CBT

In cognitive therapy, discussions between the patient and the therapist are not usually focused on the patient's past, as is the case with some forms of psychotherapy. Instead, conversations focus on the difficulties and successes the patient is having at the present time, and on skills the patient needs to learn.

The behavioral portion of cognitive-behavioral therapy may involve systematic training in relaxation techniques. By learning to relax, the patient may acquire the ability to reduce generalized anxiety and stress that often sets the stage for panic attacks.

Breathing exercises are often included in the behavioral therapy. The patient learns to control his or her breathing and avoid hyperventilation � a pattern of rapid, shallow breathing that can trigger or exacerbate some people's panic attacks.

Another important aspect of behavioral therapy is exposure to internal sensations called interoceptive exposure. During interoceptive exposure the therapist will do an individual assessment of internal sensations associated with panic. Depending on the assessment, the therapist may then encourage the patient to bring on some of the sensations of a panic attack by, for example, exercising to increase heart rate, breathing rapidly to trigger lightheadedness and respiratory symptoms, or spinning around to trigger dizziness. Exercises to produce feelings of unreality may also be used. Then the therapist teaches the patient to cope effectively with these sensations and to replace alarmist thoughts such as "I am going to die," with more appropriate ones, such as "It's just a little dizziness � I can handle it."

Another important aspect of behavioral therapy is "in vivo" or real-life exposure. The therapist and the patient determine whether the patient has been avoiding particular places and situations, and which patterns of avoidance are causing the patient problems. They agree to work on the avoidance behaviors that are most seriously interfering with the patient's life. For example, fear of driving may be of paramount importance for one patient, while inability to go to the grocery store may be, at most, handicapping for another.

Some therapists will go to an agoraphobic patient's home to conduct the initial sessions. Often therapists take their patients on excursions to shopping malls and other places the patients have been avoiding. Or they may accompany their patients who are trying to overcome fear of driving a car.

The patient approaches a feared situation gradually, attempting to stay in spite of rising levels of anxiety. In this way the patient sees that as frightening as the feelings are, they are not dangerous, and they do pass. On each attempt, the patient faces as much fear as he or she can stand. Patients find that with this step-by-step approach, aided by encouragement and skilled advice from the therapist, they can gradually master their fears and enter situations that had seemed unapproachable.

Many therapists assign the patient "homework" to do between sessions. Sometimes patients spend only a few sessions in one-on-one contact with a therapist and continue to work on their own with the aid of a printed manual.

Often the patient will join a therapy group with others striving to overcome panic disorder or phobias, meeting with them weekly to discuss progress, exchange encouragement, and receive guidance from the therapist.

Cognitive-behavioral therapy generally requires at least 8 to 12 weeks. Some people may need a longer time in treatment to learn and implement the skills. This kind of therapy, which is reported to have a low relapse rate, is effective in eliminating panic attacks or reducing their frequency. It also reduces anticipatory anxiety and the avoidance of feared situations.

What Is Cognitive Behavior Therapy?

Cognitive Behavior Therapy (CBT) is a type of psychotherapy that helps people change how they think, feel or act in order to improve their mood, reduce stress, or achieve other important health and life goals. Some goals may be specific, such as reducing worrying or procrastination, whereas others can be more general, such as figuring out why one�s life seems to lack meaning, passion or direction, and figuring out what to do about it.
Cognitive behavior therapy is often used together with other forms of treatment. For example, a combination of medication and cognitive behavior therapy may be more effective in treating severe depression than either treatment by itself.

The American Psychological Association has endorsed cognitive and behavior therapies as �well established treatments� supported by research for depression; anxiety, stress, panic disorder, obsessive-compulsive disorder, agoraphobia and other phobias; health problems such as headaches, bulimia, rheumatic pain and smoking cessation; childhood difficulties such as bedwetting and oppositional behavior; and marital distress.

Examples of Therapy Goals
� a way of feeling � feeling more content, calm, and alert; feeling less depressed, anxious, fearful, angry or fatigued.
� a way of thinking � thinking more optimistically and realistically; getting rid of negative, self-defeating thoughts.
� a way of acting � overcoming bad habits or addictions; being more assertive about things that are important to you.
� a way of being � being more present in each moment of your life, appreciating what is, rather than regretting or protesting what hasn�t been, is not, and may never be.
� improving relationships � getting along better with family, friends or co-workers; reducing arguments and misunderstandings.
� dealing with physical or medical problems � learning pain management techniques; reducing anxiety concerning medical procedures; adapting to lifestyle changes due to illness or injury.
� coping with a loss or the aftermath of a traumatic event � re-adapting to life after the loss of a loved one; coping with the aftermath of an accident, crime or disaster.
� making occupational, educational, or other important decisions � identifying an occupation that matches one�s interests and skills; deciding whether to stay in a difficult relationship.
� resolving problems due to abuse or neglect as a child � increasing self-esteem and self-confidence; becoming less dependent upon or rejecting of others.

Cognitive Behavior Therapy

Empirically-based: Cognitive-behavioral methods have been shown in controlled studies to provide effective treatment for numerous clinical problems. Cognitive-behavior therapy has been shown to be as effective as drug treatment for depression and anxiety disorders.
Goal-oriented: The cognitive-behavior therapist works with his or her patient to set goals for therapy and to monitor progress periodically to assess whether the goals are being met.
Practical and concrete: Therapy goals focus on solving concrete problems. Typical goals include: reduce depressive symptoms, eliminate panic attacks, reduce or eliminate compulsive rituals, reduce hair-pulling, decrease procrastination at work, improve relationships with others, decrease social isolation.
Active: Both patient and therapist play an active role in therapy. The therapist serves as teacher and coach, teaching the patient about what is known about his or her problems and solutions to those problems. The patient works outside of the therapy session to practice the strategies learned in therapy.
Collaborative: Patient and therapist work together to understand and develop strategies to address the patient's difficulties.
Short-term: Cognitive-behavior therapy is short-term whenever possible.
Cognitive-behavior therapy has been found in controlled studies to be an effective form of treatment for depression--in fact, it appears to be as effective as antidepressant medications. Cognitive-behavior therapy for depression focuses on the clinical observation that depressed mood often seems to result from negative patterns of thinking and behaving. For example, depressed people often have thoughts like, "I'm a failure," "I can't do anything right," "I'll never accomplish my goals," "No one cares about me," "I'll be alone forever," or similar. These thoughts can feel powerful and compelling, but usually do not tell a balanced, reasonable story. In cognitive-behavior therapy, patient and therapist work together to determine what types of negative thinking are problematic for the depressed patient, and what types of coping or balanced thoughts can be used to provide a better perspective, to lift the depressed person's mood, and help him or her function better. The therapy also often focuses on helping the depressed person increase his or her activity level or find more gratifying, pleasurable activities.

The Basics

CBT is:

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