Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) has emerged as the leading form of psychotherapy for panic, anxiety, phobias, post-traumatic stress disorder (PTSD), social anxiety, obsessive compulsive disorder (OCD), depression, stress, and many other conditions. It was developed and refined over the past four decades through the pioneering work and research of Aaron T. Beck M.D., in conjunction with extensive research and contributions by many other clinicians around the world. CBT maintains a holistic approach to each unique individual, recognizing the interrelationship between our thinking, behavior, emotions, and physiology as they interact with a given environmental context. CBT is sometimes referred to as Cognitive Therapy because of the strong and important emphasis on identifying, evaluating, and changing maladaptive patterns of thinking and relevant underlying beliefs (i.e. cognition) that are causing or maintaining anxiety, depression, or other problems. In general, cognition is represented in the way we view ourselves (self-image), other people, and the world, in our day-to-day lives. It involves the particular or unique meaning that we give to things we experience. For example, some people may interpret their own shortcomings or mistakes as perfectly normal parts of being human, whereas others might interpret similar shortcomings as meaning “I’m a failure”, or they may believe “People won’t like me if they know about these flaws”.

The term “cognitive”, at a more scientific level, refers to the psychological structures, processes, and resulting thoughts (including interpretation, images, and assumptions) that are relevant in our way of perceiving and reacting to life events. Cognitions include phenomena such as perceptions, thoughts, images, assumptions, expectations, schemas, and other beliefs about ourselves, people and life: Each of these directly affects our emotional reactions, behavior, relationships and virtually all areas of life.

Excessive worry about things that might happen (“What if_____!”), frequent self-criticism, or chronic self-doubt are just a few examples of cognitive patterns that cause or perpetuate anxiety and depression, and which might interfere with activities or progress in life. Such dysfunctional thoughts and beliefs may seem completely true, or may be occurring at a subconscious level, thus we may not be aware that they involve exaggerations, distortions, or unbalanced views about ourselves and the world. Unhelpful, maladaptive thinking can usually be changed in significant and positive ways through CBT, providing relief from emotional distress often within a matter of weeks, or ever within a given therapy session. Further, changing maladaptive thinking patterns and beliefs will lead to lasting improvements in emotional reactions, self-esteem, relationships, and other areas of life. CBT requires conscious work on the part of the client, but your therapist will provide support and guidance in the process.

Panic: “These racing thoughts / weird feelings of detachment / out of control feelings … must mean I’m going crazy!”, or , “I’m not getting air!… I’m going to pass out! … I must get out of here!”, or, “I’m having a heart attack!” (when the heart has been tested and is fine), or “I’ve got to pull the car over or else I’m going to pass out / lose control!”

Social Phobia: “I don’t know what to say to people… They’re going to notice how uncomfortable I am … They’ll see my face turn red … my hands shaking … my voice tremble… and they will think I’m weak/weird, and won’t want anything to do with me! … Won’t be able to respond … Better to just stay home, not go … Tell them I can’t…”

Generalized Anxiety Disorder: “What if he was in an accident!” , “ What if this pain is an early sign of cancer!”, “What if I lose my job!”, “What if we can’t pay the bills!”, “I can’t get everything done on time … I always feel so rushed … Can’t ever relax… “.

Depression: “I never do anything right … I’ve messed up so many things in my life … I feel like a total failure … I’m too depressed to even go for a walk … “, “Whatever I try, I’ll just fail at it … “, “Everything in the world is going downhill … “, “Everyone else seems to have friends … What is wrong with me? … Who would want to be around me …. No one really cares …”, “What’s the use … I’ll never come out of this depression …”.

OCD: “I’m contaminated … have to wash my hands again…can’t take any chances.”, or “If I don’t go back and check, it will be my fault, I’ll be responsible for (e.g. starting a fire, a hit-and-run … !)”, or “Having that (‘awful’) thought must mean I’m a bad person … (or) must mean I’ll lose control and do it!”, “I’ve got to think that through in the right order before I move on … “, ” I just need to do it again until it feels right”.

Anger: “I shouldn’t have to explain it to them a second time …Those people are so stupid!”, “How come everything in the world is so screwed up!”, “I hate getting stuck in these ridiculous lines …”, or “She/He is always doing that to me!”

Relationship issues: “She did that because she’s trying to control me.” “If he really cared, I wouldn’t have to ask him to help with the dishes.” “She never wants to do what I want to do”. “The best way to deal with him/her is to just avoid the whole issue.”

Cognitive therapy (CT) employs a positive, active, educational approach that focuses on how to change and on seeking solutions rather than just simply talking about your past, or “exploring” your feelings and problems. CT is typically provided within an emotionally supportive, empathic relationship, giving opportunity to express feelings and receive caring in addition to working directly on positive changes in your thinking behavior, and your life. The treatment is often short term, because it is more focused on specific goals and treatments techniques, and because it is based in a clear cognitive conceptualization that guides the treatment process. CT emphasizes a collaborative relationship between the therapist and the client wherein they work together to specify goals and to implement the treatment strategies. Each client is assisted in using CT/CBT techniques that will help in resolving current areas of difficulty as well as learning skills that will be useful in preventing relapse and in dealing with future life challenges.