How Does Cognitive Behavioral Therapy (CBT) Treat Anxiety, and Does it Work?
For sufferers of panic and anxiety disorders, the word “therapy” can easily sound like a sort of empty promise. Thousands of people with various anxiety conditions have found themselves disheartened after countless treatments (be it natural, medical, psychological and even physical) have failed to accomplish what they had set out to achieve: to allow the patient to live a healthy, normal life.
However, not all people react to the same therapy in the same way. Some slowly warm up to it after awhile, while others shun after the first session of experience with it. A lot of it has to do with the determination to treat one’s own condition, but most of it has to do with personal preference.
Some people prefer to rely on medication in curbing the effects of anxiety and panic disorders, while others prefer a more natural approach to their therapy. Some people rely on regular sessions with a licensed therapist, while others prefer to self medicate. Others even try all of these treatments at the same time.
For the most part, studies have shown that success in treating panic and anxiety disorders usually comes when various complimenting treatments are done in conjunction. But then, the most effective combination of anxiety and panic treatments differs from person to person.
However, some therapies have been documented to be more effective than others. And as medical research continues to uncover new ways to treat and handle anxiety and panic disorders, sufferers are given new and improved options for therapies.
One of the most successful treatments now is what has come to be known as cognitive behavioral therapy. Thousands of sufferers of anxiety disorders have come to vouch for the effectivity of cognitive behavioral therapy (or CBT as it is usually called). It has become increasingly popular among both patients and health care professionals.
And although cognitive behavioral therapy may sound like a mouthful for those unfamiliar with the term, it is elegantly simple in its core philosophy. It deals with how we think and how we act, and how that affects the way we deal with anxiety and panic. It is easier said than done, of course, but its natural simplicity speaks volumes for how accessible it can be to any number of patients and disorder sufferers.
But what exactly is cognitive behavioral therapy? What does it do? And how can it help you? Read More
What is Cognitive Behavioral Therapy?
Quite simply cognitive behavioral therapy is a kind of treatment that helps the sufferers of a variety of psychological conditions understand how their own personal thoughts and feelings affect their behavior when dealing with their condition. At its core cognitive behavioral therapy deals with the connection between mind and body, thought and action, and how one influences the other.
The Mayo Clinic defines cognitive behavioral therapy as:
“Cognitive behavioral therapy is a common type of mental health counseling (psychotherapy). With cognitive behavioral therapy, you work with a mental health counselor (psychotherapist) in a structured way, attending a limited number of sessions. By helping you become aware of inaccurate or negative thinking, cognitive behavioral therapy allows you to view challenging situations more clearly and respond to them in a more effective way.”
Cognitive behavioral therapy can be a very helpful tool in treating mental illnesses such as anxiety or depression. But, not everyone who benefits from cognitive behavioral therapy has a mental health condition. It can be a very effective tool to help anyone learn how to better manage stressful life situations.
However, CBT does not only deal with treating anxiety disorders and panic disorders. It can be a very effective method of treating a wide variety of other psychological disorders including phobias, depression, substance addiction and other emotional disorders to name a few. In fact, cognitive behavioral therapy can even be used to treat those without psychological disorders or conditions. Since it deals with thought and behavioral correction it can be applied to anyone who wants to rid themselves of stress, alcoholism, insomnia, or any number of bad habits.
Although CBT has been growing in popularity among a majority of anxiety sufferers over recent years, it is a type of therapy that has been constantly evolving and improving for far longer than that.
In fact, the roots of cognitive behavioral therapy can be traced back all the way to the mid-1920s when psychologists were first using behavioral approaches to treat phobias and anxieties within children. It was then that the understanding of human behavior started to become a critical part of psychotherapy.
In the late 1930s, cognitive behavioral training techniques would slowly become used on patients needing post-hospitalization psychiatric treatment. But it wouldn’t be until the stretch of the 1950s and 1970s that cognitive behavioral therapy would establish itself as a viable psychotherapeutic treatment across the United States, the United Kingdom and even regions of South Africa. It was during that time that psychologists and therapists all across the world began seeing and arguing for the benefits of the treatment.
The common misconception however, is that CBT is a single type of treatment. The truth is that it is a category of treatments that deal with practically the same thing: thought and behavior. Although various therapists may take liberties on how their own cognitive behavioral therapy is carried out, the fundamentals remain largely the same. The treatment focuses on a specific area of concern for the patient, and aims to “correct” both their thinking and their behavior with the hopes of either curbing or out right treating that particular problem or condition.
