What can CBT help with?
CBT is recommended in the treatment of the following conditions;
Anxiety disorders (including panic attacks and post-traumatic stress disorder)
There is also good evidence that CBT is helpful in treating many other conditions, including:
Behavioural difficulties in children
Anxiety disorders in children
Physical symptoms without a medical diagnosis
CBT can be used if you are on medication, which has been prescribed by your GP. You can also use CBT on its own. This will depend on the difficulty you want help with.
CBT is based on two specific tasks: cognitive restructuring, in which the therapist and client work together to change thinking patterns, and behavioral activation -- in which clients learn to overcome obstacles to participating in enjoyable activities. CBT focuses on the immediatepresent: what and how a person thinks more than why a person thinks that way.
CBT focuses on specific problems. In individual or group sessions, problem behaviors and problem thinking are identified, prioritized, and specifically addressed.
CBT is goal oriented. Clientss working with their therapists are asked to define goals for each session as well as longer-term goals. Longer-term goals may take several weeks or months to achieve. Some goals may even be targeted for completion after the sessions come to an end.
The approach of CBT is educational. The therapist uses structured learning experiences that teach clients to monitor and write down their negative thoughts and mental images. The goal is to recognize how those ideas affect their mood, behavior, and physical condition. Therapists also teach important coping skills, such as problem solving and scheduling pleasurable experiences.
CBT clients are expected to take an active role in their learning, in the session and between sessions. They are given homework assignments at each session -- some of them graded in the beginning -- and the assignment tasks are reviewed at the start of the next session.
CBT employs multiple strategies, including Socratic questioning, role playing, imagery, guided discovery, and behavioral experiments.
CBT is time limited. Typically, treatment with CBT lasts 14 to 16 weeks.
1. CBT for Depression:
What is CBT?
Cognitive behavioral therapy (CBT) is an effective treatment for depression. At the heart of CBT is an assumption that a person's mood is directly related to his or her patterns of thought.
Negative, dysfunctional thinking affects a person's mood, sense of self, behavior, and even physical state. The goal of cognitive behavioral therapy is to help a person learn to recognize negative patterns of thought, evaluate their validity, and replace them with healthier ways of thinking.
At the same time, therapists who practice CBT aim to help their clients change patterns of behavior that come from dysfunctional thinking. Negative thoughts and behavior predispose an individual to depression and make it nearly impossible to escape its downward spiral. When patterns of thought and behavior are changed, according to CBT practitioners and researchers, so is mood.
Anyone with mild or moderate depression can potentially benefit from cognitive behavioral therapy, even without taking medication.
A number of studies have shown CBT to be at least as effective as antidepressants in treating mild and moderate depression.
Studies also show that a combination of antidepressants and CBT can be effective in treating major depression.
2. CBT for Anxiety
Cognitive behavioral therapy (CBT) is the most widely used therapy for anxiety disorders. Research has shown it to be effective in the treatment of panic disorder, phobias, social anxiety disorder, and generalized anxiety disorder, among many other conditions.
The basic premise of cognitive behavioral therapy is that our thoughts—not external events—affect the way we feel. In other words, it’s not the situation you’re in that determines how you feel, but your perception of the situation. For example, imagine that you’ve just been invited to a big party. Consider three different ways of thinking about the invitation, and how those thoughts would affect your emotions.
Situation: A friend invites you to a big party.
The party sounds like a lot of fun. I love going out and meeting new people!
Parties aren’t my thing. I’d much rather stay in and watch a movie.
I never know what to say or do at parties. I’ll make a fool of myself if I go.
As you can see, the same event can lead to completely different emotions in different people. It all depends on our individual expectations, attitudes, and beliefs. For people with anxiety disorders, negative ways of thinking fuel the negative emotions of anxiety and fear. The goal of cognitive behavioral therapy for anxiety is to identify and correct these negative thoughts and beliefs. The idea is that if you change the way you think, you can change the way you feel.
Exposure therapy for anxiety:
Anxiety isn’t a pleasant sensation, so it’s only natural to avoid it if you can. One of the ways that people do this is by steering clear of the situations that make them anxious. If you have a fear of heights, you might drive three hours out of your way to avoid crossing a tall bridge. Or if the prospect of public speaking leaves your stomach in knots, you might skip your best friend’s wedding in order to avoid giving a toast. Aside from the inconvenience factor, the problem with avoiding your fears is that you never have the chance to overcome them. In fact, avoiding your fears often makes them stronger.
