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Everything we see is a perspective, not the truth.”
-Marcus Aurelius Antoninus
Today we will explore the Cognitive Behavior Therapy realm in treating people with anxiety. But first we need to know what it is and what it entails. As we have seen, people with anxiety can suffer from panic attacks, relentless worries, obsessive thoughts and incapacitating phobias. Their lives are difficult, having to meet every day challenges, while having to deal with their anxieties that sometimes makes it impossible to function as independently as they want to. In the past many patients were prescribed medication and given psychotherapy which hasn’t always been successful. With the event of new discoveries in the field of Neuroplasticity, researchers are finding better ways to treat anxiety.
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So, first we need to know what Cognitive Behavior Therapy (CBT) is. Cognitive Therapy examines how negative thoughts (cognition) contribute to anxiety while Behavior Therapy examines how one behaves and reacts in situations that trigger anxiety. So in a nutshell, CBT focuses on the negative patterns and distortions that individuals see in the world around them and in themselves. People working in CBT believe that our thoughts, not the external elements, affect the way one feels. If three different people looked at a picture, one may see a picture that is pretty with a resulting emotion of happy, while the second person sees the picture as being average so the emotion may be neutral. The third person may look at the picture and sees something dark and ominous resulting in an emotion of anxiety and discomfort. So practitioners of CBT believe that if you change the way one thinks, you can change how they feel.
-Sophocles
From the above example, one can see that one event or thing can lead to three different emotions in three different people. The main point here is that emotions can be dependent on each individual’s attitudes, beliefs and expectations. So for a person with anxiety, it is believed that their negative patterns of thinking will lead to negative emotions of anxiety and fear. The goal of CBT for anxiety clients is to determine his/her negative thinking patterns and beliefs and correct them. In general it is felt that if you change the way one thinks, you can change the way he/she feels.
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Cognitive-Behavioral Therapy
The following information was obtained from an article called ”Generalized Anxiety Disorder” in The New York Times (http://www.nytimes.com/health/guides/disease/generalized-anxiety-disorder/psychotherapy-and-other-treatments.html?mcubz=0). The article initially talked about Cognitive-Behavioral Therapy where the goal is to regain control of reactions to stress and what triggers it. It is believed that by doing this the individual can reduce his/her feelings of helplessness which is common in anxiety disorders. The article also mentioned that therapy can be in individual or group type settings, depending on the client’s needs. It did concur that anxiety disorders are often chronic and that re-occurrence is common. Medication was also brought up as an adjunct to CBT
-Jack Kornfield
Cognitive-Behavioral Therapy Techniques
The following information is from ”Generalized Anxiety Disorder” in The New York Times
Basic Cognitive Therapy Techniques take about 12-20 weeks where the primary goal is “to understand the realities of an anxiety-provoking situation and to respond to reality with new actions based on reasonable expectations":
- First, the patient must learn how to recognize anxious reactions and thoughts as they occur. One way of accomplishing this is by keeping a daily diary that reports the occurrences of anxiety attacks and any thoughts and events associated with them.
- These entrenched and automatic reactions and thoughts must be challenged and understood. One approach is to record and play back the words of the repetitive thoughts, over exposing the patient to the thoughts and reducing their effect. One effective approach for patients with generalized anxiety disorder targets their intolerance of uncertainty and helps them develop methods to cope with it.
- Patients are usually given behavioral homework assignments to help them change their behavior. For example, a person with generalized social phobia may be asked to buy an item and then return it the next day. As the patient performs this action, they observe any unrealistic fears and thoughts triggered by such an event.
- As the patient continues with self-observation, they begin to perceive the false assumptions that underlie the anxiety. For example, patients with OCD may learn to recognize that their heightened sense of responsibility for preventing harm in non-threatening situations is not necessary or even useful.
- At that point, the patient can begin substituting new ways of coping with the feared objects and situations.
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Systematic Desensitization is a technique that breaks the connection between the anxiety-provoking stimulus and the anxiety response. The goal of treatment here is to have the client gradually confront what is causing the fear. It could be an object or situation. There are 3 main steps to this process:
- Relaxation training
- A list composed by the patient that prioritizes anxiety-inducing situations by degree of fear
- The desensitization procedure itself, confronting each item on the list, starting with the least stressful
and nothing can stop him.”
