is a short-term treatment whenever this is possible. This means that substantial progress should be seen relatively quickly. If personality issues are extensive, of course, therapy will be longer, but always aimed at being as efficient as possible.

Cognitive-Behavioral Therapy is Helpful for:

  • Social Anxiety and Shyness
  • General Anxiety and Panic
  • Depression
  • Worry
  • Phobias and Obsessions and Compulsions
  • Increasing Effectiveness, Fulfillment, and Well-Being
  • Insomnia
  • Improving Relationships
  • Adjustment to Job and School Problems
  • Strengthening Esteem and Optimism
  • Child Behavior Problems
  • Anger, Guilt, Shame
  • Substance Abuse
  • Rational Thinking
  • Effective Communication

Depression:

Cognitive-behavior therapy as a treatment for depression
Jacqueline B. Persons, Ph.D.

Cognitive-behavior therapy has been found in controlled studies to be an effective form of treatment for depression–in fact, it appears to be as effective as antidepressant medications. Cognitive-behavior therapy for depression focuses on the clinical observation that depressed mood often seems to result from negative patterns of thinking and behaving. For example, depressed people often have thoughts like, “I’m a failure,” “I can’t do anything right,” “I’ll never accomplish my goals,” “No one cares about me,” “I’ll be alone forever,” or similar. These thoughts can feel powerful and compelling, but usually do not tell a balanced, reasonable story. In cognitive-behavior therapy, patient and therapist work together to determine what types of negative thinking are problematic for the depressed patient, and what types of coping or balanced thoughts can be used to provide a better perspective, to lift the depressed person’s mood, and help him or her function better. The therapy also often focuses on helping the depressed person increase his or her activity level or find more gratifying, pleasurable activities.

In therapy sessions, the therapist takes an active approach to teaching here-and-now coping strategies to help patients understand and change cognitions and behaviors that contribute to depressed mood. This is an active, problem-solving to therapy. Practicing new skills outside of sessions is a central part of treatment. A key goal of cognitive-behavior therapy is to provide the patient with tools that he or she can use to work on his or her depressive symptoms and to prevent future episodes. Treatment can be done in individual or group or couples format.

(San Francisco Bay Area Center for Cognitive Therapy)

Anxiety:

PANIC DISORDER AND AGORAPHOBIA
Symptoms and Treatment
Joan Davidson, Ph.D.

Panic disorder is characterized by recurrent panic attacks that seem to “come out of the blue.” Panic attacks are discrete periods of intense fear or discomfort that typically involve some of the following symptoms: shortness of breath, heart palpitations, dizziness or unsteadiness, chest pain, trembling or shaking, sweating, feelings of unreality or detachment, tingling sensations, fears of dying, and fears of going crazy or losing control. It is common for people who suffer from panic attacks to assume that they are having a medical emergency and then be told by a physician that they do not have a medical condition.

Often when people experience panic attacks they become fearful of situations that they associate with having panic attacks or situations from which they might have difficulty escaping if they did have a panic attack. Agoraphobia is the avoidance of situations or places from which escape might be difficult or help might be unavailable if a panic attack were to occur. Typical situations that people avoid include driving (especially freeways, bridges, and tunnels), public transportation, crowds, stores, restaurants, theaters, waiting in line, elevators, closed-in spaces, or being far from home.

Panic disorder and agoraphobia are highly treatable conditions. Cognitive-behavior therapy, often in conjunction with pharmacotherapy (medications), has been shown to be highly effective in the treatment of these symptoms. Cognitive-behavior therapy typically includes:

Education about the nature of panic and anxiety. The more you know, the better you’ll be able to utilize cognitive-behavioral strategies to break the cycle of panic and avoidance.

Monitoring of panic attacks and anxiety symptoms. Learning about your own panic reactions, physically, cognitively, and behaviorally, will help you to start taking control of your panic reactions.

Learning coping statements and helpful self-talk to better handle the automatic anxiety-provoking thoughts you have when you feel panic or high anxiety.

Learning abdominal breathing and progressive muscle relaxation exercises to reduce tension and create a calming response in your body whenever you feel panic or high anxiety.

Practicing exposure to the feared physical sensations of panic to learn that the sensations are not dangerous (desensitization.)

Practicing exposure to anxiety provoking or feared situations. This is often done using an “exposure hierarchy” to gradually expose yourself to situations you have been avoiding. The result is learning that you can effectively cope with anxiety and no longer need to avoid.

These cognitive-behavioral treatment methods have been shown to be highly effective in treating panic disorder in a short period of time.

(San Francisco Bay Area Center for Cognitive Therapy)

Obsessive-Compulsive Disorder:

Treatment of Obsessive-Compulsive Disorder
Michael A. Tompkins, Ph.D.

Obsessive-compulsive disorder (OCD) is an anxiety disorder that affects 2-3% of the population, making it the fourth most common psychiatric disorder in the United States.

What are obsessions? Obsessions are ideas, thoughts, impulses, or images that are experienced as intrusive and that cause anxiety or distress. Common obsessions include fears of doing harm to self or others, thoughts that things must be done perfectly, or beliefs that one has a terrible illness. For example, an individual may have the intrusive thought, “My hands are contaminated and I will hurt anyone I touch. I must wash my hands.”

What are compulsions? Compulsions are repetitive behaviors (i.e., hand washing, ordering, checking) or mental acts (i.e., praying, counting, repeating words silently) that are intended to prevent or reduce anxiety or distress. In most cases, the person feels driven to perform the compulsions. Compulsions may give some relief from anxiety, but it is only temporary.

What treatments are effective for OCD? Clinical studies have shown two treatments to be effective for OCD: behavior therapy and pharmacotherapy (medication). Behavior therapy, specifically behavior therapy that includes exposure with response (ritual) prevention, is the most effective treatment currently available. Studies have demonstrated that 60-75% of those who complete behavior therapy improve substantially and most maintain their gains years later. In behavior therapy, individuals expose themselves gradually (exposure) to the feared object, situation, or thought while refraining from carrying out the usual ritual (response prevention). For example, an individual who fears contaminating and thereby harming others would be asked to touch an object believed to be contaminated (exposure) and then not engage in any washing (response prevention). As treatment progresses, individuals gradually experience less anxiety and fewer urges to ritualize.

Medications have proven effective in controlling OCD symptoms. However, many individuals relapse (their symptoms return) when they stop the medication. For this reason, many clinicians recommend behavior therapy, or behavior therapy and medication.

(San Francisco Bay Area Center for Cognitive Therapy)