How does cognitive behavioral therapy work?
Cognitive behavioral therapy (CBT) is one of the best researched psychotherapies, it is based on clear scientific principles, and has been proven to be an effective treatment. CBT can help you make sense of overwhelming problems by breaking them down into smaller parts.
In CBT, problems are broken down into five main areas:
• physical feelings
CBT is based on the concept of these five areas being interconnected and affecting each other. For example, your thoughts about a certain situation can often affect how you feel both physically and emotionally, as well as how you act in response.
Stopping negative thought cycles
There are helpful and unhelpful ways of reacting to a situation, often determined by how you think about them.
For example, if your marriage has ended in divorce, you might think you have failed and that you are not capable of having another meaningful relationship.
This could lead to you feeling hopeless, lonely, depressed and tired, so you stop going out and meeting new people. You become trapped in a negative cycle, sitting at home alone and feeling bad about yourself.
But rather than accepting this way of thinking you could accept that many marriages end, learn from your mistakes and move on, and feel optimistic about the future.
This optimism could result in you becoming more socially active and you may start evening classes and develop a new circle of friends.
This is a simplified example, but it illustrates how certain thoughts, feelings, physical sensations and actions can trap you in a negative cycle and even create new situations that make you feel worse about yourself.
CBT aims to stop negative cycles such as these by breaking down things that make you feel bad, anxious or scared. By making your problems more manageable, CBT can help you change your negative thought patterns and improve the way you feel.
CBT can help you get to a point where you can achieve this on your own and tackle problems without the help of a therapist.
In many cases, talking about a situation is not enough and you may need to learn to face your fears in a methodical and structured way through exposure therapy.
Exposure therapy involves starting with items and situations that cause anxiety, but anxiety that you feel able to tolerate. You need to stay in this situation for anywhere from thirty minutes to an hour, or until the anxiety significantly reduces.
I will ask you to repeat an exposure exercise multiple times. After the first few times, you will find your anxiety does not climb as high and does not last as long.
You will then be ready to move to a more difficult situation. This process should be continued until you have tackled all the items and situations you want to conquer.
Exposure therapy is often done with me, especially in the beginning, but can also be carried out using self-help books or computer programs. You will need to regularly practice the exercises as directed to overcome your problems. Every exposure exercise is developed in collaboration with my clients and is highly individualized.
I am very sensitive to the challenges in doing exposure exercises effectively and I offer a lot of support and coaching. When doing exposure work I am happy to offer additional support through phone calls, texting, and emails.
You will usually meet with me weekly in the beginning of treatment, but as progress is made frequency of visits can be reduced to every two weeks and even monthly. CBT sessions usually last 50 minutes, however, exposure therapy sessions sometimes last longer to ensure your anxiety reduces during the session. The therapy usually takes place in an office, but may also occur outside (if you have specific fears there) or in your own home (particularly if you have agoraphobia or OCD involving a specific fear of items at home).
The first few sessions will be spent making sure CBT is the right therapy for you, and that you are comfortable with the process. I will ask questions about your life and background.
If you are anxious or depressed, I will ask whether it interferes with your family, work and social life. I will also ask about events that may be related to your problems, treatments you have had, and what you would like to achieve through therapy.
If CBT seems appropriate, I will let you know what to expect from a course of treatment. If it is not appropriate, or you do not feel comfortable with it, I can recommend alternative treatments.
After the initial assessment period, you will start working with me to break down problems into their separate parts – the situation, thoughts, emotions, physical feelings and actions. To help with this, I will ask you to write down your thought and behavior patterns.
You and I will analyze your thoughts, feelings and behaviors to work out if they are unrealistic or unhelpful and to determine the effect they have on each other and on you. I will be able to help you work out how to change unhelpful thoughts and behaviors.
After working out what you can change, I will ask you to practice these changes in your daily life. This may involve questioning upsetting thoughts and replacing them with more helpful ones, learning new ways to think and act, and working to overcome your distress. I will ask you to do some assignments between sessions to help with this process.
At each session, we will discuss your progress with putting the changes into practice and what it felt like. I will provide you with supportive feedback and make other suggestions to help you.
Confronting fears and anxieties can be very difficult. I will not ask you to do things you do not want to do and I will only work at a pace you are comfortable with. During your sessions, I will check to make sure you are comfortable with the progress you are making.
One of the biggest benefits of CBT is that after your course has finished, you can continue to apply the principles learned to your daily life. This should make it less likely that your symptoms will return and less likely that you will need treatment again in the future.