For healthcare professionals, cognitive behavioral therapy is an umbrella categorization for a host of other therapies and methods used to understand and deal with human behavior, thought and emotion.
Listed below are the various types of cognitive behavioral therapy:
Rational Emotive Therapy
This particular kind of therapy focuses on the emotional aspects of the patients. It looks to adjust emotional processes of the individual in an effort to change their thinking, and later on, their behavior. The idea behind rational emotive therapy is to give patients control of their emotions, and not the other way around.
For many sufferers of psychological disorders, emotions can easily be the sole dictate of both thought and action. This is particularly true for people who suffer from anxiety and depression. By being able to understand the emotions that accompany their various psychological conditions, patients are able to better cope and, eventually, treat their disorders.
In contrast with rational emotive therapy, this type of cognitive behavior therapy looks to analyze and understand the cognitive processes of a patient. Although cognitive therapy was first used to treat sufferers of depression, it has since evolved as an effective treatment for various anxiety and behavioral disorders.
With this kind of treatment, patients are taught to understand the connection between their thoughts and their emotions. They are taught to become more aware of their instinctive and impulsive thoughts, and how that can become a trigger for their disorders. Like rational emotive therapy, cognitive therapy requires a lot of introspection on the part of the patient.
A lot of psychologists believe that stress is a major trigger for a wide variety of psychological disorders. Because of this, the ability to understand, relieve and cope with stress is paramount to the curbing of the disorders themselves.
Stress-inoculation therapy is concerned with the patient’s ability to deal and cope with stress, as well as understand the underlying sources of the stress itself. It helps the sufferers become more resistant to stressful and anxiety-causing situations.
A lot of the therapy includes positive reinforcement as well as a variety of techniques which includes everything from relaxation, communication to problem solving. The foundation of stress-inoculation therapy is that the ability to overcome stress can lead to drastic, positive changes in both thought and behavior.
While other cognitive behavioral therapies deal with specific facets of the human psyche, multimodal therapy see the human being as a collection of different modes or “modalities” that each need to be understood and addressed. The core idea behind multimodal therapy is that a person’s behavior is dictated by what we experience – think, feel, sense, believe, socialize and interact with others and our environment. Instead of seeing a person as represented by one of these modes, multimodal therapy sees all of them as equally important.
Despite these different therapies, cognitive behavioral therapy deals mainly with how our mental and/or emotional faculties directly affect our behavior. Therapists and psychiatrists may recommend a different approach per case, but the general treatment is relatively the same.
In understanding how we think and how we feel, we are able to understand what we do. It is through this understanding that we are able to take control of our lives, so that we can change for the better, despite the challenges put in front of us by any psychological disorders and conditions.
How Does Cognitive Behavioral Therapy Work?
Our actions are dictated by our thoughts. When we change our thoughts, our actions follow. And when we change our mindset, so follows our behavior. That seems like a very obvious assertion on its own but that is, quintessentially, the guiding principal behind cognitive behavioral therapy.
Our emotions play a huge factor in influencing our behavior as well. Most people tend to misunderstand cognitive therapy as a way of disregarding the importance of feelings and emotions. However, it is in understanding these basic human reactions that we’re able to fully grasp how we behave. Basic emotions such as sadness, happiness and anger affect what we think, and therefore, affect what we do. Feelings and emotions cannot be disregarded when treating someone’s behavior.
The Mayo Clinic covers why cognitive behavioral therapy has been a popular and effective solution for depression and anxiety.
“Cognitive behavioral therapy is used to treat a wide range of issues. It’s often the preferred type of psychotherapy because it can quickly help… identify and cope with specific concerns. It generally requires fewer sessions than other types of therapy and is done in a structured way that deals directly with specific challenges… Cognitive behavioral therapy is a useful tool to address emotional challenges.”
Cognitive behavioral therapy is a useful way in addressing a wide range of emotional and psychological challenges that include:
- Managing symptoms and manifestations of psychological conditions on its own or with the aid of prescription drugs and medication.
- Inhibiting possible relapses of psychological conditions
- Treating psychological conditions without prescribed drugs and medications. This is particularly important for cases when patient allergies and other conditions prevent such drugs from being used.
- Learning how to better help yourself and loved ones when going through the treatment process.
- Discovering methods in managing negative emotions including depression, anger, anxiety, trauma and stress
- Overcoming traumatic experiences such as near-death experiences, accidents, loss of a loved one and other tragedies.
