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Using CBT for a justified fear?

Using CBT for a justified fear?



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I am a speech language pathologist. I have a 19 year old patient who grew up with a number of different speech impediments (not a stutter). He was bullied a lot, and because of this he is very sensitive about how he speaks.

Recently, he has become so anxious about it he has developed a stutter. Note that stuttering was not one of the impediments he grew up with. He only developed it a couple of months ago because of his anxiety. He is not in a financial position to afford a psychologist, so I decided to help him with his anxiety. I know I'm not in a position to get rid of his anxiety; thats outside my scope of practice - I'm only trying to help with the manifestation of his anxiety in his speech, which is within my scope.

He blocks completely - in other words, when trying to pronounce certain words, he becomes completely silent for a couple of seconds as he tries to "push" the word out. Rather than the usual case of repeating the same sound over and over again, he simply becomes silent while he waits for the word to come out.

His main fear is not being able to get the word out and just being completely silent while the other person is waiting for him to complete his sentence. This fear is quite justified unfortunately - most of us would be confused if a person just stopped talking and would ask him to continue. I've used CBT for a stutter before, but that was to show the patient that some of their fears (i.e. being laughed at) were irrational.

How do I address the anxiety that stems from a fear that is relatively justified and logical?


The first option is to investigate exactly what his worries are and to put them in perspective. Often, people catastrophize their fears, imagining the worst possible scenario for a given situation. While that outcome may be a realistic possibility, often is not the only or even the most likely possibility.

For instance, is he afraid that people will think he lacks intelligence? Or that people will laugh and make fun of him? You might examine his thought this way:

  1. What is the worst possible outcome if he stutters or freezes in front of another person?

  2. What is the best possible outcome in the same situation?

  3. What does he think is the most likely outcome? (Usually this is somewhere in between the two extremes).

Second, you can caution him against mind-reading (i.e., assuming he knows what others will say, do or think). If he is concerned that when he freezes, "people will think I'm stupid," encourage him to think of other possibilities. They might think that, or they might just be confused, or they might recognize he's socially uncomfortable and have compassion.

Third, while the thought or fear itself may be true (e.g. "She made fun of me") the meaning he attaches to it might not be completely valid.

What does it say about him? For instance, if he thinks "She's right, I'm stupid, I'm a loser" you can explore all of his strengths and things he does well. Often people maximize painful experiences or don't give themselves credit for other accomplishments. Other thoughts, such as "This is something I struggle with, but I'm good at other things," might be more adaptive.

What does it say about that other person? You could work with him to reframe his thoughts (e.g. "She just doesn't understand and isn't sure how to react," or "That person has to be mean to others to make himself feel good; what he says isn't really true.")

What does it mean if someone reacts poorly when he freezes? If his thought is akin to "They'll think I'm stupid" figure out what it would mean in his life if they thought that way. How would that impact him? Is it "If I freeze, they'll think I'm stupid, and then I won't… get the job, make a friend, etc."? If you can figure out what consequences he is concerned about, then you can go back to option 1 and think through how likely those scenarios are.

Often fears and anxieties have some kernel of realistic risk to them. Some spiders or snakes can be dangerous, some people can judge us and be cruel, etc. However, if the fear is paralyzing, there is often a distortion to the thoughts that can be discussed and possibly adapted to reduce anxiety.

This book may provide additional ideas:

Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond. Guilford Press. (pgs. 1801-84 discuss some of the points mentioned above).


CBT stands for Cognitive Behaviour Therapy (I mention this because in the thrill of learning it, the "B" part is often ignored or forgotten). CBT integrates aspect of both cognitive psychotherapy and behaviour psychotherapy.

Behaviour psychotherapy was formed earlier and its basic gist (very simply put) is that our behaviours and environment can influence our thoughts and feelings and so changing our behaviour / environment can change how we think and feel. (Knowing the basics of cognitive therapy, which supposes that your thoughts influence your emotions and behaviours, you can understand how it was logical to integrate both to treat someone - and thus we have CBT.)

So for the situation you described where the cognitive distortions have all been addressed, and part of the problem still exists or a new one is revealed, it may be helpful to try and address it through behavioural changes.

For example, exposure therapy is a technique in Behaviour therapy that is used to reduce certain kinds of anxiety, and could be helpful here.

As suggested by others in the comments too, for example, a behavioural change he could do is to reveal to people before hand that he has a speech impediment that sometimes causes him to stutter or pause as he searches for words. You can role play this with him. Then ask him to say it to a close friend or family member not aware of it. And then slowly escalate to saying it to a stranger.

Or ask him to deliberately pause when speaking with someone and see what their reaction is. (First role play it with him).

Sometimes facing your fears this way (in a more controlled manner) reveals new cognitive distortions (examples of which user30295 has described in his detailed answer) that one may not be aware of, and that would need to be addressed using cognitive therapy techniques.


New Developments in Cognitive-Behavioral Therapy for Social Anxiety Disorder

Social anxiety disorder (SAD) is a highly prevalent and chronic disorder that causes considerable psychosocial impairment. This article reviews recent changes in the definition of SAD in DSM-5 and summarizes the current evidence for effective cognitive-behavioral treatments in adults, children, and adolescents. Current data suggests that cognitive-behavioral therapy (CBT) is efficacious in the treatment of this condition. Among different CBT approaches, individual cognitive therapy may be associated with the largest effect sizes. In this review, interventions targeting dysfunctional cognitive processes that contribute to the effective treatment of SAD are discussed. Some recent findings from neuroimaging research and studies on the augmentation of CBT using neuroenhancers indicate that changes in emotion regulation as well as fear extinction are important psychological mediators of positive outcome. Furthermore, internet-delivered CBT is a promising field of technological innovation that may improve access to effective treatments. Despite the availability of effective treatments, treatment-resistant SAD remains a common problem in clinical practice that requires more research efforts. Finally, potential areas for further development of CBT as well as its dissemination in health care are summarized.

Keywords: Cognitive therapy Emotion regulation Fear extinction Internet-delivered CBT Neuroenhancement Social anxiety disorder Treatment-resistant SAD.


Cognitive Behavioral Therapy For The Death Of A Loved One

There is a common thought pattern following the death of a loved one that could be categorized as faulty thinking, which makes cognitive behavioral therapy, with its emphasis on isolating, challenging, and correcting faulty thinking patterns, an important piece of the grief recovery puzzle.

Actually there are many common faulty thinking patterns following the death of a loved one but the one we want to talk about here is called fortune telling, which is basically where you believe you have a crystal ball that lets you see into the future in order to perfectly predict how things are going to play out.

In the throes of grief fortune telling manifests as the idea that you’ll never be happy again, that there’s no reason to expect anything good out of life anymore, that how you’re feeling now is how you’re going to feel forever.

Beliefs exert a powerful impact on thoughts, emotions, and behavior and therefore a powerful impact on outcomes. Often what we believe will happen ends up acting as a self-fulfilling prophecy, it ends up happening because we make our behavior and the behavior of those around us line up with our beliefs.

There is no denying that after losing a loved one things can never be the same again, but the difference is that going through the process of grief recovery leaves you with a scar whereas not going through the process of grief recovery leaves you with an open wound. Those who loudly proclaim that there is no such thing as ‘grief recovery’ or ‘closure’ are often victims of fortune telling, where their beliefs that they can never be happy again, that there’s no reason to expect anything good out of life anymore, and that they’re going to feel the same way forever keep them from ever taking those difficult steps towards healing.

When we say ‘closure’ we don’t mean forgetting, we don’t even necessarily mean moving on if by moving on what is meant is ceasing to think about or love the person who has passed away. What we do mean is recognizing that loss as final and having the courage to say goodbye, both to the person and to how things were, in order to stop letting the past take up too much space in the present and future. This is closure in the Gestalt sense of the word, closure in the sense of moving all the way through the needs satisfaction cycle so that it’s possible to open up new gestalts instead of staying perpetually stuck in the old one.

The point of cognitive behavioral therapy is to isolate the faulty thinking patterns responsible for dysfunction and then challenge them. In the context of this article, some questions to ask are:

“How can you be so sure you’ll never be happy again? Have you ever had an emotional state that lasted forever?”
“How do you know nothing good will ever come your way again? Have you ever had bad things happen to you when you thought the result would be good or good things happen to you when you thought the result would be bad?”
“Have you ever been wrong about a prediction you were sure would come true in the past? When?”

None of us can perfectly predict the future, but our thoughts, beliefs, and actions in the present can and do exert a profound influence on that future. By making room for the possibility, however small, of having a happy future where good things happen to you the first threads of that future start to be woven together.


PHOBIA

Behavior Therapy and Cognitive Behavior Therapy are types of treatment that are based firmly on research findings. These approaches aid people in achieving specific changes or goals.

  • A way of acting: like smoking less or being more outgoing
  • A way of feeling: like helping a person to be less scared, less depressed, or less anxious
  • A way of thinking: like learning to problem-solve or get rid of self-defeating thoughts
  • A way of dealing with physical or medical problems: like lessening back pain or helping a person stick to a doctor’s suggestions.

HOW TO GET HELP: If you are looking for help, either for yourself or someone else, you may be tempted to call someone who advertises in a local publication or who comes up from a search of the Internet. You may, or may not, find a competent therapist in this manner. It is wise to check on the credentials of a psychotherapist. It is expected that competent therapists hold advanced academic degrees. They should be listed as members of professional organizations, such as the Association for Behavioral and Cognitive Therapies or the American Psychological Association. Of course, they should be licensed to practice in your state. You can find competent specialists who are affiliated with local universities or mental health facilities or who are listed on the websites of professional organizations. You may, of course, visit our website (www.abct.org) and click on "Find a CBT Therapist"

According to the Diagnostic and Statistical Manual phobic disorders fall into three types, based on the nature of the object or situation that produces the fear:

1) Simple phobias involve a fear of particular objects or situations, such as heights, the dark, moths, or small spaces.

2) Social phobias involve a fear of being watched or evaluated by others and a belief that the individual will, in some way, appear foolish. This results in avoidance of such situations as eating in front of others or going to parties or meetings.

3) Agoraphobia involves a fear of being unable to escape quickly or reach help in the event of sudden incapacitation, commonly a panic attack. Specifically, therefore, agoraphobia involves a fear of a wide variety of situations that the individual believes will either increase the likelihood of incapacitation or reduce the chance of reaching help should incapacitation occur. These situations include going to malls, using public transport, and generally being alone.

