YUJUAN CHOY, M.D.


What is Cognitive Behavioral Therapy (CBT)?

Cognitive behavioral therapy (CBT) is a form of psychotherapy that incorporates cognitive and behavioral interventions in the treatment of emotional or psychiatric problems. The goal of cognitive therapy is to gain a different perspective on problems, and to change maladaptive or unhelpful thought patterns. Individuals learn to examine their feelings and evaluate negative or irrational thoughts related to mood, anxiety, work or relationship problems. In behavioral therapy, individuals learn to gain better control over unwanted behaviors or to overcome fears and avoidance of certain situations or events. Some psychiatric disorders require more cognitive interventions whereas others focus predominantly on behavioral changes. In a majority of cases, both types of techniques are used to some extent.

CBT is a collaborative process that involves active participation. Treatment is individualized depending on the specific problem. It is generally time-limited, with average length of treatment ranging from 12 to 20 weeks. However, treatment may take longer (a year or more) for people with a long-standing illness, a history of poor response to other forms of treatment, or illness complicated by depression or substance use. You should discuss with your therapist the expected length of treatment for your specific problem.

CBT has been validated for the treatment of a variety of problems including depression and anxiety disorders. It is the gold-standard psychotherapy treatment for disorders like social anxiety disorder, generalized anxiety disorder and panic disorder. CBT with the focus on behavioral intervention has also been shown to be effective for the treatment of post-traumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD). For a list of other disorders that can be helped by CBT, readers are referred to the Beck Institute.

The following are brief descriptions of how CBT can work for some anxiety disorders. It is not meant to be comprehensive, and techniques may vary among cognitive behavioral therapists.

How does CBT for Social Anxiety Disorder work?

CBT is the most widely studied and validated psychotherapy treatment for social anxiety disorder. The goal of treatment is to manage social anxiety by lowering anxiety symptoms and enabling individuals to participate in previously avoided social situations. CBT is a collaborative process and requires a motivation to change old habits and learn better ways to deal with social situations. In CBT treatment, patients acquire skills to better cope with social situations and break the cycle of anxiety. They learn to identify anxious thoughts that are common in anticipation of or during a social encounter, such as as "I'm going to be nervous," "I'm going to look like a fool," or "I'm going to totally fail." These thoughts increase anxiety and interfere with social interactions. Patients will learn to evaluate these thoughts and develop more realistic, alternative perspectives. They also practice participating in social situations, first in the session with the therapist, and then branching to real life settings. Exposure exercises are developed collaboratively, and is always conducted in a controlled, systematic way, and paced gradually from less fearful to more anxiety-provoking situations.

How does CBT for Generalized Anxiety Disorder (GAD) work?

CBT is a well-studied and validated psychotherapy treatment for GAD. In CBT treatment, patients acquire skills to better cope with daily stress and help control their worry thoughts. Thoughts such as "I'm going to fail, " "I'm never going to be able to cope," or "My boss is going to fire me," often interfere with work performance and ability to solve problems at hand. Patients learn to evaluate these thougths and develop more realistic, alternative perspectives. They also learn behavioral techniques to help decrease anxiety, such as progressive muscle relaxation and deep breathing. The ability to handle stress bettter and control these worry thoughts will decrease overall anxiety, improve quality of sleep, concentration, productivity at work, and relationship with others.

How does CBT for Panic Disorder work?

CBT is a well-studied and validated psychotherapy treatment for panic disorder. The goal of treatment is to control panic attacks and prevent future attacks. Patients will learn how to control these symptoms through both cognitive skills as well as behavioral techniques such a progressive muscle relaxation and deep breathing. They will learn to identify triggers for panic attacks, correct misconceptions about panic symptoms, and evaluate fears that commonly occur during panic attacks, such as "I'm going to die," "I''m having a heart attack," or "Something really bad is happening." Over the course of treatment, patients will gain control of their life by gradually entering situations that they have been avoiding. Being able to face the fears will help control recurrence of panic attacks and ultimately, improve anxiety and quality of life.

How does Prolonged Exposure for PostTraumatic Stress Disorder (PTSD) work?

Prolong exposure is a form of CBT treatment with emphasis on behavioral interventions.  It is normal to avoid memories or thougths that are painful, but this avoidance results in more problems in the long-run by maintaining PTSD symptoms. With the help of the therapist, patients learn to process the traumatic event so that they can better understand what happened and be able to move forward. Prolonged exposure involves replaying some of the images and memories of the trauma in a safe, controlled environment. Patients learn to cope with the intrusive memories and unwanted physiological reactions. The other important component of treatment is called live exposure, which is gradually entering relatively safe situations that have been avoided after the trauma. Patients first start to deal with less frightening situations, then subsequently move on to more anxiety-provoking situations when they are ready. They learn to evaluate the negative thoughts that they have developed as a result of the trauma. Studies have found that gradually confronting the painful thoughts, images and memories of the event in a safe environment is an essential part of recovery from PTSD.

How does Prolonged Exposure and Response Prevention (EXRP) for Obsessive Compulsive Disorder (OCD)  work?

EXRP is a form of CBT treatment with emphasis on behavioral interventions. Patients will identify triggers for their obsessions and compulsions, and will evaluate their unwanted thoughts in a more realistic and less threatening way. Patients will then gradually expose themselves to feared situations or feared outcomes of their obsessions. Exposure exercises are developed collaboratively, and always conducted gradually in a safe, controlled environment, first in the session, and then in real life settings. Another important part of treatment is called response prevention, which has been shown to reduce the frequency of compulsions. In this approach, patients develop alternative ways to cope with anxiety and discomfort instead of resorting to compulsive rituals. Because OCD is a chronic ilness in which symptoms can resurface even after successful treatment, patients learn behavioral strategies to cope with stress and decrease the chance of relapse in the future.