- Mentally preparing yourself to cope with physical illness such as cancer, leukemia or other dreaded diseases.
- Improve the quality of life when suffering from sleep, sexual, bipolar, phobia or anxiety disorders.
In a good number of cases, cognitive behavioral therapy is even more effective when complimented by other treatments or medications. However, the core concern of cognitive behavioral therapy is still the relationship between feelings, thoughts and behavior, and how they affect one another.
How Thoughts and Feelings Can Influence Behavior – An Example
To give you an idea of how thoughts and feelings can influence behavior, an example can be taken from an average night out. Imagine that you’re at a local bar and you’re waiting for a friend to come join you. Earlier that day, you had run into them on the street after being out of touch for a good number of years.
Your conversation brings back a lot of good memories and you invite them out for a drink that night. You trade numbers and set a date for the evening. That night however, you find yourself waiting as long as forty-five minutes past the time of the date. Your friend is nowhere in sight, and you can’t get in touch with them.
It’s normal to run scenarios of what could’ve happened to your friend. But it’s also normal to feel certain things because of those thoughts. One possible scenario is that your friend got into some kind of emergency and had to change plans last minute. Their phone battery could have run out and they have no way of contacting you.
It is an understandable scenario, and something that is beyond your control and not your fault. However, an alternative scenario is that your friend stood you up and blocked your number. You completely misread your earlier conversation, and for your friend, they were just far too polite to reject you to your face.
The latter scenario can be a cause for stress and anxiety for a lot of people. Suddenly, you’re worried about your friend’s perception of you. You begin to criticize yourself, and analyze how your earlier conversation had gone. Your self-esteem drops and suddenly your disposition towards this friend of yours changes.
At the end of the day, your behavior is dictated by either of these possible scenarios. If you believe that your friend’s absence was completely valid, you could end up getting in touch with them in the future to check on what happened to them. However, if you feel that you were intentionally stood up, you can just as quickly withdraw from your friend and shut them out from your life.
This is only one of countless examples of how such a simple thought can influence your behavior entirely.
But how does this relationship between thought, feeling and action relate to cognitive behavior therapy?
As mentioned earlier, cognitive behavioral therapy works by understanding the underlying patterns behind both our thoughts, feelings and our actions. Essentially, changing destructive and negative thoughts can have a big influence in changing our destructive and negative behavioral patterns.
From there, the patient (alongside his doctor or therapist) is able to work on how he or she can “correct” these patterns to prevent manifestations of their psychological condition. What follows is an example of how cognitive behavioral therapy can help treat those with phobia of flying, for example.
Flight anxiety is more common than most people believe. More than half of the people onboard a flight have anxious thoughts prior or during the flight itself. Some people simply note the possibility of a crash then immediately shrug it off, while others are completely terrified by the mere concept of it.
Pteromerhanophobia is the technical term for the fear of flying. However, unlike most people, individuals who suffer with this particular phobia find flying an utterly paralyzing experience. They dread the idea of being cooped up in a seat tens of thousands of feet above the ground, and they are horrified by the possibility of suddenly plummeting to their doom at a moments notice.
Harboring these negative thoughts on flying can easily lead anyone to avoid any sort of air travel. The mere thought of planning a business trip or vacation suddenly becomes problematic, especially when an air flight ticket is required. If left unabated, movies, television shows and even prints and photos of flying can become troublesome for the sufferer, and can literally intervene with their life.
Although the end goal of the patient should be to eventually get on a plane without so much of drop of sweat, that isn’t the main concern of cognitive behavior therapy (but if that outcome becomes the result, then all the better). Instead cognitive behavior therapy first works by changing their behavior towards flying in general. By first understanding and confronting the thoughts and feelings that accompany the act of flying, patients can then move on to the next step of slowly changing their behavior.
A cycle can quickly form if the negative behavior is left unattended to. The thoughts and actions that give us the freedom we are used to can easily become as paralyzing and debilitating as the conditions that impede them. CBT aims to stop that negative cycle before it can get out of control. But that isn’t the only way that the therapy works.
It also works by making overwhelming situations more manageable by segmenting them into more convenient portions. Instead of stepping back to see the bigger picture, cognitive behavioral therapy trains you how to inspect and analyze the different aspects of your life, and understand how it relates to your condition. Normally, patients undergoing this process are asked to identify a situation that manifests their condition and keep note of the thoughts, emotions and actions that stem from it.