Agoraphobia is usually thought to be the most crippling phobic disorder, and simple phobia the least. People suffering with phobias can also have problems with chronic anxiety and depression. Simple phobias often begin in childhood social phobias in the late teens and agoraphobia in the mid-20's. Phobias appear to be more common in females than in males, although social phobia seems to be fairly evenly divided.

The cause of the various phobia disorders is still under considerable dispute. Traditionally, psychologists have believed that phobias are the result of experiencing a traumatic event in the presence of a specific situation or object (conditioning) being bitten by a dog, for example. However, recent research suggests that this is likely to be the case in only a certain portion of phobic cases, especially cases of simple phobia and some social phobias, such as fear of eating, drinking, or writing in front of others.

Other ways in which many simple phobias and some social phobias are probably acquired include the passing of false or exaggerated information (e.g., being told dogs are dangerous) or seeing or hearing of someone else being injured or distressed in a particular situation (e.g., seeing someone being bitten by a dog).

Some social phobias appear to be worsenings of lifelong behaviors and personality factors. In other words, some people who are afraid of going to parties or formal meetings may report that they have always been "basically shy," but only since they took on new responsibilities has this become severe enough to be considered a problem. The immediate cause of agoraphobic fear and avoidance involves an unexpected panic attack. This first panic attack is reported to occur "out of the blue." The agoraphobic then begins to fear the occurrence of another such attack and avoids those situations that they believe may cause or worsen a future attack.

The reasons why an individual may begin to associate certain situations with panic attacks are not yet known. In addition, the cause of the initial panic attack is only just beginning to be investigated. Some factors that might be responsible for causing the first panic attack include life stressors, earlier experience with loss of control, a tendency to breathe too fast, or fluctuations in brain chemicals.

The basic treatment of choice for the phobic disorders involves what is called graduated exposure to the phobic stimulus. This means that the person is gradually and gently brought into contact with the avoided object or situations until he or she "gets used to " it. Repeated investigations have demonstrated the value of exposure-based techniques for all types of phobias. For maximum improvement in most cases of social phobia, it also appears to be necessary to teach people to re-evaluate some of their thoughts and beliefs to learn, for example, that "everyone is not watching me" or that "if I say the wrong thing, people will not think I am stupid." Some form of social skills training may also be of value, because it may produce new skills and/or increase confidence.

While exposure to the feared object or situations is of immense value for the avoidance component of agoraphobia, maximum improvement is unlikely to occur without some attempt being made to deal with the unexpected panic attacks.

Treatment for panic attacks has traditionally involved the use of medications such as imipramine (Tofranil) or alprazolam (Xanax). More recently, psychological techniques are proving to be just as effective.


Cognitive Behavioral Therapy

Cognitive Behavioral Therapy is a therapeutic approach in psychology that is intended to help individuals learn to cope with anxiety inducing or stressful situations by rationally addressing faulty cognition and the ways in which it leads to inappropriate and self-defeating behaviors. For those with some knowledge of the history of psychology, even the name of the therapy might cause some confusion, as the disciplines of cognitive psychology and behaviorism are often seen as being at odds with one another. In this case, however, the theorists are more firmly on the side of cognitive psychology &ndash they definitely hold cognitive processes to have some degree of agency in causing behavior. They are not simply types of behavior in and of themselves.

Behavioral Therapies

The whole of cognitive behavioral therapy is quite vast, with a number of different approaches and techniques that ultimately intend to accomplish the same goals. As a therapeutic device, it has proven quite successful in helping diminish phobias, overcome anxiety disorders, and relieve the symptoms of posttraumatic stress disorder.

Exposure Therapy

One of the areas in which cognitive behavioral therapy, or CBT, has made the most strides is in dealing with anxiety and phobia. The underlying principle behind CBT is that one holds false beliefs and expectations about the world that adversely color our interactions with others, causing undue stress and anxiety. The psychologist O. Mowrer was one of the first to attempt to undermine those false beliefs with a form of therapy intended to improve behavior by way of cognition.

This type of therapy, known as exposure therapy, worked as follows. Suppose that you were afraid of spiders. Even if you knew rationally that a spider wasn't poisonous and posed no threat to you, you would still feel anxious when a spider came near you, and have feelings close to panic if one touched you. For the cognitive psychology, what is going on here? You hold false beliefs about spiders on some level, such that when you're exposed to them, your experience is affected adversely by your irrational cognition. The anxiety and fear you feel as a result reinforces those irrational feelings, making things worse.

With exposure therapy, you would be gradually exposed to your stressor (spiders), while at the same time having your typical response (anxiety and fear) suppressed. For instance, a therapist might place a spider near you and help you maintain a sense of calm through talking and becoming slowly and gradually acclimated to the idea of having a spider near you. In time, you might even be able to touch the spider. Eventually, your fears should diminish entirely. How does this work? It's simply that, if you're exposed to a spider without allowing your anxiety to be triggered, the stimulus of the spider gradually becomes disassociated from the response of anxiety, and the phobia is conquered.

Aaron Beck's Negative Triad

Another cognitive psychologist, Aaron Beck, was the first to formalize the idea of the cyclical interplay between environment, cognition, and behavior, calling it the negative triad. The negative triad works as follows.

First, one holds a "negative schema" regarding the world. Maybe this is the expectation that you will be treated poorly by others, or that others are looking to harm you in some way. Maybe it's simply the expectation that any cats you meet will bring you bad luck. Whatever the case, these negative schema are self-destructive beliefs with the tendency to induce stress in those who hold them.

When one interacts with the world, this negative schema provides the framework in which the interaction will unfold. If one talks to a job interviewer with a feeling of positivity, one might have good results. By contrast, if one talks to a job interviewer with a negative schema in place, feeling as if the situation is hopeless, then the meeting will probably go bad.

When the meeting does go bad, it reinforces our negative schema. We feel that our expectations have been met, and are thus justified. What we need to come to realize, according to Beck, is that our negative schema actually *cause* the poor outcomes and our own self-destructive behaviors. With conscious recognition, however, these cognitive biases and negative schemas can be overcome, and one can approach the world with feelings of confidence that will ultimately produce good results.

Success with Post-Traumatic Stress Disorder

Elsewhere, researchers have had a great deal of success applying CBT to posttraumatic stress disorders. Typically, those suffering from this disorder will feel a sense of generalized anxiety as a result of an earlier, unresolved traumatic event. Generally, this event will have led to the formation of negative schema that can, at least theoretically, be undone with CBT. Mark Reinecke at Northwestern University has conducted a number of recent studies that further verify the utility of CBT in combating posttraumatic stress disorder.

Criticisms

While CBT is one of the most popular therapeutic approaches to come out of clinical psychology in decades, it is not well loved by everyone. There are detractors, for instance, who claim that the relative simplicity and low implementation cost of CBT have led to its becoming more popular than warranted. As evidence for this, they cite the general lack of evidence that CBT can be therapeutically effective against schizophrenia and other psychotic disorders.

Evaluation

Cognitive Behavioral Therapy is the attempt to overcome anxiety, depression, and neuroses through the conscious recognition of self-destructive beliefs, with the assumption being that changing this cognition will ultimately change one's behavior, and thusly one's experience with the world.

CBT has had success in treating phobias through a technique called exposure therapy that involves gradual exposure to the object of fear, coupled with a systematic repression of the anxiety response.

Aaron Beck formalized the cyclical interplay of environment, cognition, and behavior with his "negative triad", a cycle in which one's negative schema affects one's experiences, and those experiences in turn reinforce one's negative schema.

While CBT has been shown to be effective in treating posttraumatic stress disorder, depression, anxiety, and phobias, little evidence has been cited that it is effective in dealing with schizophrenia and other psychotic disorders.

References

Mowrer, O. &ldquoLearning Theory and Behavior.&rdquo New York: John Wiley & Sons, 1960.


Stopping negative thought cycles

There are helpful and unhelpful ways of reacting to a situation, often determined by how you think about them.

For example, if your marriage has ended in divorce, you might think you've failed and that you're not capable of having another meaningful relationship.

This could lead to you feeling hopeless, lonely, depressed and tired, so you stop going out and meeting new people. You become trapped in a negative cycle, sitting at home alone and feeling bad about yourself.

But rather than accepting this way of thinking you could accept that many marriages end, learn from your mistakes and move on, and feel optimistic about the future.

This optimism could result in you becoming more socially active and you may start evening classes and develop a new circle of friends.

This is a simplified example, but it illustrates how certain thoughts, feelings, physical sensations and actions can trap you in a negative cycle and even create new situations that make you feel worse about yourself.

CBT aims to stop negative cycles such as these by breaking down things that make you feel bad, anxious or scared. By making your problems more manageable, CBT can help you change your negative thought patterns and improve the way you feel.

CBT can help you get to a point where you can achieve this on your own and tackle problems without the help of a therapist.


Results

Study selection

A total of 233 publications were identified from the electronic database of which 24 were removed as duplicates. An additional study [ 15] was identified in the reference list of a previous review [ 13]. The full texts of the remaining 10 studies were assessed, of which six were included in our systematic review and five in our meta-analysis (Figure 1).

Study characteristics

The characteristics of the six included studies are summarized in Table 1 (please see Table 1, Appendix 2, in the supplementary data, available in Age and Ageing online ).

Participants

The six reviewed studies included a total of 1,626 participants with mean age of 75.71 (74% female, n = 1,208 sample size 80 to 434) mainly recruited from the general community (n = 1,546, 95%). At baseline, one study [ 24] (n = 122) included subjects with at least one episode of fall in the year before the study. Two studies (n = 266) reported that 18% [ 25] and 56% [ 26] of participants had at least one fall episode in the year before the studies began. Two studies reported that 23% [ 15] and 61% [ 27] of participants had at least one fall episode 3 months and 6 months before the studies began respectively.

Intervention

Four studies [ 15, 24– 26] adopted group-based interventions and two [ 27, 28] adopted individual interventions. Five studies [ 15, 24– 26, 28] used face-to-face contact and one study [ 27] used both face-to-face and telephone contact. The length of intervention ranged from four to 20 weeks, and the number of face-to-face sessions ranged from three to nine with durations of 20–120 min.

The core components of the CBT interventions included cognitive restructuring, personal goal setting and promotion of physical activities. The CBT interventions of three studies [ 25– 27] were delivered by nurses.

