Cognitive behavioral therapy (CBT) is a form of psychotherapy that focuses on identifying and restructuring negative patterns of thought and behavior
If you suffer from an anxiety disorder or depression, even the simplest activity, like going to school, work, or the grocery store, may at times feel overwhelming. But you don’t have to resign yourself to dealing with this distress every day. With the help of an approach called Cognitive Behavioral Therapy (CBT), you can gain better control of your situation.
Many people who are coping with a variety of mental health diagnoses find using CBT helps them manage their fears, improving their quality of life and functioning. Unlike psychoanalysis, a common form of therapy that analyzes people’s behaviors and patterns to gain deeper understanding of motivations and reactions, CBT takes a more proactive approach to actually change disordered or negative ways of thinking.
What Is Cognitive Behavioral Therapy?
CBT is a structured, action-oriented type of psychological treatment that was created in the 1960s by Dr. Aaron Beck, founder of the Beck Institute for Cognitive Behavior Therapy. In recent years, a growing number of clinicians are adopting this technique to teach people to “reset” their thoughts and reactions.
Nina F. Rifkind, LCSW, ACS, an Anxiety, Phobia, and OCD Specialist and Owner of Wellspring Counseling in New Jersey, specializes in using structured CBT. She knows from her own experiences working with patients just how powerful CBT can be. “CBT is an approach that focuses on identifying and restructuring negative patterns of thought and behavior that can cause distress and perpetuate anxiety and depression,” Rifkind says.
Who Should Use Cognitive Behavior Therapy?
The American Psychological Association’s website says that CBT can be effective in addressing a range of disorders, including depression, anxiety disorders, alcohol or drug abuse, relationship issues, and other serious forms of mental illness. Rifkind also points out that CBT is appropriate to use with varying populations including children and adolescents, using age-appropriate language and explanations. Often CBT is used in conjunction with other behavioral health approaches; the treatment protocol is personalized for an individual’s specific diagnosis and needs.
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Looking at the Specifics of CBT
“Let’s say an adolescent is having panic attacks in school. We need do our best to help the child identify the thoughts that trigger his or her physical symptoms of panic,” Rifkind says. When a person is in the midst of a panic attack, adrenalin is rushing through the body, making it difficult to think clearly and logically. “Perhaps a child is afraid of being trapped in the classroom and feels dizzy and sweaty, and notices the heart and head are pounding,” she says.
Once the child is not in that anxiety-provoking situation, then he can use CBT as a framework to challenge his fear of being trapped and to show that it isn’t rational. “Once the person is outside of the situation, we need to challenge the catastrophic thinking by asking, ‘Have you ever been trapped in the classroom before, and if so, did anything bad ever happen?’” The key in CBT is to counter catastrophic thinking with evidence of past experiences, and realistic probabilities, Rifkind stresses. She also points out that the behavioral part of CBT is to address the avoidant behavior. “We gradually reintroduce things [the person is afraid of] and pair them with new [more accurate] thoughts,” she says.
Setting Concrete Goals
Rifkind says she has patients who are afraid to leave the house, afraid to take the subway, afraid to have sleepovers, go to the movies, and a host of activities they may avoid because of anxiety. All of these, and so many other anxiety-based issues can and do respond to CBT.
For patients with anxiety disorders, Rifkind says she typically begins the therapeutic process by defining the individual’s goal, which may be to drive long distances on the highway or attend a large social event. Then she constructs a hierarchy of steps to achieve that goal, beginning with the first step that the person is willing to try toward reaching the desired results. These steps make up “homework” that the patient completes in between sessions, repeating each step in the hierarchy until she feels comfortable moving to the next. “I also give people a scale to rate their level of distress as they begin exposure to their feared situation,” she says. For example, if a patient is afraid to drive on the highway, Rifkind might ask her to drive for one exit and rate her level of discomfort. If the rating is an eight, the patient may repeat this one-exit drive twice a day until the distress level drops to a two, at which point she will increase her distance on the highway to two exits, and do the same when the distress level drops again.
“We build on these steps over time, as the patient gradually becomes desensitized to the fear, until she’s able to accomplish her goals,” Rifkind explains. Often, the issue that brings someone to treatment may not represent the entire spectrum of her anxiety. It may be a starting point, though, and once the patient tackles this, then CBT may be adapted to address other issues over time. Regardless of the specific issue being treated, the tools built with CBT may be applied to a wide range of circumstances, helping patients use these skills to cope in many situations. “Once people begin to see that the treatment works, it builds their confidence and motivates them to push themselves further toward their goals,” she says.
What to Expect in Results
Using a structured treatment like CBT to address anxiety and depression can help the symptoms subside or even go into remission, Rifkind stresses. CBT also teaches people skills that will last them far beyond the end of treatment. “As mental health issues can wax and wane over a lifetime, people will use the skills they learn with CBT to cope when the stresses of life that can cause a flare in symptoms,” she adds. The duration of therapy depends on the individual, but many patients go once weekly and find relief within weeks. Many also feel their issues are under control in six months or less.
How to Find a Qualified CBT Provider
If you, or a family member, are in need of CBT, you’ll want to find a qualified therapist in your area. Rifkind recommends finding a provider who specializes in CBT and is experienced in treating the specifics issues you face.
She encourages people to utilize provider directories on the websites of well-respected national behavioral health organizations. A few she suggests include the Anxiety and Depression Association of America, the International OCD Association, and the Association for Behavioral and Cognitive Therapies. “When people are looking for a therapist for the first time, I usually suggest they make appointments with more than person to make sure that they find a therapist who is a good fit for them. Feeling comfortable and connected with your therapist is critical to the process,” Rifkind adds.
Lisa D. Ellis
Beck Institute for Cognitive Behavior Therapy. Accessed March 10, 2018. Available at: https://beckinstitute.org/
Rifkind, Nina F., LCSW, ACS, Wellspring Counseling. Phone interview March 8, 2018. Available at: https://www.psychologytoday.com/us/therapists/nina-f-rifkind-denville-nj/166133
“What Is Cognitive Behavioral Therapy? Clinical Practice Guidelines for the Treatment of Post Traumatic Stress Disorder.” American Psychological Association. Accessed March 10, 2018. Available at: http://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral.aspx
Besma (Bess) Benali, Clinical Social Work/Therapist, MSW, RSW, Counselling Ottawa. I am trained in Cognitive Behavioural Therapy (CBT), Brief Psychodynamic Therapy, ACT, and mindfulness. Clients come to me because they are struggling and feel like they are trapped in a darkness that no matter what they have tried (and many have tried therapy before) they can’t pull themselves out. I help my clients understand themselves in ways no one has ever taught them before allowing them to see positive changes.