Cognitive Behavior Therapy

What is Cognitive Behavior Therapy?

Sometimes you may occasionally experience thoughts, images or ideas that can become an obsession or preoccupation. These intrusive or toxic thoughts can be quite disturbing and evoke all kinds of negative feelings. When you have this persistent stream of negative thoughts, you can experience anxiety, panic, or a deep depression.

Cognitive Behavior Therapy, or CBT, is a kind of psychological treatment that is based on the concept that negative thoughts can lead to negative feelings that can lead to non-productive or maladaptive behaviors. The first step at addressing your behaviors of avoidance, immobilization or isolation is to change your dysfunctional or obsessional thought patterns.

CBT is based on behavioral outcome research that compares other treatments or no treatment to cognitive behavioral strategies. The experimental data tells us what specific tools or strategies have been found to be most effective in managing the problems for a variety of psychological conditions.

Treatment is then a partnership between you, the client, and me, the therapist. At the first session, you will be asked to come up with a list of goals or objectives for treatment. The sessions are then personalized for your specific problem list of target behaviors or goals for treatment. For example, if I have social anxiety related issues and I have been avoiding social situations, I might want to attend more functions at work or at school, I may want to strive for a lower overall level of anxiety or distress, I might want to increase my assertiveness and my communication skills. A treatment protocol is created with your input and homework can be assigned to reinforce the skills and build the positive behaviors outlined in the sessions. CBT is usually time limited and can be completed in 3 – 6 months. A decrease in the intensity and frequency of the negative or problematic symptoms can be accomplished in as little as 6 – 8 weeks.

What are the Building Blocks of CBT?

Cognitive Therapy - The cognitive portion of CBT is built on an approach founded by Dr. Donald Meichenbaum (Cognitive Behavior Modification), Dr. Albert Ellis (Rational Emotive Behavior Therapy or REBT) and Dr. Aaron Beck (Cognitive Therapy). Dr. Meichenbaum focused on identifying one’s negative internal dialogue in order to change unwanted behaviors. Dr. Meichenbaum viewed behavior as an outcome of our own irrational self-talk.

Dr. Ellis developed REBT in the mid-1950s as an alternative to psychoanalysis, which he felt was time-consuming and ineffective. Dr. Ellis’ REBT suggested that our negative or damaging beliefs strongly affected our emotional functioning. Certain illogical or toxic beliefs can make us feel depressed, anxious or angry and lead to self-defeating behaviors.

Dr. Beck developed cognitive therapy as a way to treat depression in the 1960s. Dr. Beck worked with depressed clients and found that they experienced an automatic chain of negative thoughts that appeared to occur spontaneously. Dr. Beck labelled these cognitions “automatic thoughts” and he found that their content fell into three categories — negative ideas about the self, the world, and the future.

Cognitive theorists can help you recognize that you may be having a series of ongoing irrational or dysfunctional thoughts. The first step at managing your negative thoughts is to write them down as they happened. In this way, you can learn to recognize exactly what you are thinking including the frequency and intensity of those thoughts. How anxious or how depressed do the troubling thoughts make you feel? Once the negative thoughts are identified, we can then start to identify patterns or themes for your negative thinking.

Dr. David Burns popularized the work of Dr. Beck in 1980 with the publication of his book, Feeling Good: The Mood Therapy. He wrote this book specifically for people who were suffering from the effects of anxiety and depression. He simplified the concepts of CBT for a wide audience. Feeling Good was so well received it has sold over 5 million copies to date. Research studies showed that simply by reading the book, 65% of those surveyed reported a reduction of their symptom list. He outlined the relationship of one's negative thoughts to their subsequent negative feelings and behaviors. “If I am thinking negatively, I am feeling negative and therefore behaving in a negative or maladaptive manner. If I can learn to think more positively, I feel more positive and as a consequence I am behaving in a more positive or adaptive manner.” He quotes the Greek Philosopher Epictetus, who said that people are disturbed not by events but rather by our thoughts about those events. Dr. Burns gave his readers concrete and well researched tools and strategies to elevate their mood.

Behavior Therapy – The behavioral component of CBT are the actions or behaviors we can address to resolve conflict or reduce your anxiety or depression. This process begins by identifying the target behaviors or set of goals that you want to change because of the difficulties or conflicts you may be experiencing in life. We then work together and look for a history of the problem. What is happening in my life that continues to work against me or cause me conflict or distress? Once the particular aversive stimuli or antecedents are identified that might be causing the problem, you can learn specific tools to reduce or eliminate those unwanted symptoms in frequency and intensity.

One strategy unique for the treatment of anxiety is called exposure. Exposure therapy gradually exposes you to what is frightening and it helps cope with their fears associated with a particular issue. One might for example, have a fear of flying. The difficulty getting on an airplane or the inability to take a trip because of crippling anxiety would certainly contaminate the travel experience.