Comparisons

Of four studies [ 15, 24, 27, 28] with two intervention arms, three studies compared CBT with inactive control [ 15, 27, 28] and one study compared the combined use of CBT and Tai Chi with Tai Chi alone [ 24]. Two further studies were three-arm trials in which CBT was compared with care-as-usual and CBT with Tai Chi [ 25, 26]. The mean follow-up period from immediate post-intervention to final measurement was 9.00 ± 4.12 months, ranging from 4 to 12 months.

Outcomes

Two studies [ 25, 26] assessed fear of falling by the FES [ 18]. Another two studies [ 27, 28] adopted the international version of the FES (FES-I) and another one study [ 24] adopted the Chinese version of the FES-I. The remaining one study [ 15] adopted the modified version of the FES. Three studies [ 25– 27] assessed balance by the Tinetti mobility scale (TMS) and one [ 28] used the functional reach test.

Methodological quality

The quality of the included studies varied (please see Table 2, Appendix 3, in the supplementary data , available in Age and Ageing online). Five studies [ 24– 28] reported adequate random sequence generation, and four [ 24– 27] reported adequate assessor binding. Five studies [ 15, 24– 26, 28] were assessed at low risk of attrition bias. All the six included studies were rated at low risk of reporting bias and other bias. However, all the six included studies had high risk of performance bias due to the lack of blinding between research personnel and participants that probably could lead to the overestimation of true effects of CBT.

Quantitative data analyses

Effects of CBT intervention

Fear of falling

Figure 2 summarizes the immediate between-groups effects of CBT compared with control conditions. Our analysis of five studies [ 24– 28] revealed a significant (P < 0.001) small effect size of 0.33 (95% CI 0.21–0.46) in favour of CBT compared with control with no significant heterogeneity (I 2 = 0%, P = 0.793). For the short-term retention effect (<6 months) (please see Figure 3, Appendix 4 in the Supplementary Data, available in Age and Ageing online ), our analysis (n = 4) [ 24– 26, 28] showed a significant (P = 0.002) small effect size of 0.25 (95% CI 0.09-0.41) in favour of CBT with no significant heterogeneity (I 2 = 0%, P = 0.679). For the long-term (≥6 months) retention effect, our analysis (n = 2) [ 27, 28] showed a significant (P < 0.001) small effect size of 0.37 (95% CI 0.21–0.53) in favour of CBT with no significant heterogeneity (I 2 = 0%, P = 0.975).

Meta-analysis and forest plots of (A) five studies using CBT for fear of falling immediately after the interventions ended and (B) four studies using CBT for balance immediately after the interventions ended.

Meta-analysis and forest plots of (A) five studies using CBT for fear of falling immediately after the interventions ended and (B) four studies using CBT for balance immediately after the interventions ended.

Balance

There was no effect of CBT on balance immediately following the trial, but a small effect of 0.18 (95% CI 0.02–0.33, P = 0.031) at the short-term (<6 months) follow-up. We did not calculate the long-term (≥6 months) effect as only one study [ 28] with last follow-up ≥ 6 months.

Subgroup analysis

Only adequate number of trials (n = 5) was available for the subgroup analysis for the immediate effect of fear of falling. Our analysis (please see Table 3, Appendix 5 in the Supplementary Data, available in Age and Ageing online ) based on the treatment delivery format (individual versus group-based intervention) revealed a significant difference (Q = 0.200, df = 1, P < 0.000). Group-based interventions showed a significant (P < 0.000) small effect size of 0.29 (95% CI 0.00–0.36), revealing a weaker effect than individual based interventions, which displayed a significant (P = 0.013) small to moderate effect size of 0.35 (95% CI 0.20–0.51).

Sensitivity analysis

With one trial [ 24] compared Tai Chi with and without CBT removed, the immediate effect (g = 0.34, 95% CI 0.20–0.48, P < 0.001) of CBT on fear of falling remained and the short-term (<6 months) retention effect on fear of falling increased from g = 0.25 to g = 0.28 (95% CI 0.10-0.46, P = 0.002). There was no effect on balance immediately following the trial and at the short-term (<6 months) follow-up (please see Figure 4, Appendix 6, in the Supplementary Data, available in Age and Ageing online ).

Publication bias

Less than 10 trials were identified, thus the Fail-Safe N analysis was performed and indicated that the required number of missing studies to bring the P-value > 0.05 (immediate effect on fear of falling) was 27.


Is Cognitive Behavioral Therapy for You? Maybe Not

Maybe you are thinking about going to therapy. So you do a search on the Internet for information and you come across one of the more popular types of therapy, cognitive behavioral therapy (CBT).

During your search you find that much of the information is vague and non-descript. In frustration you find the same generic information either cut and pasted or rewritten for the masses on various mental health sites. You see that cognitive behavioral therapy (CBT) is sometimes explained as a combination of two therapies: cognitive therapy (focusing on helping the patient change their irrational or dysfunctional thought patterns) and behavioral therapy (focusing on changing maladaptive actions and behaviors).

The literature proclaims this type of therapy as effective for treating a multitude of mental health conditions. Yet in many cases you aren't shown the studies or research to back up these claims.

Will CBT be an effective treatment for you? The answer is: It all depends. There are many factors which impact on the usefulness or functionality of any mental health treatment.

In this post I am going to discuss why there is no clear consensus on what cognitive behavioral therapy entails. In addition, I will list some of the potential reasons why CBT or some variations of CBT may not be an effective treatment for some people.

When someone uses the term "CBT" can we be certain of what they mean?

One of the problems in assessing whether or not CBT is an effective treatment for you is the fact that when people write about this type of therapy they usually speak in very general terms. Thomas A. Richards, Ph.D., Director of the Social Anxiety Instiute has this to say about CBT:

The insurance companies like CBT so much so that quite often they will not pay for any other type of therapy. The reason they like it so much? CBT is usually short-term and costs less than psychodynamic or interpersonal type therapies.

But what does it mean when a therapist says he or she does CBT? You may have to ask the individual therapist as there are a wide variety of ways this therapy may be interpreted and used.

For example, here are just some of the off-shoot varieties of cognitive behavioral therapies offered. If you read any of the descriptions you will see that these methodologies can be extremely different from one another but still under the umbrella of CBT.

Dialetical behavioral therapy

Acceptance and commitment therapy

Stress inoculation therapy

Mindfulness-based stress reduction

The other thing to keep in mind is that CBT may look a lot different for patients who are being treated for vastly different mental conditions. For example, someone coming in to be treated for schizophrenia may have a totally different experience than someone seeking CBT for panic attacks.

What happens during therapy, therapeutic technique, focus, and average length of treatment may be different for each patient. A therapist who says he or she does CBT really doesn't tell us anything about the actual therapy or what it will be like for the patient.

Do your research

If you really want to know what CBT may be like my suggestion is to ask other patients who have actually undergone this type of therapy. Everyone's experience is going to be different but at least you will get a better idea of what this therapy may be like from the patient perspective.

My other suggestion is to ask questions from a qualified mental health professional who is currently in practice, utilizes this approach, and has stayed current in their knowledge of effective CBT techniques.

Reasons why CBT may not be an effective therapy for you.

Your therapist may lack skill, experience, and education about effective cognitive behavioral techniques. One reason why CBT may get a bad rap in some cases is because of the overabundance of "therapists" who claim that they do this type of therapy so that insurance will pay them. Yet calling yourself a CBT therapist doesn't always mean that you are an effective therapist by association.

One of my worst therapy experiences was with a therapist who labeled himself as a cognitive behavioral therapist. He may have known some basic techniques, but he failed to tailor his approach so that I could achieve my goals. In fact, it was such a frustrating experience that I had to terminate therapy early. This was my first experience with CBT. My therapist's ineptness colored some of my perceptions about this type of therapy.

However, I do wish to say that some patients have wonderful experiences with therapists who use this approach and report that their CBT was very effective for treating their particular disorder. As with any type of treatment, everyone will have a unique response. Here are a few things to keep in mind about CBT.

1. Don't assume that just because a therapist says he or she is skilled at CBT makes him or her a good therapist for you.

Always check your therapist's credentials and don't be afraid to ask questions about their training and experience. In some cases the definition of CBT is so vague that it loses all meaning, especially when someone does not have sufficient training to conduct this type of therapy or any type of therapy for that matter. The following are some examples of this.

CBT is so popular that someone thought it might be a good idea to train general practitioners to conduct brief CBT for patients who they otherwise might refer to a mental health professional. General practitioners are quickly becoming the Walmarts of the medical world--your one stop shop for all your mental and medical needs.

Guess what? Being trained for four half days in cognitive behavioral therapy isn't enough training to make a difference.

In a 2002 study published in the British Medical Journal (BMJ) researchers concluded that training general practitioners to treat depressed patients with brief cognitive behavioral therapy is ineffective. This conclusion doesn't seem surprising especially since their training was so inadequate.

There are also therapists who claim they can conduct CBT sessions online and that these sessions will be just as good as an in-office meeting. Some people greatly disagree with this view stating that the therapist is missing out on critical aspects of communication such as tone, body language, and facial expression.

Not to mention the ethical concerns with online therapy. Email makes messages vulnerable to hackers. You may also be getting therapy from someone with little to no credentials.

The bottom line is that a medical professional or therapist who says he or she does cognitive behavioral therapy tells you nothing about their training, education, or ability to help you. Be wary.

2. In some cases cognitive behavior therapy stresses the therapy technique over the relationship between therapist and patient.

If you are an individual who is sensitive, emotional, and desires rapport with your therapist, CBT may not deliver in some cases. Again, the therapist is the critical element here.

One of the potential roadblocks is that some therapists will hammer away at the patient's dysfunctional thoughts but pay little attention to the fact that this is a multidimensional person affected by emotions, social interactions, and biology. It has been said that therapeutic technique is often less important to the overall outcome of therapy than the relationship one has with the therapist. If you do wish to try cognitive behavior therapy, find a therapist who meshes with your personality.

3. CBT promotes assumptions which may be faulty.

One of the basic tenets of CBT is that your faulty or irrational thought patterns and cognitions are responsible for maladaptive behavior and mental health problems. If one accepts this premise ,then some practitioners may dismiss the other factors which play a part in mental illness such as genetics and biology.

It assumes that the thoughts precede emotions, which isn't always true. It also usually labels any "negative" thoughts as pathological or dysfunctional. Again, this is not true.

Another faulty assumption is that changing one's thinking patterns can improve one's mood or decrease the symptoms of a mental disorder. Unfortunately this does not always happen. One cannot always "think" themselves better.

