Treatment: Cognitive behavior therapy

The psychological treatment provided at the Anxiety and Depression Clinic is known as cognitive behavior therapy (CBT). CBT is the psychological treatment with the most scientific evidence supporting its' efficacy for anxiety disorders and depression. (Note. Medication is not available through the ADC, although many individuals in our program receive medication from an outside physician or psychiatrist that can be arranged on your own).

Cognitive Behavior Therapy (CBT) is a method of psychotherapy that involves helping people to see how their thoughts and behaviors relate to the way they feel and how this might contribute to the problems they are experiencing. Because each individual is unique, treatment is individualized to each individual's presenting problem. However, in all cases we make use of various CBT treatment strategies (see below) to attempt to help the person resolve their problem and improve their functioning. CBT is goal-oriented, where the therapist and the client work together to develop goals and then develop a step-by-step plan to achieve those goals. While the therapist is responsible for developing and implementing the treatment plan, clients actively participate in treatment both within and between sessions (for example, clients are given task assignments to complete outside of the therapy sessions).

Cognitive Behavior Therapy has two primary components: Cognitive Therapy and Behavior Therapy.

I. COGNITIVE THERAPY Brief video explanation: https://www.youtube.com/watch?v=9c_Bv_FBE-c
Cognitive Therapy refers to an approach pioneered by Albert Ellis (Rational Emotive Behavior Therapy) and Aaron Beck (Cognitive Therapy) in the 1960s. Cognitive therapy is based upon a theory of emotion known as appraisal theory. Appraisal theory suggests that individuals experience emotional reactions based upon how they appraise, or interpret, situations and events in their lives. Thus, to change chronic negative emotional states such as anxiety or depression, in cognitive therapy, clients learn how to recognize and modify the thinking patterns that are causing and maintaining them. These thinking patterns often become so automatic that they are typically out of our awareness, and thus it takes some work to even identify them. One of the major strategies of cognitive therapy is "logical analysis" wherein clients learn how to analyze these thoughts using principles of logic, and when distortions are identified, replace the negative automatic thoughts with more realistic, less emotionally charged, thoughts. Over time these new thoughts can replace the old ones. For a detailed description of cognitive therapy, appraisal theory, and emotions click here.

II. BEHAVIOR THERAPY
Behavior Therapy focuses on isolating specific behaviors the client wants to change and uses strategies, based upon learning theory, to achieve that goal. Specific techniques are used to control or even eliminate undesired behaviors. Strategies that fall into the category of behavior therapy include: exposure (desensitization) for phobias, assertiveness training, social skills training, behavioral activation to increase positive events in a persons life, relaxation training, sleep hygiene, stimulus control to reduce/eliminate unwanted behaviors (e.g., overeating).

III. ADDITIONAL TREATMENT STRATEGIES
While almost everyone receives some combination of cognitive and behavioral treatment strategies, other approaches are incorporated within the treatment plan when appropriate. Since CBT has clearly established its efficacy as a treatment approach for emotional disorders, clinical researchers have been able to develop modifications and additions to traditional CBT in order to make these treatments even more effective. These additional treatment approaches (see below), when appropriate, are typically incorporated within the standard CBT approach.

Schema Focused CBT Brief video explanation: https://youtu.be/PTjdN4tyETY
Schema Therapy, a form of cognitive therapy, was developed by Dr. Jeffrey Young to deal more effectively with lifelong problems which are seen as a result of negative core beliefs (schemas) about oneself and/or others. These negative schema include fears of abandonment and rejection, feelings of social alienation, mistrust of others, feelings that nothing one accomplishes is ever good enough, the belief that one is inherently flawed, feeling overly dependent upon others, constant feeling vulnerable, etc. Compared to standard cognitive therapy, schema focused therapy looks more deeply into childhood origins of problems and relies on more imagery and emotive techniques to bring about change.

Compassion Focused CBT (CFT) Brief video: https://www.youtube.com/watch?v=-kfUE41-JFw
The central therapeutic technique of CFT, developed primarily by Paul Gilbert, is compassionate mind training, which teaches the skills and attributes of compassion. Compassion focused therapy is especially appropriate for people who have high levels of shame and self-criticism and who have difficulty in feeling warmth toward, and being kind to, themselves or others. Such problems of shame and self-criticism are often rooted in a history of abuse, bullying, neglect, and/or lack of affection in the family.

Mindful Based Cognitive Therapy (MBCT) Brief video: https://www.youtube.com/watch?v=ytEFmXjWA0c
Mindfulness- and acceptance-based strategies focus on becoming aware of all incoming thoughts and feelings and accepting them rather than reacting to them. This process is known as decentering and aids in disengaging from negative thought patterns such as self-criticism, rumination, or anxious thinking. The goal of MBCT is to interrupt these automatic processes and teach individuals to focus less on reacting to incoming stimuli, and instead accepting and observing them without judgment. This mindfulness practice allows the participant to notice when automatic processes are occurring and to alter their reaction to be more of a reflection. A basic tenet of this model is the notion that difficult situations and emotions are a part of life and by rigidly controlling them, or avoiding them, will actually lead to more difficulty. Thus, the emphasis is on fully experiencing negative thoughts and feelings as a way to ultimately move forward with one's life.

MAJOR ADVANTAGE OF COGNITIVE BEHAVIOR THERAPY: PROVEN EFFECTIVENESS

There are numerous research studies demonstrating that Cognitive Behavior Therapy is an effective treatment for the range of anxiety disorders and depression. In a recent review of Evidence-Based Treatments by the American Psychological Association's Division of Clinical Psychology, Task Force on Psychological Interventions, cognitive behavioral interventions were by far the most common to qualify as empirically supported. For more information on research evidence see: https://div12.org/psychological-treatments/