Exposure therapy can be used very successfully for a fear of flying and other phobias to reduce the anxiety and worry associated with a particular area of concern. A fear hierarchy or ladder of fears is created and you are gradually exposed to what is causing you anxiety. Stressors are identified and given a value associated from the lowest level to the highest level of fear or distress. A number is given to each step or level of the hierarchy. Anxiety is measured on a level from 0 to 100, with 0 being the lowest and 100 being the highest, and 30 to 40 being the so-called “normal level of anxiety”. You will not be asked to move to a higher level of anxiety until you are able to achieve a level of calm at the lower level of anxiety.

For example, if you have a fear of flying it might be suggested that you first drive past an airport, allowing yourself to experience the anxiety associated with this behavior, then by practicing your breathing and relaxation exercises, you can reduce your anxiety to a so-called “normal level” of 30-40. You may then move to the next step of the fear hierarchy or expose yourself to a higher level of anxiety and perhaps stand inside the airport or even take a short flight. You can successfully train yourself to fly without any anxiety or with a reduced level of anxiety and fly successfully with the completion of a fear hierarchy. The lessening of the anxiety is achieved through practice with diaphragmatic or deep breathing, deep muscle relaxation, and visualization or guided imagery.

Prolonged exposure (PE) is designed to treat post-traumatic stress disorder or PTSD. PE teaches you to gradually approach trauma-related memories, feelings, and situations that have previously been avoided following a traumatic event. PE allows you to help yourself face your fears and associated anxiety. PE must be done very carefully so as not to re-traumatize yourself. It is imperative to engage in treatment with a licensed psychologist who has the knowledge and specialized training to work with those of you who have experienced traumatic life events.

Post-Traumatic Stress Disorder (PTSD) is a mental health condition that is triggered by experiencing a terrifying event or watching it happen firsthand. The symptoms of PTSD may include flashbacks, nightmares and severe disabling anxiety including having uncontrollable thoughts about the event. Exposure therapy and desensitization will be suggested if you meet the diagnosis of PTSD.

Exposure therapy helps you face the distress and anguish associated with the trauma. Exposure therapy for PTSD must be done very carefully, it is important that you as the client is not re-traumatized. For some, memories of a trauma can be confronted all at once and I can employ a strategy called flooding. Desensitization is another technique utilized when working with a survivor of trauma. Desensitization starts with a less upsetting life stressor and works up to the most severe trauma. Relaxation exercises are utilized to address one piece of the trauma at a time. When we have an established relationship and you have learned to trust the relationship, we can begin talking about the details of your traumatic life events and confront the previously fear inducing conditions slowly and carefully, and can decrease the PTSD related symptoms and thus regain control of your life.

I can help you determine what treatment strategies will work for you and your particular issues. You are never forced to take part in an intervention that you feel tentative or are fearful about. I will work with you and discuss the different kinds of techniques that might be utilized and tell you exactly what treatment will involve. You will therefore continue to feel in control of your circumstances.

Mindfulness and Meditation - As a CBT therapist, I am fortunate to have the benefit of wellness and spiritual techniques such as mindfulness and meditation as tools in my repertoire. Mindfulness and meditation can give you the emotional distance and perspective you may need in order to learn to rationally respond to your negative or toxic thoughts. Mindfulness is a strategy that you can use to raise your consciousness to what is being experienced in the present with both your body and mind. Mindfulness without judgment and with acceptance can decrease your anxiety or stress. This strategy can allow you to take control of your responses to potentially stressful life events. You learn to manage stressors in a more objective manner. The physiological or bodily response to your anxiety is diminished as well.

How Does Cognitive Behavior Therapy Work?

Cognitive Behavior Therapy or CBT helps you learn to change their dysfunctional thought patterns by replacing negative or maladaptive thoughts with more positive or adaptive ones. We work together to learn how to think more positively and consequently behave in a more positive manner. CBT is a great therapeutic technique for busy people who may have a limited amount of discretionary time. CBT is goal directed and time limited. Significant results are often seen in as few as 6 – 8 sessions. You start feeling better quickly!

Cognitive Behavior Therapy is a collaborative process between the two of us. I will ask about your specific goals for treatment or target behaviors at the initial meeting. This outlines what thoughts and behaviors might be problematic for you and therefore need to be addressed. The therapy sessions can provide concrete tools for you to modify any disabling or stressful behaviors. Suggestions are given to practice strategies at home to reinforce the skills you are learning in our sessions. Examples of this kind of “homework” include asking you to first write down your negative thoughts. You are then asked to rationally respond or detoxify your negative thoughts. It can also be suggested that you practice the relaxation and diaphragmatic breathing techniques at home that are done in our sessions. You are also taught to practice these new techniques in actual anxiety provoking situations as they happen in real life, in order to further reinforce these skills.

What Problem Areas Can Benefit from CBT?

  • Anxiety disorders including Panic Disorder, OCD, Phobias, PTSD and Social Anxiety Disorder

  • Psychological factors that may be contributing to medical issues

  • Depression

  • Relationship Issues

  • Body Dysmorphic Disorder

  • Eating Disorders

  • Pregnancy Loss and Infertility

  • Grief and Bereavement

  • ADHD

  • Insomnia and other sleep difficulties

  • Chronic Pain

  • Smoking Cessation

  • Substance Abuse