In a provocative article published in Time magazine entitled "Yes, I Suck: Self-Help Through Negative Thinking" writer John Cloud cites studies which show that attempting to get people to think more positively can backfire and make them feel even more unhappy than before. Those positive affirmations of the positivity gurus don't help much either.

Research has found that most people feel worse and not better after self-infliction of inflated statements of their worthiness.

In addition, changing your thought patterns may not help you with the fact that you got fired from your job due to poor work performance, got a bad grade on a test because you didn't study, or got a D.U.I for driving while drunk. Sometimes "negative" thoughts such as "I really messed up" are true. As the Time article points out sometimes we do fail and instead of wasting time fighting negative thoughts, maybe we should accept them, take ownership of our mistakes, and move on.

4. CBT may not give you enough time to meet your goals.

As stated previously, insurance companies love CBT because it is generally considered brief therapy. And we are talking really brief here. In some cases CBT may be limited to as little as six to twelve sessions.

As a patient I lift my brow in doubt. Really? Someone going in to be treated for depression who has early traumas, current social stressors, and a biological predisposition for a mood disorder is going to be all patched and ready to go in a few months? I would like to see that happen.

Jeremy Holmes, consultant clinical psychologist for Community Health NHS Trust, wrote a detailed commentary on the lack of real data to show that brief therapies actually work in the long run. For example, he cited a study which showed that six to 12 sessions of cognitive behavior therapy produced better results than care from a general practitioner at four months, but that this clinical gain was not maintained at 12 months. In other words, the studies which show CBT to be an effective treatment may have some flaws especially when it comes to showing long term gains.

5. Research shows that CBT or certain CBT techniques may be ineffective for many types of mental disorders.

I saved the big guns for last. Despite the popularity of CBT and the generalized statements that this type of therapy is effective for a multitude of mental health problems, there is also research to the contrary. There are mental health experts who agree that certain CBT techniques may be counterproductive or should be avoided altogether in treating certain mental disorders.

In a landmark 2009 review published in the journal Psychological Medicine, the study authors concluded that CBT is of no value in treating schizophrenia and has limited effect on depression. The authors also concluded that CBT is ineffective in preventing relapses in bipolar disorder.

In a 2009 study published in the British Journal of Psychiatry researchers compared depression treatment in adolescents over a period of 28 weeks. The study authors compared treatment with SSRI antidepressants versus the use of a combination of SSRIs and CBT. At the end of the 28 weeks both groups showed improvement but there were no significant differences between them. It was found that CBT did not add any benefit to the antidepressant treatment.

Dr. Thomas A Richards, director of the Social Anxiety Institute explains how telling the individual with social anxiety to stop thinking negative thoughts is not going to work. He also states that giving the socially anxious person positive affirmations to recite will do nothing. Instead, this practitioner advocates employing specific cognitive techniques such as helping the patient to be aware of their automatic negative thinking.

Dr. Stephen Phillipson writes on OCD Online that a critical element of good cognitive behavioral therapy is that the therapist be warm, understanding and compassionate. He also talks about how more traditional CBT techniques are ineffective for those patients with obsessive-compulsive disorder (OCD). He stresses that OCD is not a thought disorder but an anxiety disorder, which means that it is less likely a manifestation of irrational thoughts. He states that: "Helping OCD sufferers to see the irrational nature of their thought content is counterproductive."

The experts on PsychCentral agree that CBT has limited potential for helping those with Histrionic Personality Disorder. The authors state that: "Cognitive-oriented approaches are generally largely ineffective in treatment of this disorder and should be avoided." The reason, they share, is that people with this disorder are often incapable of examining their thoughts and motivations.

Although the first recommendation for someone who has a mental health condition, including an anxiety-related disorder, may be to receive cognitive behavioral therapy, it may be wise to do a little research first. Consider these questions:

Has CBT been shown to be an effective treatment for your particular disorder?

What does the research show?

What type of credentials, training, and experience does your therapist have?

Will brief therapy meet your needs or will you need more time?

What types of techniques does your therapist actually use during the course of treatment?

If possible I would fully recommend interviewing your chosen therapist before making the actual appointment.

Cognitive behavioral therapy includes a broad spectrum of therapeutic principles and techniques. Vague descriptions that CBT will be effective to treat your mental health disorder have little merit.

Patients deserve and require more substantial information than generalizations. As with any type of treatment or therapy, there will be plusses and minuses about using this approach. Look at CBT not as some cure for what ails you but maybe as one tool you can choose from an array of treatment options. CBT just may help you but you won't know unless you actually undergo treatment. In order for any therapy to work, your therapist will need to tailor their techniques to suit your goals, personality, and type of disorder.

CBT is not a one-size-fits-all methodology. We go wrong when we assume that this is a unified approach known to all. The details are very important in making any judgement about whether this approach may work for you.

These articles were written by a longtime HealthCentral community member who shared valuable insights from her experience living with multiple chronic health conditions. She used the pen name "Merely Me."


8 CBT techniques for anxiety that will calm an anxious mind:

Our thoughts make us anxious

The first thing to recognise about anxiety is that external factors are not making you anxious, your internal thoughts are. And if your inner thoughts are causing the problem, you can change the way you think about the situation.

Of course, this isn’t easy. We trust our brains to deliver the right information quickly so we can go about our business. So it can be hard to realise that our thoughts are giving us the wrong messages.

The first step in CBT therapy is understanding how our thoughts are responsible for the way we feel. There is nothing in everyday normal life to feel anxious about. The only thing that is making you anxious is you. But, you can change that.

Thoughts can’t hurt you

You’re having a panic attack and you feel as you’re going to die. In a social situation, a person with social anxiety might think they’re going to collapse. Someone with OCD might feel so stressed about checking or counting they feel physically sick.

How do we get to such extreme physical symptoms from a single thought? Because we’ve programmed ourselves to have an automatic reaction to the stressful situation. Our thoughts tumble out of our minds with no chance of stopping and escalate into a full-blown panic attack.

But think – thoughts cannot hurt you. Look around you now. Focus on a book or a lamp and say to yourself “Oh my God if I look at that book, I’ll faint.” No amount of you thinking it will make it happen.

The next time you feel anxious, remember: just because you think it, it doesn’t mean you can make it happen.

Don’t set yourself up to fail

What’s the difference between a person with driving phobia and someone who drives without anxiety? The person who drives normally doesn’t think about driving before they set off.

Someone with the driving phobia will already be worrying about the journey, what will happen, what could go wrong, will they get lost, have an accident, or will they have a panic attack?

Now think about the driver who didn’t have anxiety. What do you think would happen if he or she started thinking the same thoughts as the anxious driver?

The chances are that the once confident driver could now start to feel a little anxious about driving. But the roads haven’t changed, nor has the car they are driving. Only their thoughts. Don’t forget, your thoughts are responsible, not external factors.

Be rational and logical

Time to think like Spock. When you are in a stressful situation, your mind starts racing and is out of control. The best way to stop this is to take a step back and think rationally. It helps if you look at the situation from another perspective or another person’s point of view.

Let’s take that driving example again. For every worrying thought that crops up, look at it in a rational manner as if you were talking to a friend.

What if you did get lost? Do you have a sat nav or a map? What if you do break down? Do you have breakdown cover? Identify what you feel is dangerous about the situation and look at it calmly and rationally.

Ask yourself ‘What’s the worst that could happen?’

What for you is the worst thing that could happen? If you get anxious during interviews, what do you fear the most?

Not being able to answer a question? Do you feel trapped in a social situation that you can’t escape from? Are you worried you’ll have a panic attack on an aeroplane?

Identify your worst fear and then examine it logically. No one has died from a panic attack. Panic attacks end. Yes, they are extremely horrible, but you are safe, you are not in danger.

Talk to yourself and reassure yourself about the thing you are most afraid of. By analysing them in a logical way, you take their power away.

Start taking small steps

So, you know that your thoughts are making you anxious and that they cannot hurt you. The next way to beat your anxiety with CBT techniques is to start taking small steps that will build up your confidence in the situation you find stressful.

The best way to tackle this is to make a ladder with the small steps at the bottom that cause you some anxiety but you can do, and goals at the top that cause you extreme anxiety and you cannot do.

The way to work through the ladder is to start at the bottom and go through each step until you are bored with it. Only then do you move onto the next step. Most importantly, reward yourself after each step to reinforce a positive emotion with your success.

Be patient and kind to yourself

If you have suffered from a phobia or anxiety for years or decades, remember that these CBT techniques won’t work overnight. Your brain has been programmed to feel anxiety.

You have learned over the years that a certain situation is dangerous. Now your brain has to unlearn all the lessons you gave it. This takes time, patience and endurance.

Remember, you may have setbacks as well as good weeks. Don’t expect your progress to be without a few bumps here and there. But reward any small victories and don’t downplay your successes.

Remember, what’s easy for some is really hard for you. It is also very easy to slip into a ‘Why me?’ way of thinking but this doesn’t help in the long run. Of course, lots of people have got it easier than you, but equally, a lot more have it much harder.

If all else fails, act normal

It helps to remember that anxiety is a natural response to stress. As a result, adrenalin rushes through our bodies preparing us to fight or flight. Blood is drawn away from areas such as the stomach (we don’t need to digest food in an emergency situation) and directed to the legs and arms for running or fighting.

One way to train our brains that anxiety is an incorrect response is to do something that lets the brain know adrenalin is not required.

For example, I remember being in the middle of a panic attack and my friend said something ridiculous which made me laugh. All the anxiety dissipated because my laughter informed my brain there was nothing to be afraid of.

It is hard to stop being frightened, but try having open body posture, smiling, talking calmly, and breathing slowly. Even chewing a piece of gum will help as it redirects blood back to the stomach.

Being in the grip of an anxious episode is extremely frightening. However, remember that you are in control of your thoughts, and by using these CBT techniques, it is possible to calm your anxiety.

Copyright © 2012-2021 Learning Mind. All rights reserved. For permission to reprint, contact us.

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A nice reminder of the effectiveness of CBT, thanks Janey. The ability to reframe our perceptions is incredibly powerful and I’ve found stoic philosophy very helpful in practicing these mental models.

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ABOUT LEARNING MIND

Learning Mind is a blog created by Anna LeMind, B.A., with the purpose to give you food for thought and solutions for understanding yourself and living a more meaningful life. Learning Mind has over 50,000 email subscribers and more than 1,5 million followers on social media.

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DISCLAIMER

All content published on this website is intended for informational purposes only. Learning Mind does not provide medical, psychological, or any other type of professional advice, diagnosis, or treatment.


