COGNITIVE BEHAVIORAL THERAPY

Therefore, one way to change people’s feelings or behavior is to target distorted thoughts they have about themselves and their lives. This helps them shift the way they interpret situations, how they feel about those situations, and how they respond to them.

It is an extremely powerful intervention, and has been proven effective in the treatment of many conditions, including depression, generalized anxiety disorder, panic disorder, and post-traumatic stress disorder.

There are a variety of CBT approaches, but most share some common elements. These include a structured, goal-directed approach that is time-limited, usually taking 12-16 sessions. Therapy, which is conducted according to a specific plan, does not delve much into the past, but focuses on the here and now.

A CBT program’s success is measurable precisely because there is a plan, a goal, and a limited time in which to accomplish it.

At the heart of CBT is a challenge to a person’s belief system. For example, say a depressed person believes he is worthless. He is constantly telling himself this, and views everything that happens to him through this negative lens. If a friend crosses the street before greeting him, he does not think:

“He was in a rush and needed to get to the dentist’s office over there.” Instead, he thinks, “I am worthless and so he is avoiding me.” This can lead to a cascade of automatic thoughts. “Nobody will ever be my friend. I will always be alone.” Clearly, these thoughts will lead to more negative feelings, more negative interpretations of events, and more isolation, creating a downward spiral.

With a therapist’s help, the individual is encouraged to challenge both his beliefs and his automatic thoughts through a variety of techniques. He may be asked to view his beliefs as a hypothesis or possibility, rather than a fact, and to “test the validity” of these beliefs by looking for real evidence (which he usually will not be able to come up with).

He may use self-talk to coach himself through a situation, deliberately replacing negative thoughts with more positive ones.

He may, with the therapist’s help, rehearse a future situation, going through steps (such as relaxation, deep breathing, and an encouraging internal dialogue) that will help him cope. As he gains these skills, the therapist may expose him to increasingly difficult situations in a process called graded exposure.

Another key part of treatment is psycho education, which involves teaching someone about her condition. Whether that condition is obsessive-compulsive disorder or anxiety, it is important that she understand why she’s been having so much difficulty; how to identify when the condition is affecting her; and how to interrupt and stop it.

Imagine a person with a panic disorder who, as the panic begins, feels a terrible tightness in her chest. She is certain this is a heart attack, and is terrified she may die. Her panic spins out of control, the pain and the panic now fueling one another.

After learning about panic attacks, she can understand that this feeling is just part of a dysfunctional process that isn’t her fault. Recognizing the signs of an impending attack early enables her to begin using the skills she has learned to keep herself calm so the cycle is shortened or prevented altogether.