Exposure therapy, as the name suggests, exposes you to the situations or objects you fear. The idea is that through repeated exposures, you’ll feel an increasing sense of control over the situation and your anxiety will diminish. The exposure is done in one of two ways: Your therapist may ask you to imagine the scary situation, or you may confront it in real life. Exposure therapy may be used alone, or it may be conducted as part of cognitive behavioral therapy.
Rather than facing your biggest fear right away, which can be traumatizing, exposure therapy usually starts with a situation that’s only mildly threatening and works up from there. This step-by-step approach is called systematic desensitization. Systematic desensitization allows you to gradually challenge your fears, build confidence, and master skills for controlling panic.
Making anxiety therapy work for you:
There is no quick fix for anxiety. Overcoming an anxiety disorder takes time and commitment. Therapy involves facing your fears rather than avoiding them, so sometimes you’ll feel worse before you get better. The important thing is to stick with treatment and follow your therapist’s advice. If you’re feeling discouraged with the pace of recovery, remember that therapy for anxiety is very effective in the long run. You’ll reap the benefits if you see it through.
You can also support your own anxiety therapy by making positive choices. Everything from your activity level to your social life affects anxiety. Set the stage for success by making a conscious decision to promote relaxation, vitality, and a positive mental outlook in your everyday life.
Learn about anxiety. In order to overcome anxiety, it’s important to understand the problem. That’s where education comes in. Education alone won’t cure an anxiety disorder, but it will help you get the most out of therapy.
Cultivate your connections with other people. Loneliness and isolation set the stage for anxiety. Decrease your vulnerability by reaching out to others. Make it a point to see friends; join a self-help or support group; share your worries and concerns with a trusted loved one.
Adopt healthy lifestyle habits. Physical activity relieves tension and anxiety, so make time for regular exercise. Don’t use alcohol and drugs to cope with your symptoms, and try to avoid stimulants such as caffeine and nicotine, which can make anxiety worse.
Reduce stress in your life. Examine your life for stress, and look for ways to minimize it. Avoid people who make you anxious, say no to extra responsibilities, and make time for fun and relaxation in your daily schedule.
3. CBT for Low Self- Esteem:
In order to overcome low self-esteem it's necessary to break the cycle that keeps it going. Cognitive Behaviour Therapy (CBT) is an ideal approach for tackling low self-esteem, because it provides a clear framework for understanding how the problem developed and what keeps it going. CBT focuses on thoughts, beliefs and opinions, but also provides a practical approach for changing those beliefs by changing behaviour. It encourages you to try out new ways of behaving, and to observe the effect that this has on the way you feel about yourself. In this way you can learn to:
notice self-critical thinking and nip it in the bud
counter the bias against yourself by focusing on your skills
change the Rules for Living that cause you to enter the vicious cycle
tackle your Bottom Line.
What is low self-esteem?
Self-esteem is an aspect of the way we view ourselves. It's different from self-image, which might describe a whole range of characteristics (such as 'I'm British' or 'I'm female') but without implying whether they are good or bad. Self-esteem refers to the overall opinion we have of ourselves and the value we place on ourselves as people. Low self-esteem means that the tone of this opinion is negative: for example, 'I'm unlovable' or 'I'm useless'. Of course most of us have mixed opinions of ourselves, but if your overall opinion is that you are an inadequate or inferior person, if you feel that you have no true worth and are not entitled to the good things in life, this means your self-esteem is low. And low self-esteem can have a painful and damaging effect on your life.
What causes low self-esteem?
The beliefs you have about yourself often appear to be statements of fact, although actually they're really only opinions. They are based on the experiences you've had in life, and the messages that these experiences have given you about the kind of person you are. If your experiences have been negative, your beliefs about yourself are likely to be negative too.
Crucial experiences that help to form our beliefs about ourselves often (although not always) occur early in life. What you saw, heard and experienced in childhood - in your family, in the wider community and at school - will have influenced the way you see yourself. Examples of early experiences that could lead to your thinking badly of yourself include:
systematic punishment, neglect or abuse
failing to meet parental standards
failing to meet peer-group standards
being on the receiving end of other people's stress or distress.
belonging to a family or social group that other people are prejudiced towards
an absence of praise, warmth, affection or interest
being the odd one out, at home or at school.