Benefits of Cognitive Behavioral Therapy for Teens

Amy Morin, LCSW, is the Editor-in-Chief of Verywell Mind. She's also a psychotherapist, the author of the bestselling book ൕ Things Mentally Strong People Don't Do," and the host of The Verywell Mind Podcast.

Carly Snyder, MD is a reproductive and perinatal psychiatrist who combines traditional psychiatry with integrative medicine-based treatments.

Cognitive behavioral therapy often referred to as CBT, is a type of psychotherapy that focuses on making connections between thoughts, behavior, and feelings. Psychotherapists who use CBT help people identify and change dysfunctional patterns.   CBT is often used with adolescents. It can be effective in treating a wide range of issues including eating disorders, substance abuse, anxiety, and depression.  


Cognitive Therapy for anxiety is, to some extent, relative to different age groups. Techniques of Cognitive Therapy, in general, is very effective across all ages, the reception, however, varies according to different ages. Adults and older adults prefer cognitive Therapy over medication, as it suits better. Although, the adults and older adults are less motivated to open up and accept change of thoughts emotionally.

For children, teens, and young adult, on the other hand, sees the exact opposite scenario. For them, their physiology is able enough to tolerate medication, unlike older adults. But, when it comes to cognition therapy, they are more open to sharing emotions and more malleable to change of thoughts.

If you are suffering from anxiety, and plan to receive cognitive Therapy -you will need to be patient and committed. It is not a matter of quick fix or immediate change. The CBT process will aim to cure the negative structures of your thought process at the root and replace it with healthy approaches.

1. Does Cognitive Therapy work for anxiety?

Since the distortion of cognition essentially causes anxiety, cognition therapy can be a pivotal instrument in the matter. Doctors and therapists structured the processes of CBT, specifically to help individuals with anxiety and depression.

2. Why does CBT work for anxiety?

Cognitive distortions like blaming others, the misconception of fairness, emotional reasoning, following the global trend, unacceptance of mistakes and such, lead to anxiety. CBT techniques for anxiety help you identify such distortions. Draw productive emotions out of adverse events and exhibit correctional behavior.

3. How long does it take for CBT to work for anxiety?

CBT techniques for anxiety are generally short-term as compared to other mental therapies. It generally takes from a few weeks to months.

4. What are the cognitive symptoms of anxiety?

The initial cognitive symptoms of anxiety are low self-esteem and a sense of uselessness.


Cognitive Behavioral Therapy For The Death Of A Loved One

There is a common thought pattern following the death of a loved one that could be categorized as faulty thinking, which makes cognitive behavioral therapy, with its emphasis on isolating, challenging, and correcting faulty thinking patterns, an important piece of the grief recovery puzzle.

Actually there are many common faulty thinking patterns following the death of a loved one but the one we want to talk about here is called fortune telling, which is basically where you believe you have a crystal ball that lets you see into the future in order to perfectly predict how things are going to play out.

In the throes of grief fortune telling manifests as the idea that you’ll never be happy again, that there’s no reason to expect anything good out of life anymore, that how you’re feeling now is how you’re going to feel forever.

Beliefs exert a powerful impact on thoughts, emotions, and behavior and therefore a powerful impact on outcomes. Often what we believe will happen ends up acting as a self-fulfilling prophecy, it ends up happening because we make our behavior and the behavior of those around us line up with our beliefs.

There is no denying that after losing a loved one things can never be the same again, but the difference is that going through the process of grief recovery leaves you with a scar whereas not going through the process of grief recovery leaves you with an open wound. Those who loudly proclaim that there is no such thing as ‘grief recovery’ or ‘closure’ are often victims of fortune telling, where their beliefs that they can never be happy again, that there’s no reason to expect anything good out of life anymore, and that they’re going to feel the same way forever keep them from ever taking those difficult steps towards healing.

When we say ‘closure’ we don’t mean forgetting, we don’t even necessarily mean moving on if by moving on what is meant is ceasing to think about or love the person who has passed away. What we do mean is recognizing that loss as final and having the courage to say goodbye, both to the person and to how things were, in order to stop letting the past take up too much space in the present and future. This is closure in the Gestalt sense of the word, closure in the sense of moving all the way through the needs satisfaction cycle so that it’s possible to open up new gestalts instead of staying perpetually stuck in the old one.

The point of cognitive behavioral therapy is to isolate the faulty thinking patterns responsible for dysfunction and then challenge them. In the context of this article, some questions to ask are:

“How can you be so sure you’ll never be happy again? Have you ever had an emotional state that lasted forever?”
“How do you know nothing good will ever come your way again? Have you ever had bad things happen to you when you thought the result would be good or good things happen to you when you thought the result would be bad?”
“Have you ever been wrong about a prediction you were sure would come true in the past? When?”

None of us can perfectly predict the future, but our thoughts, beliefs, and actions in the present can and do exert a profound influence on that future. By making room for the possibility, however small, of having a happy future where good things happen to you the first threads of that future start to be woven together.


8 CBT techniques for anxiety that will calm an anxious mind:

Our thoughts make us anxious

The first thing to recognise about anxiety is that external factors are not making you anxious, your internal thoughts are. And if your inner thoughts are causing the problem, you can change the way you think about the situation.

Of course, this isn’t easy. We trust our brains to deliver the right information quickly so we can go about our business. So it can be hard to realise that our thoughts are giving us the wrong messages.

The first step in CBT therapy is understanding how our thoughts are responsible for the way we feel. There is nothing in everyday normal life to feel anxious about. The only thing that is making you anxious is you. But, you can change that.

Thoughts can’t hurt you

You’re having a panic attack and you feel as you’re going to die. In a social situation, a person with social anxiety might think they’re going to collapse. Someone with OCD might feel so stressed about checking or counting they feel physically sick.

How do we get to such extreme physical symptoms from a single thought? Because we’ve programmed ourselves to have an automatic reaction to the stressful situation. Our thoughts tumble out of our minds with no chance of stopping and escalate into a full-blown panic attack.

But think – thoughts cannot hurt you. Look around you now. Focus on a book or a lamp and say to yourself “Oh my God if I look at that book, I’ll faint.” No amount of you thinking it will make it happen.

The next time you feel anxious, remember: just because you think it, it doesn’t mean you can make it happen.

Don’t set yourself up to fail

What’s the difference between a person with driving phobia and someone who drives without anxiety? The person who drives normally doesn’t think about driving before they set off.

Someone with the driving phobia will already be worrying about the journey, what will happen, what could go wrong, will they get lost, have an accident, or will they have a panic attack?

Now think about the driver who didn’t have anxiety. What do you think would happen if he or she started thinking the same thoughts as the anxious driver?

The chances are that the once confident driver could now start to feel a little anxious about driving. But the roads haven’t changed, nor has the car they are driving. Only their thoughts. Don’t forget, your thoughts are responsible, not external factors.

Be rational and logical

Time to think like Spock. When you are in a stressful situation, your mind starts racing and is out of control. The best way to stop this is to take a step back and think rationally. It helps if you look at the situation from another perspective or another person’s point of view.

Let’s take that driving example again. For every worrying thought that crops up, look at it in a rational manner as if you were talking to a friend.

What if you did get lost? Do you have a sat nav or a map? What if you do break down? Do you have breakdown cover? Identify what you feel is dangerous about the situation and look at it calmly and rationally.

Ask yourself ‘What’s the worst that could happen?’

What for you is the worst thing that could happen? If you get anxious during interviews, what do you fear the most?

Not being able to answer a question? Do you feel trapped in a social situation that you can’t escape from? Are you worried you’ll have a panic attack on an aeroplane?

Identify your worst fear and then examine it logically. No one has died from a panic attack. Panic attacks end. Yes, they are extremely horrible, but you are safe, you are not in danger.

Talk to yourself and reassure yourself about the thing you are most afraid of. By analysing them in a logical way, you take their power away.

Start taking small steps

So, you know that your thoughts are making you anxious and that they cannot hurt you. The next way to beat your anxiety with CBT techniques is to start taking small steps that will build up your confidence in the situation you find stressful.

The best way to tackle this is to make a ladder with the small steps at the bottom that cause you some anxiety but you can do, and goals at the top that cause you extreme anxiety and you cannot do.

The way to work through the ladder is to start at the bottom and go through each step until you are bored with it. Only then do you move onto the next step. Most importantly, reward yourself after each step to reinforce a positive emotion with your success.

Be patient and kind to yourself

If you have suffered from a phobia or anxiety for years or decades, remember that these CBT techniques won’t work overnight. Your brain has been programmed to feel anxiety.

You have learned over the years that a certain situation is dangerous. Now your brain has to unlearn all the lessons you gave it. This takes time, patience and endurance.

Remember, you may have setbacks as well as good weeks. Don’t expect your progress to be without a few bumps here and there. But reward any small victories and don’t downplay your successes.

Remember, what’s easy for some is really hard for you. It is also very easy to slip into a ‘Why me?’ way of thinking but this doesn’t help in the long run. Of course, lots of people have got it easier than you, but equally, a lot more have it much harder.

If all else fails, act normal

It helps to remember that anxiety is a natural response to stress. As a result, adrenalin rushes through our bodies preparing us to fight or flight. Blood is drawn away from areas such as the stomach (we don’t need to digest food in an emergency situation) and directed to the legs and arms for running or fighting.

One way to train our brains that anxiety is an incorrect response is to do something that lets the brain know adrenalin is not required.

For example, I remember being in the middle of a panic attack and my friend said something ridiculous which made me laugh. All the anxiety dissipated because my laughter informed my brain there was nothing to be afraid of.

It is hard to stop being frightened, but try having open body posture, smiling, talking calmly, and breathing slowly. Even chewing a piece of gum will help as it redirects blood back to the stomach.

Being in the grip of an anxious episode is extremely frightening. However, remember that you are in control of your thoughts, and by using these CBT techniques, it is possible to calm your anxiety.

Copyright © 2012-2021 Learning Mind. All rights reserved. For permission to reprint, contact us.

Share This Story! Share this content

This Post Has One Comment

A nice reminder of the effectiveness of CBT, thanks Janey. The ability to reframe our perceptions is incredibly powerful and I’ve found stoic philosophy very helpful in practicing these mental models.

Leave a Reply Cancel reply

ABOUT LEARNING MIND

Learning Mind is a blog created by Anna LeMind, B.A., with the purpose to give you food for thought and solutions for understanding yourself and living a more meaningful life. Learning Mind has over 50,000 email subscribers and more than 1,5 million followers on social media.