-Alexander Solzhenitsyn
Exposure and Response Treatment involves exposing the client repeatedly to the feared item or situation. This could be done using visualization methods or literally confronting them. The therapist will use the most fearful stimulus first. “Exposure treatments are usually known as either flooding or graduated exposure”:
- Flooding exposes the person to the anxiety-producing stimulus for as long as 1 - 2 hours.
- Graduated exposure gives the patient a greater degree of control over the length and frequency of exposures.
According to the article, the above two types of interventions both require the client to experience the anxiety over and over again until the stimulating exposure loses its effect. It also stated that combining exposure with cognitive therapy seem to be beneficial for the anxiety client’s progress.
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Modeling Treatment is generally mostly used with phobia clients. The process includes:
- The therapy typically uses an actor who approaches an anxiety-producing object or engages in a fear-provoking activity that is similar to the patient's specific problem. Either a live or videotaped situation may be used, although the live model is considered to be more effective.
- The patient observes this event and tries to learn how to behave in a comparable manner.
-Aristotle
Anxiety Management Therapy can be used as an alternative to CBT for generalized anxiety disorder. It incorporates patient education, relaxation training and exposure to anxiety-provoking stimuli but excludes the cognitive retraining.
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There are other therapies that may be used that are commonly called emotion-based psychotherapy (EBT): psychodynamic therapy, or talk therapy which involve interpersonal therapy, attention intervention, supportive psychotherapy and psychoanalysis. This is generally used to deal with the root cause of the anxiety of the client.
Relaxation Training & Related Therapies can include Relaxation Training, Breathing Retraining, & Biofeedback.
all your moods are created by your 'cognitions,' or thoughts.
A cognition refers to the way you look at things
-your perceptions, mental attitudes, and beliefs.
It includes the way you interpret things - what you say,
about something or someone to yourself.”
-David D. Burns
In an effort to give you a better idea of whether CBT is effective for Anxiety intervention, I found an article called Cognitive Behavioural Therapy (CBT) (https://www.your.md/condition/cognitive-behavioural-therapy/#introduction) where the pros and cons of CBT were discussed.
Advantages of CBT:
- Research has shown CBT can be as effective as medicine in treating many types of depression and other mental health disorders.
- CBT can be completed in a relatively short period of time compared with other types of talking therapies.
- The highly structured nature of CBT means it can be provided in different formats, including in groups, self-help books and computer programs.
- Skills you learn in CBT are useful, practical and helpful strategies that can be incorporated into everyday life to help you cope better with future stresses and difficulties.
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Disadvantages of CBT:
- To benefit from CBT, you need to commit yourself to the process. A therapist can help and advise you, but cannot make your problems go away without your co-operation.
- Due to the structured nature of CBT, it may not be suitable for people with more complex mental health needs or learning difficulties.
- Some critics argue that because CBT only addresses current problems and focuses on specific issues, it does not address the possible underlying causes of mental health conditions, such as an unhappy childhood.
- CBT focuses on the individual’s capacity to change themselves (their thoughts, feelings and behaviours), and does not address wider problems in systems or families that often have a significant impact on an individual’s health and wellbeing.
and things may happen to you,
but the only things that matter are
the things that happen in you.”
-Eric Butterworth
I tried to give you an idea of what CBT is and what it entails. Many articles stated that it was an effective intervention but they encourage everyone to research, who in your community is a qualified CBT practitioner and is trained in your area of need. Getting the right therapist is essential to the successful of your outcome. Everyone needs to weigh the pros and cons of anything before deciding which route to take.
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I will continue to cover other interventions for anxiety. I hope you will continue to join me in my journey to explore the world of anxiety and what can help anxiety disorder sufferers to live a more fulfilled and happier life. Thank-you for reading my article on Neuroplasticity: Cognitive Behavior Therapy (CBT). If you would like to follow me, please check HERE.
These are my previous articles on Neuroplasticity & Anxiety if you are interested in reading it:
Neuroplasticity: Hope For People With Anxiety?
@cabbagepatch/neuroplasticity-hope-for-people-with-anxiety
Neuroplasticity: How to deal with Anxiety Disorders Like Panic Attacks
@cabbagepatch/neuroplasticity-how-to-deal-with-anxiety-disorders-like-panic-attacks