In the end, the purpose of cognitive behavioral therapy is to train patients and individuals with psychological conditions how to manage and deal with negative thoughts and feelings, and convert that into positive action.
How Effective is Cognitive Behavioral Therapy?
CBT has been documented as one of the most effective treatments for anxiety and depression. It is the therapy most highly recommended (and practiced) by leading therapists and psychiatrists for patients suffering from various intensities of depression. It is so popular a treatment of CBT is largely considered as being just as effective as antidepressants themselves.
But despite the recorded success stories of the therapy, the program is not infallible. Like most other anxiety and panic treatments, CBT is still largely dependent on the patient’s willingness to be treated. A defeatist and uncooperative attitude can lead to immediate failure of the therapy. Success with the process relies very much on the relationship between doctor and patient. The patient must be willing to trust in the treatment of their doctor, and be able to have the confidence to travel the long road to recovery.
Because of this, cognitive behavioral therapy is not made for everyone. There are certainly a lot of people that the treatment is not designed for, which includes individuals who are immediately hostile towards therapists, specialists and psychiatrists. Despite that, there are a number of alternative treatments, depending on the needs and personality type of the patient.
Antidepressants, for example, are a popular alternative to CBT. Antidepressants run the slight risk of addiction and dependency however, so it is always recommended to consult your physician regarding the dosage of antidepressants. On top of that, antidepressants do not take effect immediately, especially when compared to drugs like benzodiazepines. It’s normal to spot changes in anxious and depressed behavior as long as a month after the initial dosage.
Antidepressants are as effective as benzodiazepines in the treatment of panic disorder. Moreover, antidepressants do not have the same risks of tolerance and dependency that are associated with benzodiazepine treatment. However, since antidepressants take longer to work that significant improvement might not be observed until after a month of treatment.
It isn’t also uncommon for sufferers of anxiety and depression to take antidepressants to compliment cognitive behavioral therapy. This technique is usually done to help sufferers slowly take the first steps towards recovery. In time, these patients should be weaned off antidepressants so that they can be independent of the effects of medication. Tranquilizers is also another option outside of anti depressants, but unfortunately they cannot be taken for the long term.
However, the effectiveness of cognitive behavioral therapy among willing, able and cooperative patients is undeniable. Still, cognitive behavior therapy was not designed for long term treatment. It has been largely considered as only a short term form of therapy. Because of this, it isn’t unheard of for patients to relapse without a standing long term form of treatment. However, constant and vigilant application of the methods, techniques and learnings picked up from therapy can prove to be more than effective in making long lasting effects for the patient.
Unfortunately, CBT suffers from its own list of limitations. Although psychological disorders are largely treated like physical diseases, it is a common mistake to assume that psychological disorders are treated in the same way as their physical counterparts. Unlike physical sicknesses such as fevers, flus and colds, psychological conditions such as anxiety and panic disorders are not treated as quickly, or as easily.
The mind does not have an immune system that regenerates maligned areas over time. Instead, it can just as easily deteriorate if left untreated. There is no pill you can take that acts as an immediate cure to a psychological condition. Like other psychological treatments, cognitive behavioral therapy requires motivation and pro-activity. The treatment also requires that the patient confront their fears and anxieties. This can become problematic if the sufferer is not ready and willing to take that critical step towards recovery.
Traditionally, CBT lasts from a single month to half of a year. This depends of course, on the type of treatment you are undergoing, and what your doctor recommends for you.
There is always a chance that you may relapse into anxiety even after a full fledged treatment of CBT. But even if that is the case, the techniques picked up from the therapy can still be used again. These techniques are like muscles that need to be flexed and used regularly so that they can remain effective. It is also possible for patients to take a refresher course in case they have forgotten the key techniques and practices of the process.
What Happens During Cognitive Behavioral Therapy?
For patients going through CBT for the first time, it is important for them to prepare for sessions in order to be more confident about the treatment. Doctors and therapists will normally walk first time patients through the process and give them time to adequately prepare for the program.
Bear in mind that licensed therapists using cognitive behavioral therapy have gone through extensive and specialized training programs designed specifically for the process. Although methods and practices differ from therapist to therapist, there are some basic foundations of CBT that remain constant throughout. Even then, these specialists recognize that patients’ needs differ from case to case and because of that, what may work on one patient may not necessarily work on another. However, never use another patient’s experience as a barometer for your own treatment; although it never hurts to ask others what they felt and learned from having gone through the process.