Join our mailing list

DISCLAIMER

All content published on this website is intended for informational purposes only. Learning Mind does not provide medical, psychological, or any other type of professional advice, diagnosis, or treatment.


Results

Study selection

A total of 233 publications were identified from the electronic database of which 24 were removed as duplicates. An additional study [ 15] was identified in the reference list of a previous review [ 13]. The full texts of the remaining 10 studies were assessed, of which six were included in our systematic review and five in our meta-analysis (Figure 1).

Study characteristics

The characteristics of the six included studies are summarized in Table 1 (please see Table 1, Appendix 2, in the supplementary data, available in Age and Ageing online ).

Participants

The six reviewed studies included a total of 1,626 participants with mean age of 75.71 (74% female, n = 1,208 sample size 80 to 434) mainly recruited from the general community (n = 1,546, 95%). At baseline, one study [ 24] (n = 122) included subjects with at least one episode of fall in the year before the study. Two studies (n = 266) reported that 18% [ 25] and 56% [ 26] of participants had at least one fall episode in the year before the studies began. Two studies reported that 23% [ 15] and 61% [ 27] of participants had at least one fall episode 3 months and 6 months before the studies began respectively.

Intervention

Four studies [ 15, 24– 26] adopted group-based interventions and two [ 27, 28] adopted individual interventions. Five studies [ 15, 24– 26, 28] used face-to-face contact and one study [ 27] used both face-to-face and telephone contact. The length of intervention ranged from four to 20 weeks, and the number of face-to-face sessions ranged from three to nine with durations of 20–120 min.

The core components of the CBT interventions included cognitive restructuring, personal goal setting and promotion of physical activities. The CBT interventions of three studies [ 25– 27] were delivered by nurses.

Comparisons

Of four studies [ 15, 24, 27, 28] with two intervention arms, three studies compared CBT with inactive control [ 15, 27, 28] and one study compared the combined use of CBT and Tai Chi with Tai Chi alone [ 24]. Two further studies were three-arm trials in which CBT was compared with care-as-usual and CBT with Tai Chi [ 25, 26]. The mean follow-up period from immediate post-intervention to final measurement was 9.00 ± 4.12 months, ranging from 4 to 12 months.

Outcomes

Two studies [ 25, 26] assessed fear of falling by the FES [ 18]. Another two studies [ 27, 28] adopted the international version of the FES (FES-I) and another one study [ 24] adopted the Chinese version of the FES-I. The remaining one study [ 15] adopted the modified version of the FES. Three studies [ 25– 27] assessed balance by the Tinetti mobility scale (TMS) and one [ 28] used the functional reach test.

Methodological quality

The quality of the included studies varied (please see Table 2, Appendix 3, in the supplementary data , available in Age and Ageing online). Five studies [ 24– 28] reported adequate random sequence generation, and four [ 24– 27] reported adequate assessor binding. Five studies [ 15, 24– 26, 28] were assessed at low risk of attrition bias. All the six included studies were rated at low risk of reporting bias and other bias. However, all the six included studies had high risk of performance bias due to the lack of blinding between research personnel and participants that probably could lead to the overestimation of true effects of CBT.

Quantitative data analyses

Effects of CBT intervention

Fear of falling

Figure 2 summarizes the immediate between-groups effects of CBT compared with control conditions. Our analysis of five studies [ 24– 28] revealed a significant (P < 0.001) small effect size of 0.33 (95% CI 0.21–0.46) in favour of CBT compared with control with no significant heterogeneity (I 2 = 0%, P = 0.793). For the short-term retention effect (<6 months) (please see Figure 3, Appendix 4 in the Supplementary Data, available in Age and Ageing online ), our analysis (n = 4) [ 24– 26, 28] showed a significant (P = 0.002) small effect size of 0.25 (95% CI 0.09-0.41) in favour of CBT with no significant heterogeneity (I 2 = 0%, P = 0.679). For the long-term (≥6 months) retention effect, our analysis (n = 2) [ 27, 28] showed a significant (P < 0.001) small effect size of 0.37 (95% CI 0.21–0.53) in favour of CBT with no significant heterogeneity (I 2 = 0%, P = 0.975).

Meta-analysis and forest plots of (A) five studies using CBT for fear of falling immediately after the interventions ended and (B) four studies using CBT for balance immediately after the interventions ended.

Meta-analysis and forest plots of (A) five studies using CBT for fear of falling immediately after the interventions ended and (B) four studies using CBT for balance immediately after the interventions ended.

Balance

There was no effect of CBT on balance immediately following the trial, but a small effect of 0.18 (95% CI 0.02–0.33, P = 0.031) at the short-term (<6 months) follow-up. We did not calculate the long-term (≥6 months) effect as only one study [ 28] with last follow-up ≥ 6 months.

Subgroup analysis

Only adequate number of trials (n = 5) was available for the subgroup analysis for the immediate effect of fear of falling. Our analysis (please see Table 3, Appendix 5 in the Supplementary Data, available in Age and Ageing online ) based on the treatment delivery format (individual versus group-based intervention) revealed a significant difference (Q = 0.200, df = 1, P < 0.000). Group-based interventions showed a significant (P < 0.000) small effect size of 0.29 (95% CI 0.00–0.36), revealing a weaker effect than individual based interventions, which displayed a significant (P = 0.013) small to moderate effect size of 0.35 (95% CI 0.20–0.51).

Sensitivity analysis

With one trial [ 24] compared Tai Chi with and without CBT removed, the immediate effect (g = 0.34, 95% CI 0.20–0.48, P < 0.001) of CBT on fear of falling remained and the short-term (<6 months) retention effect on fear of falling increased from g = 0.25 to g = 0.28 (95% CI 0.10-0.46, P = 0.002). There was no effect on balance immediately following the trial and at the short-term (<6 months) follow-up (please see Figure 4, Appendix 6, in the Supplementary Data, available in Age and Ageing online ).

Publication bias

Less than 10 trials were identified, thus the Fail-Safe N analysis was performed and indicated that the required number of missing studies to bring the P-value > 0.05 (immediate effect on fear of falling) was 27.


Cognitive Behavioral Therapy

Cognitive Behavioral Therapy is a therapeutic approach in psychology that is intended to help individuals learn to cope with anxiety inducing or stressful situations by rationally addressing faulty cognition and the ways in which it leads to inappropriate and self-defeating behaviors. For those with some knowledge of the history of psychology, even the name of the therapy might cause some confusion, as the disciplines of cognitive psychology and behaviorism are often seen as being at odds with one another. In this case, however, the theorists are more firmly on the side of cognitive psychology &ndash they definitely hold cognitive processes to have some degree of agency in causing behavior. They are not simply types of behavior in and of themselves.

Behavioral Therapies

The whole of cognitive behavioral therapy is quite vast, with a number of different approaches and techniques that ultimately intend to accomplish the same goals. As a therapeutic device, it has proven quite successful in helping diminish phobias, overcome anxiety disorders, and relieve the symptoms of posttraumatic stress disorder.

Exposure Therapy

One of the areas in which cognitive behavioral therapy, or CBT, has made the most strides is in dealing with anxiety and phobia. The underlying principle behind CBT is that one holds false beliefs and expectations about the world that adversely color our interactions with others, causing undue stress and anxiety. The psychologist O. Mowrer was one of the first to attempt to undermine those false beliefs with a form of therapy intended to improve behavior by way of cognition.

This type of therapy, known as exposure therapy, worked as follows. Suppose that you were afraid of spiders. Even if you knew rationally that a spider wasn't poisonous and posed no threat to you, you would still feel anxious when a spider came near you, and have feelings close to panic if one touched you. For the cognitive psychology, what is going on here? You hold false beliefs about spiders on some level, such that when you're exposed to them, your experience is affected adversely by your irrational cognition. The anxiety and fear you feel as a result reinforces those irrational feelings, making things worse.

With exposure therapy, you would be gradually exposed to your stressor (spiders), while at the same time having your typical response (anxiety and fear) suppressed. For instance, a therapist might place a spider near you and help you maintain a sense of calm through talking and becoming slowly and gradually acclimated to the idea of having a spider near you. In time, you might even be able to touch the spider. Eventually, your fears should diminish entirely. How does this work? It's simply that, if you're exposed to a spider without allowing your anxiety to be triggered, the stimulus of the spider gradually becomes disassociated from the response of anxiety, and the phobia is conquered.

Aaron Beck's Negative Triad

Another cognitive psychologist, Aaron Beck, was the first to formalize the idea of the cyclical interplay between environment, cognition, and behavior, calling it the negative triad. The negative triad works as follows.

First, one holds a "negative schema" regarding the world. Maybe this is the expectation that you will be treated poorly by others, or that others are looking to harm you in some way. Maybe it's simply the expectation that any cats you meet will bring you bad luck. Whatever the case, these negative schema are self-destructive beliefs with the tendency to induce stress in those who hold them.

When one interacts with the world, this negative schema provides the framework in which the interaction will unfold. If one talks to a job interviewer with a feeling of positivity, one might have good results. By contrast, if one talks to a job interviewer with a negative schema in place, feeling as if the situation is hopeless, then the meeting will probably go bad.

When the meeting does go bad, it reinforces our negative schema. We feel that our expectations have been met, and are thus justified. What we need to come to realize, according to Beck, is that our negative schema actually *cause* the poor outcomes and our own self-destructive behaviors. With conscious recognition, however, these cognitive biases and negative schemas can be overcome, and one can approach the world with feelings of confidence that will ultimately produce good results.

Success with Post-Traumatic Stress Disorder

Elsewhere, researchers have had a great deal of success applying CBT to posttraumatic stress disorders. Typically, those suffering from this disorder will feel a sense of generalized anxiety as a result of an earlier, unresolved traumatic event. Generally, this event will have led to the formation of negative schema that can, at least theoretically, be undone with CBT. Mark Reinecke at Northwestern University has conducted a number of recent studies that further verify the utility of CBT in combating posttraumatic stress disorder.

Criticisms

While CBT is one of the most popular therapeutic approaches to come out of clinical psychology in decades, it is not well loved by everyone. There are detractors, for instance, who claim that the relative simplicity and low implementation cost of CBT have led to its becoming more popular than warranted. As evidence for this, they cite the general lack of evidence that CBT can be therapeutically effective against schizophrenia and other psychotic disorders.

Evaluation

Cognitive Behavioral Therapy is the attempt to overcome anxiety, depression, and neuroses through the conscious recognition of self-destructive beliefs, with the assumption being that changing this cognition will ultimately change one's behavior, and thusly one's experience with the world.

