Understanding Cognitive Behavioral Therapy – Part 2

Uses for CBT

For many years, CBT was used primarily to treat anxiety disorders and depression. However, over the years it has gained recognition as an effective therapy for a vast array of other psychiatric disorders. It’s also an effective treatment for emotional, interpersonal, and life challenges that many people encounter at some point in their lives (e.g. a divorce or loss), but aren’t considered forms of “mental illness”. Mental health disorders that can benefit from CBT include:

  • Anxiety disorders (including social anxiety disorder, panic disorder, and phobias)
  • Mood disorders (depression, bipolar disorder)
  • Adjustment disorders
  • Posttraumatic stress disorder (PTSD)
  • Obsessive-compulsive disorder (OCD)
  • Substance use disorders
  • Sleep disorders
  • Sexual disorders
  • Eating disorders
  • Personality disorders (particularly borderline personality disorder)
  • Schizophrenia and schizoaffective disorder

Other problems and issues CBT can help include:

  • Relationship problems
  • Chronic pain
  • Anger problems
  • Performance anxiety
  • Bad habits
  • Chronic pain
  • Chronic fatigue
  • Serious or chronic illness
  • Life transitions
  • Loss and grief
  • Low self-esteem
  • Low self-confidence
  • Stress
  • Relapse prevention

There have been many studies done on the effectiveness of CBT for various disorders. For individuals struggling with mild to moderate depression, CBT is often the only form of treatment needed. For those battling severe depression, medication may be necessary as an adjunct to CBT. Cognitive behavioral therapy is one of the most effective treatments for all types of anxiety disorders. With regards to specific phobias, social anxiety disorder, PTSD, and OCD, a CBT method known as exposure therapy (or exposure and response prevention), can be especially beneficial. Exposure therapy allows individuals to confront intensely fearful situations (e.g. fear of flying), things (e.g. spiders, dogs), or traumatic memories in small, graduated steps – under the guidance of a skilled therapist – in order to overcome the anxiety the feared thing once triggered. For example, someone with a fear of dogs may start by looking at photos of dogs, then watching dog videos, then observing dogs through a window or other barrier, and ultimately petting a friendly dog. With each exposure, the goal is to become increasingly “desensitized” to the feared thing, while practicing self-soothing techniques and self-talk in order to manage the anxiety they experience. Ultimately, they will learn 1) that the feared situation or thing isn’t really so scary after all and 2) that they can handle any anxiety it elicits. For individuals with bipolar disorder, schizophrenia, or schizoaffective disorder – all disorders that typically require lifelong treatment with medication – CBT is often used as an adjunct form of treatment rather than the primary form. Proper medication is often necessary to stabilize the patient before any kind of therapy can begin. Once stable, CBT is often used to help them better understand their disorders, how to manage them, how to cope with symptoms when they develop, and how to keep stress to a minimum to decrease the risk of a relapse.

What to Expect

Cognitive behavioral therapy is usually provided in the clinician’s office. Typically, sessions occur once a week and last from 50 to 55 minutes. As a general rule, the course of therapy will last somewhere between 10 and 25 sessions. In psychodynamic and psychoanalytically based therapies, the client does most of the talking while the therapist sits quietly, asking an occasional question or making a comment here and there. The therapist is the “blank slate”, and the therapeutic relationship is very one-sided (which is essential for that type of therapy). Some individuals prefer this style, while others find it frustrating and uncomfortable because it seems the therapist often “just sits there”. In CBT, however, the therapeutic relationship is a much more direct, two-sided, and collaborative interaction. The therapist and client work closely together throughout the process. Homework assignments are also very common with CBT. They may involve reading something, filling out a worksheet, or practicing a new behavior or skill. The assignment is typically discussed in the following session.    Homework assignments give clients the opportunity to keep practicing and applying what they’ve learned in between sessions. As with all types of therapy, it’s important to be prepared for some degree of discomfort at first. After all, initially opening up about very personal, private issues to a total stranger is rarely easy. However, a skilled therapist will help put you at ease. Keep in mind, also, that as humans, we tend to be resistant to change. Psychotherapy is no different. It’s always important to work with a therapist who is very experienced with CBT and, as much as possible, also experienced in treating your specific disorder or problem effectively by using it. Don’t be afraid to make several calls when looking for a therapist. Cognitive behavioral therapy truly is one of the greatest “inventions” of our time. Millions of people have benefited significantly from it over the past several decades. While it may not sound as prestigious as many years of therapy in which you learn that, deep down, you really hate your mother, don’t underestimate its effectiveness. It has the power to change your life in a very positive, lasting way – in a fairly short period of time.

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