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Cognitive-Behavioral Therapy (CBT)

Cognitive-Behavioral Therapy (CBT) is a structured, goal-oriented, and educational approach to treatment.  CBT operates under the belief that negative feelings and behaviors result from the way you perceive and interpret situations around you, rather than the situations themselves.  By working to change the thinking patterns that bring on negative emotions, CBT empowers you to become your own therapist and problem-solver, so that you not only feel better, but stay better.

Situation
Thoughts
Feelings/Behaviors
You text a friend, and they don't respond.
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You text a friend, and they don't respond.
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You text a friend, and they don't respond.
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You text a friend, and they don't respond.
"Did I say or do something wrong? Is she mad at me?"
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"Is she okay? What if she was hurt/in an accident?"
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"She's probably busy.  I'll check in with her later."
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"She's always doing this! Is it that hard to text me back?"
Anxious (on edge, replaying conversations, poor focus)
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Scared (racing heart, rapid breathing)
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Calm (will continue with
daily routine)
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Angry (feeling tense, raising voice, banging fists)

In the example above, you will notice that the situation remained the same, but the resulting feelings and behaviors varied.  This shows that it is not a situation that determines our emotions and actions, but the way we think about and perceive them.  The goal of CBT is not to think more positively, but to think more rationally about situations, and to strengthen our problem-solving abilities.  In addition to challenging unhelpful thinking, CBT also targets unhelpful behaviors, such as avoidance, checking, worrying, among others.  

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  • Sessions begin with a brief review of how you've been feeling since we last met, summed up in a few sentences.

  • We then review your homework, including your successes, as well as challenges.

  • Next, we set the session's agenda, which is a list of 1-2 goals we would like to achieve during the session. Examples include learning to cope with a specific stressor, reducing an unhelpful behavior, learning more about specific symptoms you've been experiencing, etc... 

  • We will address each item using an educational, skills-based, and problem-solving approach, then collaboratively design homework so that you can practice and reinforce your new skills between sessions.

  • I will have you summarize the session, answer any questions you may have, and ask you to provide me with feedback on how you feel the session went.  Feedback is important, as it allows me to make sure we are on the same page, and that you are feeling heard.

How are CBT Sessions Strutured?

Exposure and Response Prevention (ERP)

ERP is a specific form of Cognitive-Behavioral Therapy, and the number one treatment for Obsessive-Compulsive Disorder, as well as other anxiety and avoidance-based conditions.  The goal is to gradually expose you to your obsessions, triggers, and avoided situations, without engaging in rituals to reduce the accompanying anxiety/discomfort.  While initially this is challenging, after repeated exposures, your body begins to gather evidence to gradually disconfirm (or unlearn) a particular fear.  You will also give your body a chance to habituate to the discomfort you experience in the triggering situation. Think about jumping in a cold pool during the summer.  Initially, the water is cold, and you may want to get out, but after staying in for a period of time, your body gets used to the water.  This is called habituation.  Exposures are done in a hierarchical manner, which allows for your confidence to build as you confront more challenging triggers. 
 
I take a team approach with clients, helping them to engage in exposures during session first, before collaboratively assigning homework to continue practicing at home.  With treatment, clients feel a greater sense of freedom, independence, and confidence, knowing that rituals/compulsions are no longer a necessary, and time-consuming part of their everyday lives.

Acceptance and Commitment Therapy (ACT)

ACT is another form of Cognitive-Behavioral Therapy, and a helpful adjunct to ERP. The goal of ACT is to increase one's flexibility and openness to experiencing uncomfortable thoughts and feelings, while continuing to engage in behaviors and activities that are meaningful, and in line with one's values.  ACT focuses on being mindful of unwanted thoughts and feelings, without acting on them in ways that will sabotage your ability to lead a fulfilling life.

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