CBT has had success in treating phobias through a technique called exposure therapy that involves gradual exposure to the object of fear, coupled with a systematic repression of the anxiety response.

Aaron Beck formalized the cyclical interplay of environment, cognition, and behavior with his "negative triad", a cycle in which one's negative schema affects one's experiences, and those experiences in turn reinforce one's negative schema.

While CBT has been shown to be effective in treating posttraumatic stress disorder, depression, anxiety, and phobias, little evidence has been cited that it is effective in dealing with schizophrenia and other psychotic disorders.

References

Mowrer, O. &ldquoLearning Theory and Behavior.&rdquo New York: John Wiley & Sons, 1960.


New Developments in Cognitive-Behavioral Therapy for Social Anxiety Disorder

Social anxiety disorder (SAD) is a highly prevalent and chronic disorder that causes considerable psychosocial impairment. This article reviews recent changes in the definition of SAD in DSM-5 and summarizes the current evidence for effective cognitive-behavioral treatments in adults, children, and adolescents. Current data suggests that cognitive-behavioral therapy (CBT) is efficacious in the treatment of this condition. Among different CBT approaches, individual cognitive therapy may be associated with the largest effect sizes. In this review, interventions targeting dysfunctional cognitive processes that contribute to the effective treatment of SAD are discussed. Some recent findings from neuroimaging research and studies on the augmentation of CBT using neuroenhancers indicate that changes in emotion regulation as well as fear extinction are important psychological mediators of positive outcome. Furthermore, internet-delivered CBT is a promising field of technological innovation that may improve access to effective treatments. Despite the availability of effective treatments, treatment-resistant SAD remains a common problem in clinical practice that requires more research efforts. Finally, potential areas for further development of CBT as well as its dissemination in health care are summarized.

Keywords: Cognitive therapy Emotion regulation Fear extinction Internet-delivered CBT Neuroenhancement Social anxiety disorder Treatment-resistant SAD.


Benefits of Cognitive Behavioral Therapy for Teens

Amy Morin, LCSW, is the Editor-in-Chief of Verywell Mind. She's also a psychotherapist, the author of the bestselling book ൕ Things Mentally Strong People Don't Do," and the host of The Verywell Mind Podcast.

Carly Snyder, MD is a reproductive and perinatal psychiatrist who combines traditional psychiatry with integrative medicine-based treatments.

Cognitive behavioral therapy often referred to as CBT, is a type of psychotherapy that focuses on making connections between thoughts, behavior, and feelings. Psychotherapists who use CBT help people identify and change dysfunctional patterns.   CBT is often used with adolescents. It can be effective in treating a wide range of issues including eating disorders, substance abuse, anxiety, and depression.  


Is Cognitive Behavioral Therapy for You? Maybe Not

Maybe you are thinking about going to therapy. So you do a search on the Internet for information and you come across one of the more popular types of therapy, cognitive behavioral therapy (CBT).

During your search you find that much of the information is vague and non-descript. In frustration you find the same generic information either cut and pasted or rewritten for the masses on various mental health sites. You see that cognitive behavioral therapy (CBT) is sometimes explained as a combination of two therapies: cognitive therapy (focusing on helping the patient change their irrational or dysfunctional thought patterns) and behavioral therapy (focusing on changing maladaptive actions and behaviors).

The literature proclaims this type of therapy as effective for treating a multitude of mental health conditions. Yet in many cases you aren't shown the studies or research to back up these claims.

Will CBT be an effective treatment for you? The answer is: It all depends. There are many factors which impact on the usefulness or functionality of any mental health treatment.

In this post I am going to discuss why there is no clear consensus on what cognitive behavioral therapy entails. In addition, I will list some of the potential reasons why CBT or some variations of CBT may not be an effective treatment for some people.

When someone uses the term "CBT" can we be certain of what they mean?

One of the problems in assessing whether or not CBT is an effective treatment for you is the fact that when people write about this type of therapy they usually speak in very general terms. Thomas A. Richards, Ph.D., Director of the Social Anxiety Instiute has this to say about CBT:

The insurance companies like CBT so much so that quite often they will not pay for any other type of therapy. The reason they like it so much? CBT is usually short-term and costs less than psychodynamic or interpersonal type therapies.

But what does it mean when a therapist says he or she does CBT? You may have to ask the individual therapist as there are a wide variety of ways this therapy may be interpreted and used.

For example, here are just some of the off-shoot varieties of cognitive behavioral therapies offered. If you read any of the descriptions you will see that these methodologies can be extremely different from one another but still under the umbrella of CBT.

Dialetical behavioral therapy

Acceptance and commitment therapy

Stress inoculation therapy

Mindfulness-based stress reduction

The other thing to keep in mind is that CBT may look a lot different for patients who are being treated for vastly different mental conditions. For example, someone coming in to be treated for schizophrenia may have a totally different experience than someone seeking CBT for panic attacks.

What happens during therapy, therapeutic technique, focus, and average length of treatment may be different for each patient. A therapist who says he or she does CBT really doesn't tell us anything about the actual therapy or what it will be like for the patient.

Do your research

If you really want to know what CBT may be like my suggestion is to ask other patients who have actually undergone this type of therapy. Everyone's experience is going to be different but at least you will get a better idea of what this therapy may be like from the patient perspective.

My other suggestion is to ask questions from a qualified mental health professional who is currently in practice, utilizes this approach, and has stayed current in their knowledge of effective CBT techniques.

Reasons why CBT may not be an effective therapy for you.

Your therapist may lack skill, experience, and education about effective cognitive behavioral techniques. One reason why CBT may get a bad rap in some cases is because of the overabundance of "therapists" who claim that they do this type of therapy so that insurance will pay them. Yet calling yourself a CBT therapist doesn't always mean that you are an effective therapist by association.

One of my worst therapy experiences was with a therapist who labeled himself as a cognitive behavioral therapist. He may have known some basic techniques, but he failed to tailor his approach so that I could achieve my goals. In fact, it was such a frustrating experience that I had to terminate therapy early. This was my first experience with CBT. My therapist's ineptness colored some of my perceptions about this type of therapy.

However, I do wish to say that some patients have wonderful experiences with therapists who use this approach and report that their CBT was very effective for treating their particular disorder. As with any type of treatment, everyone will have a unique response. Here are a few things to keep in mind about CBT.

1. Don't assume that just because a therapist says he or she is skilled at CBT makes him or her a good therapist for you.

Always check your therapist's credentials and don't be afraid to ask questions about their training and experience. In some cases the definition of CBT is so vague that it loses all meaning, especially when someone does not have sufficient training to conduct this type of therapy or any type of therapy for that matter. The following are some examples of this.

CBT is so popular that someone thought it might be a good idea to train general practitioners to conduct brief CBT for patients who they otherwise might refer to a mental health professional. General practitioners are quickly becoming the Walmarts of the medical world--your one stop shop for all your mental and medical needs.

Guess what? Being trained for four half days in cognitive behavioral therapy isn't enough training to make a difference.

In a 2002 study published in the British Medical Journal (BMJ) researchers concluded that training general practitioners to treat depressed patients with brief cognitive behavioral therapy is ineffective. This conclusion doesn't seem surprising especially since their training was so inadequate.

There are also therapists who claim they can conduct CBT sessions online and that these sessions will be just as good as an in-office meeting. Some people greatly disagree with this view stating that the therapist is missing out on critical aspects of communication such as tone, body language, and facial expression.

Not to mention the ethical concerns with online therapy. Email makes messages vulnerable to hackers. You may also be getting therapy from someone with little to no credentials.

The bottom line is that a medical professional or therapist who says he or she does cognitive behavioral therapy tells you nothing about their training, education, or ability to help you. Be wary.

2. In some cases cognitive behavior therapy stresses the therapy technique over the relationship between therapist and patient.

If you are an individual who is sensitive, emotional, and desires rapport with your therapist, CBT may not deliver in some cases. Again, the therapist is the critical element here.

One of the potential roadblocks is that some therapists will hammer away at the patient's dysfunctional thoughts but pay little attention to the fact that this is a multidimensional person affected by emotions, social interactions, and biology. It has been said that therapeutic technique is often less important to the overall outcome of therapy than the relationship one has with the therapist. If you do wish to try cognitive behavior therapy, find a therapist who meshes with your personality.

3. CBT promotes assumptions which may be faulty.

One of the basic tenets of CBT is that your faulty or irrational thought patterns and cognitions are responsible for maladaptive behavior and mental health problems. If one accepts this premise ,then some practitioners may dismiss the other factors which play a part in mental illness such as genetics and biology.

It assumes that the thoughts precede emotions, which isn't always true. It also usually labels any "negative" thoughts as pathological or dysfunctional. Again, this is not true.

Another faulty assumption is that changing one's thinking patterns can improve one's mood or decrease the symptoms of a mental disorder. Unfortunately this does not always happen. One cannot always "think" themselves better.

In a provocative article published in Time magazine entitled "Yes, I Suck: Self-Help Through Negative Thinking" writer John Cloud cites studies which show that attempting to get people to think more positively can backfire and make them feel even more unhappy than before. Those positive affirmations of the positivity gurus don't help much either.

Research has found that most people feel worse and not better after self-infliction of inflated statements of their worthiness.

In addition, changing your thought patterns may not help you with the fact that you got fired from your job due to poor work performance, got a bad grade on a test because you didn't study, or got a D.U.I for driving while drunk. Sometimes "negative" thoughts such as "I really messed up" are true. As the Time article points out sometimes we do fail and instead of wasting time fighting negative thoughts, maybe we should accept them, take ownership of our mistakes, and move on.

4. CBT may not give you enough time to meet your goals.

As stated previously, insurance companies love CBT because it is generally considered brief therapy. And we are talking really brief here. In some cases CBT may be limited to as little as six to twelve sessions.

As a patient I lift my brow in doubt. Really? Someone going in to be treated for depression who has early traumas, current social stressors, and a biological predisposition for a mood disorder is going to be all patched and ready to go in a few months? I would like to see that happen.

Jeremy Holmes, consultant clinical psychologist for Community Health NHS Trust, wrote a detailed commentary on the lack of real data to show that brief therapies actually work in the long run. For example, he cited a study which showed that six to 12 sessions of cognitive behavior therapy produced better results than care from a general practitioner at four months, but that this clinical gain was not maintained at 12 months. In other words, the studies which show CBT to be an effective treatment may have some flaws especially when it comes to showing long term gains.

