Have you ever noticed that you start to feel anxious, overwhelmed, or down without a clear cause? Or have there been times when you snap at someone unexpectedly or start tearing up at a minor stressor? Perhaps you have experienced physical symptoms, such as your heart racing or fluttering, an unexpected headache, or feeling generally on edge. Do you regularly avoid certain places or situations that make you uncomfortable, such as a crowded place, driving on highways, ordering at restaurants, or a movie theatre?
There is a relationship between the environment we are in, how we think, what we physically feel, and how we behaviorally respond. Cognitive behavior therapy (CBT) is an evidence-based psychotherapy that focuses on this specific relationship. Cognitive behavior therapy allows a clinician to work collaboratively with a child or adult to help them identify the patterns and build awareness between how they think, how they feel, and what they do. The more awareness we can build around these patterns and relationships, the easier it is to implement specific skills that target thoughts, physical feelings, and behaviors in an adaptive and healthy way.
As a psychologist working primarily with anxiety disorders, I notice my clients often talking about a lack of awareness regarding their thoughts and feeling like they have no control over the types of thoughts they have and when they experience them. For example, I often hear clients explain how they get into their car at the end of the workday and suddenly, they are home without being able to identify what they were thinking about for the twenty-minute ride. This is a common occurrence and example of how our minds automatically set to autopilot without a conscious awareness of how our thoughts are influencing us. With the implementation of very specific skills, including building our present-focused awareness, actively evaluating our thoughts, and challenging automatic interpretations, we can have more control over our thoughts and how we respond to them. These skills are critical in managing anxiety, depression, and enjoying life overall.
Thoughts: You can think of the neural pathways in your brain as different roads, and whichever road you drive down most frequently becomes a highway. You get from point A to point B quickly. Oftentimes, people with anxiety or depression tend to experience catastrophic or worst-case thinking. CBT focused on a skill called cognitive restructuring, which refers to the ability to challenge catastrophic and other distorted types of thinking by evaluating evidence for and against the thought to eventually replace the negative thought with something more helpful and realistic.
Feelings: How would you describe feeling physically anxious? Some people may say they feel like there are butterflies in their stomach. How would you describe feeling excited? Oftentimes, people describe the same physical sensation of butterflies in their stomach. We often learn that the physical feeling we have is connected to the emotion we are experiencing; however, we can cognitively appraise our physical sensations differently. Through skills like interoceptive exposures, psychologists help clients tolerate physical sensations and interpret them differently so the physical feeling is less distressing to the individual.
Behaviors: The third component of CBT is focusing on the very specific behavior associated with out emotion, or the emotion driven behavior. It is natural for humans to behaviorally respond to discomfort and distress by trying to get away from that feeling or avoid that feeling to feel more comfortable. However, in the case of anxiety, depression, panic, or a phobia, the urge to avoid the trigger is extremely intense due to the strength of the fear. When someone does in fact avoid the trigger, they feel an immediate sense of relief in the short-term, which is highly reinforcing to continue avoiding. However, in the long-term, the avoidant behaviors tend to exacerbate anxiety and substantiate the fear response. What does this look like clinically? An example of this sort of avoidance related to anxiety or fear is as follows: A woman travels regularly via flying; however, on one flight she wakes up early to make her flight after a poor night of sleep. She drinks more caffeine than usual and is unsettled as the flight begins due to other stress. When the flight takes off the woman experiences a panic attack. Consequently, she starts avoiding flying because she is afraid to experience another panic attack. In the short term, this avoidance of flying does alleviate the fear that she will experience another panic attack. However, in her mind she starts to believe that panic is associated with flying and she doubts her ability to ever fly again. This example demonstrates the nature of avoiding fear and anxiety-inducing triggers. Cognitive behavior therapy is an excellent therapy to address avoidant behaviors specifically so that people can re-engage in their lives without living according to fear and anxiety.
Overall, cognitive behavior therapy is an excellent form of treatment to address mental health struggles with an emphasis on being empirically supportive and collaborative. If you begin cognitive behavior therapy you can expect your clinician to provide a great deal of education, skills, and opportunities for exposure while you plan an active role as the expert in your experience. The clinician will work with you collaboratively to create the most effective treatment plan in a way that is structured, goal-oriented, and consistently re-evaluated to ensure you are making the progress you hope within the treatment setting. Cognitive behavior therapy is not meant to last forever, but rather to provide a specific skillset focused on moving forward.
At Growth Psychology, once the initial phase of treatment is complete, we encourage our clients to use our services on a maintenance schedule. Maintenance sessions look like check-ups, or less frequent meetings where clients can ensure they are meeting their goals and tweak the strategies they are utilizing to create lasting change.
If you struggle with anxiety, depression, panic attacks, phobias, or a body-focused repetitive behavior (hair-pulling or skin-picking), cognitive behavior therapy is the treatment modality for you!