Different programs vary in their requirements and amount of preparation. Logistics may also become a concern when prepping for therapy. Normally, very minimal preparation is required but it is still important to fulfill them as diligently as possible.
Patients need to understand what the goals of the therapy are. This allows patients to manage their own expectations for the course. Nothing is more disheartening and counterproductive than being let down by a treatment.
In particular, the whole process of CBT might seem quite strange for first time patients. Common questions for first timers are:
- What must be accomplished over the course of therapy?
- What sort of timeline should be followed?
- How can you ensure that working with your doctor or therapist will produce real results in your life?
However, most specialists are very transparent with their patients. They chart the process of the therapy from start to finish. Specifically, their work with sufferers of anxiety and panic disorders follows a fairly common order of events:
- Orientation (briefing the patient on the process of the treatment)
- Assessment (identifying the problem)
- Planning (creating a treatment plan)
- Implementation (executing the planned treatment)
However, you may pre-terminate the treatment at anytime, especially if you are uncomfortable during any of the steps of the therapy itself. Some doctors and therapists might even recommend that you don’t push forward with the rest of their treatment if they feel you are not yet ready for this kind of therapy.
But you can set your mind at ease by knowing that licensed clinicians that practice cognitive behavioral therapy have been trained with how to accomplish the necessary goals, as well as knowing how to overcome many of the challenges you will have to face. Most therapists and doctors see themselves as a team alongside their patient. Since honesty, trust, and sincerity is very important in being able to succeed with CBT, the doctor patient relationship is incredibly important.
The cognitive-behavioral approach, as its name implies, focuses on how problematic beliefs and behaviors play a role in the development of psychological conditions. More importantly, the treatment allows us to understand how changing these problematic beliefs and behaviors can be done to alleviate and treat possible disorders.
Models for understanding specific disorders and difficulties have been advanced by cognitive behavioral researchers and clinicians, and these models provide a road map for the process of therapy.
CBT can help you as well as your doctor understand how various symptoms fit together and what changes need to be made to reduce the symptoms of your condition.
And CBT does not progress blindly through treatment of course. By becoming familiar with these CBT models and using them as a way of assessing treatment, you will feel more comfortable about the process of therapy. As mentioned earlier, it is very important to trust and be comfortable with the treatment and the person treating you, for it to be truly effective.
Furthermore, by educating yourself about the process of the therapy, you will gain important insights and understanding of your own problems and conditions. With guidance from your doctor, you can begin taking the first steps towards resolving them and moving towards living a fuller life.
There are many resources that discuss how cognitive behavioral therapy can work for both yourself and your loved ones. But basically, effective cognitive behavioral therapy depends establishing and maintaining a strong alliance with the individuals who are part of your treatment, whether it be directly or indirectly (this includes your doctor, as well as any friends and family that are openly supporting you). This will help you work towards understanding your own struggles and difficulties with treating your condition.
The latter skill is acquired and discovered alongside your doctor. It is often referred to as “case conceptualization” wherein your problems are identified and the necessary treatment plan is put together for execution. There are dozens of resources on the web and in print covering how this can be done; however do not attempt to do cognitive behavioral therapy on yourself. Although a large amount of self-reinforcement techniques (positive thinking, meditation, etnatural approachc.) can be done on your own, the bulk of the therapy requires a doctor or a therapist to guide you through the recovery process.
Of course it is always important for your doctor to know in advance what kinds of difficulties or challenges you might face during the treatment process. This is critical in being able to outline possible solutions should you run into them.
It is quite common to run into problems and difficulties that were not originally anticipated during treatment. You and your therapist w ill be forced to adapt to new situations and scenarios while not losing sight of your original goals. Some additional time might need to be allotted for dealing with these issues.
Similarly, some patients do not improve at the rate they would have been expected. However, there are a good many patients that only begin to see the positive effects of CBT close to the end of the program. Because of this, don’t be afraid to ask your doctor for an extension of the treatment, especially if you feel that you need more time to fully integrate the practices and techniques into your life.
In some cases, a few extra sessions might actually be what is recommended by your doctor anyway. Therapists and specialists that care for the well-being of their patients should immediately recommend an extension of the treatment if they feel that it’s to their benefit. Making this kind of adjustment does not mean extending the therapy indefinitely. Rather, the original plan for the treatment is revisited and adjustments to it are clearly articulated. For example, your doctor might suggest adding five extra sessions for you if they feel that you particularly caught on to the treatment techniques near the end of the program.