Sometimes negative beliefs about yourself are caused by experiences later in life, such as workplace bullying or intimidation, abusive relationships, persistent stress or hardship, or traumatic events.
4. CBT for Post Traumatic Stress Disorder (PTSD):
Research shows that cognitive behavioural therapy it is the most effective type of counseling for PTSD and its aftermath.
Traumatic events can often be very difficult to come to terms with, but confronting your feelings and seeking professional help is often the only way of effectively treating PTSD.
It is possible for PTSD to be successfully treated many years after the traumatic event occurred, which means it is never too late to seek help.
Trauma-focused CBT uses a range of psychological treatment techniques to help you come to terms with the traumatic event.
For example, your therapist may ask you to confront your traumatic memories by thinking about your experience in detail. During this process your therapist will help you cope with any distress you feel, while identifying any unhelpful thoughts or misrepresentations you have about the experience.
By doing this, your therapist can help you gain control of your fear and distress by changing the negative way you think about your experience, such as feeling that you are to blame for what happened or fear that it may happen again.
You may also be encouraged to gradually restart any activities you have avoided since your experience, such as driving a car if you had an accident.
A course of treatment usually involves 8-12 weekly sessions of trauma-focused CBT
Cognitive restructuring refers to the process in CBT of identifying and changing inaccurate negative thoughts that contribute to the development of depression. This is done collaboratively between the client and therapist, often in the form of a dialogue. For instance, a college student may have failed a math quiz and responded by saying, "That just proves I'm stupid."
The therapist might ask if that's really what the test means. In order to help the student recognize the inaccuracy of the response, the therapist could ask what the student's overall grade is in math. If the student answers, "It's a B," the therapist can then point out that his answer shows he's not stupid because he couldn't be stupid and get a B. Then together they can explore ways to reframe what the performance on the quiz actually says.
The "I'm stupid" response is an example of an automatic thought. Clients with depression may have automatic thoughts in response to certain situations. They're automatic in that they're spontaneous, negative, and don't come out of deliberate thinking or logic. These are often underpinned by a negative or dysfunctional assumption that is guiding the way clients view themselves, the situation, or the world around them.
Other examples of automatic thinking include:
Always thinking the worst is going to happen. For instance, a person may convince himself he is about to lose his job because the boss didn't talk to him that morning or he heard an unsubstantiated rumor that his department was going to cut back.
Always putting the blame on oneself even when there is no involvement in something bad that happened. For example, if someone did not return your call, you might blame it on the fact that you are somehow a very unlikeable person.
Exaggerating the negative aspects of something rather than the positive. Think of someone who exercises a stock option from a bonus a week before the stock rises another 10%. Instead of enjoying the bonus money he just got, he tells himself he never gets the breaks or that he's too afraid to take risks that he should take. If he weren't, he would have known to wait.
The idea in CBT is to learn to recognize those negative thoughts and find a healthier way to view the situation. The ultimate goal is to discover the underlying assumptions out of which those thoughts arise and evaluate them. Once the inaccuracy of the assumption becomes evident, the client can replace that perspective with a more accurate one.
Between sessions, the client may be asked to monitor and write down the negative thoughts in a journal and to evaluate the situation that called them up. The real goal is for the client to learn how to do this on his or her own.
Behavioral activation is another goal of CBT that aims to help clients engage more often in enjoyable activities and develop or enhance problem-solving skills.
Inertia for example, is a major problem for people with depression. One major symptom of depression is loss of interest in things that were once found enjoyable. A person with depression stops doing things because he or she thinks it's not worth the effort. But this only deepens the depression.
In CBT, the therapist helps the client schedule enjoyable experiences, often with other people who can reinforce the enjoyment. Part of the process is looking at obstacles to taking part in that experience and deciding how to get past those obstacles by breaking the process down into smaller steps.
Clients are encouraged to keep a record of the experience, noting how he or she felt and what the specific circumstances were. If it didn't go as planned, the client is encouraged to explore why and what might be done to change it. By taking action that moves toward a positive solution and goal, the client moves farther from the paralyzing inaction that locks him or her inside the depression.