Cognitive-Behavioral Therapy

Cognitive behavioral therapy aims to solve problems concerning dysfunctional emotions, behaviors and cognitions through a goal oriented systematic approach.  Because of the interrelationship between thoughts, feelings and behaviors, cognitive behavioral therapeutic interventions involve treating not only thoughts and feelings, but also behavior.  This process includes the learning, exploring and testing out of different ideas and behaviors.  Coping strategies are developed as well as improved skills of awareness, introspection and evaluation.

During cognitive behavioral therapy, problems are tackled head-on in a practical manner.  Cognitive behavioral therapy is instructive; it provides specific techniques, skills and understandings that can be used in order to facilitate recovery and enable patients to develop techniques that are effective throughout the course of their lives.

Problems treated by Cognitive Behavioral Therapy

Cognitive-behavioral therapy (CBT) is very useful in treating anxiety disorders.  The cognitive part helps people change the thinking patterns that support their fears and the behavioral part helps people change the way they react to anxiety-provoking situations.

For example, cognitive-behavioral therapy can help people with panic disorder learn that their panic attacks are not really heart attacks and help people with social phobia learn how to overcome the belief that others are always watching and judging them.  When people are ready to confront their fears, they are shown how to use exposure techniques to desensitize themselves to situations that trigger their anxieties.

People with obsessive-compulsive disorder (OCD) who fear dirt and germs are encouraged to get their hands dirty and wait increasing amounts of time before washing them.  The therapist helps the person cope with the anxiety that waiting produces; after the exercise has been repeated a number of times, the anxiety diminishes.  People with social phobia may be encouraged to spend time in feared social situations without giving in to the temptation to flee and to make small social blunders and observe how people respond to them.  Since the response is usually far less harsh than the person fears, these anxieties are lessened.  People with post-traumatic stress disorder (PTSD) may be supported through recalling their traumatic event in a safe situation, which helps reduce the fear it produces.  CBT therapists also teach deep breathing and other types of exercises to relieve anxiety and encourage relaxation.

Exposure-based behavioral therapy has been used for many years to treat specific phobias. The person gradually encounters the object or situation that is feared, perhaps at first only through pictures or tapes, then later face-to-face.  Often the therapist will accompany the person to a feared situation to provide support and guidance.

CBT is undertaken when people decide they are ready for it and with their permission and cooperation.  To be effective, the therapy must be directed at the person’s specific anxieties and must be tailored to his or her needs. There are no side effects other than the discomfort of temporarily increased anxiety.

CBT or behavioral therapy often lasts about 12 weeks.  It may be conducted individually or with a group of people who have similar problems.  Group therapy is particularly effective for social phobia.  Often “homework” is assigned for participants to complete between sessions.  There is some evidence that the benefits of CBT last longer than those of medication for people with panic disorder, and the same may be true for OCD, PTSD, and social phobia.  If a disorder recurs at a later date, the same therapy can be used to treat it successfully a second time.

Medication can be combined with psychotherapy for specific anxiety disorders, and this is the best treatment approach for many people.

Portions excerpted from: NIMH