5. Research shows that CBT or certain CBT techniques may be ineffective for many types of mental disorders.

I saved the big guns for last. Despite the popularity of CBT and the generalized statements that this type of therapy is effective for a multitude of mental health problems, there is also research to the contrary. There are mental health experts who agree that certain CBT techniques may be counterproductive or should be avoided altogether in treating certain mental disorders.

In a landmark 2009 review published in the journal Psychological Medicine, the study authors concluded that CBT is of no value in treating schizophrenia and has limited effect on depression. The authors also concluded that CBT is ineffective in preventing relapses in bipolar disorder.

In a 2009 study published in the British Journal of Psychiatry researchers compared depression treatment in adolescents over a period of 28 weeks. The study authors compared treatment with SSRI antidepressants versus the use of a combination of SSRIs and CBT. At the end of the 28 weeks both groups showed improvement but there were no significant differences between them. It was found that CBT did not add any benefit to the antidepressant treatment.

Dr. Thomas A Richards, director of the Social Anxiety Institute explains how telling the individual with social anxiety to stop thinking negative thoughts is not going to work. He also states that giving the socially anxious person positive affirmations to recite will do nothing. Instead, this practitioner advocates employing specific cognitive techniques such as helping the patient to be aware of their automatic negative thinking.

Dr. Stephen Phillipson writes on OCD Online that a critical element of good cognitive behavioral therapy is that the therapist be warm, understanding and compassionate. He also talks about how more traditional CBT techniques are ineffective for those patients with obsessive-compulsive disorder (OCD). He stresses that OCD is not a thought disorder but an anxiety disorder, which means that it is less likely a manifestation of irrational thoughts. He states that: "Helping OCD sufferers to see the irrational nature of their thought content is counterproductive."

The experts on PsychCentral agree that CBT has limited potential for helping those with Histrionic Personality Disorder. The authors state that: "Cognitive-oriented approaches are generally largely ineffective in treatment of this disorder and should be avoided." The reason, they share, is that people with this disorder are often incapable of examining their thoughts and motivations.

Although the first recommendation for someone who has a mental health condition, including an anxiety-related disorder, may be to receive cognitive behavioral therapy, it may be wise to do a little research first. Consider these questions:

Has CBT been shown to be an effective treatment for your particular disorder?

What does the research show?

What type of credentials, training, and experience does your therapist have?

Will brief therapy meet your needs or will you need more time?

What types of techniques does your therapist actually use during the course of treatment?

If possible I would fully recommend interviewing your chosen therapist before making the actual appointment.

Cognitive behavioral therapy includes a broad spectrum of therapeutic principles and techniques. Vague descriptions that CBT will be effective to treat your mental health disorder have little merit.

Patients deserve and require more substantial information than generalizations. As with any type of treatment or therapy, there will be plusses and minuses about using this approach. Look at CBT not as some cure for what ails you but maybe as one tool you can choose from an array of treatment options. CBT just may help you but you won't know unless you actually undergo treatment. In order for any therapy to work, your therapist will need to tailor their techniques to suit your goals, personality, and type of disorder.

CBT is not a one-size-fits-all methodology. We go wrong when we assume that this is a unified approach known to all. The details are very important in making any judgement about whether this approach may work for you.

These articles were written by a longtime HealthCentral community member who shared valuable insights from her experience living with multiple chronic health conditions. She used the pen name "Merely Me."


Stopping negative thought cycles

There are helpful and unhelpful ways of reacting to a situation, often determined by how you think about them.

For example, if your marriage has ended in divorce, you might think you've failed and that you're not capable of having another meaningful relationship.

This could lead to you feeling hopeless, lonely, depressed and tired, so you stop going out and meeting new people. You become trapped in a negative cycle, sitting at home alone and feeling bad about yourself.

But rather than accepting this way of thinking you could accept that many marriages end, learn from your mistakes and move on, and feel optimistic about the future.

This optimism could result in you becoming more socially active and you may start evening classes and develop a new circle of friends.

This is a simplified example, but it illustrates how certain thoughts, feelings, physical sensations and actions can trap you in a negative cycle and even create new situations that make you feel worse about yourself.

CBT aims to stop negative cycles such as these by breaking down things that make you feel bad, anxious or scared. By making your problems more manageable, CBT can help you change your negative thought patterns and improve the way you feel.

CBT can help you get to a point where you can achieve this on your own and tackle problems without the help of a therapist.


PHOBIA

Behavior Therapy and Cognitive Behavior Therapy are types of treatment that are based firmly on research findings. These approaches aid people in achieving specific changes or goals.

  • A way of acting: like smoking less or being more outgoing
  • A way of feeling: like helping a person to be less scared, less depressed, or less anxious
  • A way of thinking: like learning to problem-solve or get rid of self-defeating thoughts
  • A way of dealing with physical or medical problems: like lessening back pain or helping a person stick to a doctor’s suggestions.

HOW TO GET HELP: If you are looking for help, either for yourself or someone else, you may be tempted to call someone who advertises in a local publication or who comes up from a search of the Internet. You may, or may not, find a competent therapist in this manner. It is wise to check on the credentials of a psychotherapist. It is expected that competent therapists hold advanced academic degrees. They should be listed as members of professional organizations, such as the Association for Behavioral and Cognitive Therapies or the American Psychological Association. Of course, they should be licensed to practice in your state. You can find competent specialists who are affiliated with local universities or mental health facilities or who are listed on the websites of professional organizations. You may, of course, visit our website (www.abct.org) and click on "Find a CBT Therapist"

According to the Diagnostic and Statistical Manual phobic disorders fall into three types, based on the nature of the object or situation that produces the fear:

1) Simple phobias involve a fear of particular objects or situations, such as heights, the dark, moths, or small spaces.

2) Social phobias involve a fear of being watched or evaluated by others and a belief that the individual will, in some way, appear foolish. This results in avoidance of such situations as eating in front of others or going to parties or meetings.

3) Agoraphobia involves a fear of being unable to escape quickly or reach help in the event of sudden incapacitation, commonly a panic attack. Specifically, therefore, agoraphobia involves a fear of a wide variety of situations that the individual believes will either increase the likelihood of incapacitation or reduce the chance of reaching help should incapacitation occur. These situations include going to malls, using public transport, and generally being alone.

Agoraphobia is usually thought to be the most crippling phobic disorder, and simple phobia the least. People suffering with phobias can also have problems with chronic anxiety and depression. Simple phobias often begin in childhood social phobias in the late teens and agoraphobia in the mid-20's. Phobias appear to be more common in females than in males, although social phobia seems to be fairly evenly divided.

The cause of the various phobia disorders is still under considerable dispute. Traditionally, psychologists have believed that phobias are the result of experiencing a traumatic event in the presence of a specific situation or object (conditioning) being bitten by a dog, for example. However, recent research suggests that this is likely to be the case in only a certain portion of phobic cases, especially cases of simple phobia and some social phobias, such as fear of eating, drinking, or writing in front of others.

Other ways in which many simple phobias and some social phobias are probably acquired include the passing of false or exaggerated information (e.g., being told dogs are dangerous) or seeing or hearing of someone else being injured or distressed in a particular situation (e.g., seeing someone being bitten by a dog).

Some social phobias appear to be worsenings of lifelong behaviors and personality factors. In other words, some people who are afraid of going to parties or formal meetings may report that they have always been "basically shy," but only since they took on new responsibilities has this become severe enough to be considered a problem. The immediate cause of agoraphobic fear and avoidance involves an unexpected panic attack. This first panic attack is reported to occur "out of the blue." The agoraphobic then begins to fear the occurrence of another such attack and avoids those situations that they believe may cause or worsen a future attack.

The reasons why an individual may begin to associate certain situations with panic attacks are not yet known. In addition, the cause of the initial panic attack is only just beginning to be investigated. Some factors that might be responsible for causing the first panic attack include life stressors, earlier experience with loss of control, a tendency to breathe too fast, or fluctuations in brain chemicals.

The basic treatment of choice for the phobic disorders involves what is called graduated exposure to the phobic stimulus. This means that the person is gradually and gently brought into contact with the avoided object or situations until he or she "gets used to " it. Repeated investigations have demonstrated the value of exposure-based techniques for all types of phobias. For maximum improvement in most cases of social phobia, it also appears to be necessary to teach people to re-evaluate some of their thoughts and beliefs to learn, for example, that "everyone is not watching me" or that "if I say the wrong thing, people will not think I am stupid." Some form of social skills training may also be of value, because it may produce new skills and/or increase confidence.

While exposure to the feared object or situations is of immense value for the avoidance component of agoraphobia, maximum improvement is unlikely to occur without some attempt being made to deal with the unexpected panic attacks.

Treatment for panic attacks has traditionally involved the use of medications such as imipramine (Tofranil) or alprazolam (Xanax). More recently, psychological techniques are proving to be just as effective.


Cognitive Therapy for anxiety is, to some extent, relative to different age groups. Techniques of Cognitive Therapy, in general, is very effective across all ages, the reception, however, varies according to different ages. Adults and older adults prefer cognitive Therapy over medication, as it suits better. Although, the adults and older adults are less motivated to open up and accept change of thoughts emotionally.

For children, teens, and young adult, on the other hand, sees the exact opposite scenario. For them, their physiology is able enough to tolerate medication, unlike older adults. But, when it comes to cognition therapy, they are more open to sharing emotions and more malleable to change of thoughts.

If you are suffering from anxiety, and plan to receive cognitive Therapy -you will need to be patient and committed. It is not a matter of quick fix or immediate change. The CBT process will aim to cure the negative structures of your thought process at the root and replace it with healthy approaches.

1. Does Cognitive Therapy work for anxiety?

Since the distortion of cognition essentially causes anxiety, cognition therapy can be a pivotal instrument in the matter. Doctors and therapists structured the processes of CBT, specifically to help individuals with anxiety and depression.

2. Why does CBT work for anxiety?

Cognitive distortions like blaming others, the misconception of fairness, emotional reasoning, following the global trend, unacceptance of mistakes and such, lead to anxiety. CBT techniques for anxiety help you identify such distortions. Draw productive emotions out of adverse events and exhibit correctional behavior.

3. How long does it take for CBT to work for anxiety?

CBT techniques for anxiety are generally short-term as compared to other mental therapies. It generally takes from a few weeks to months.

4. What are the cognitive symptoms of anxiety?

The initial cognitive symptoms of anxiety are low self-esteem and a sense of uselessness.