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Cognitive Behavioral Therapy for Anxiety and Depression

If you’re troubled by chronic anxiety, panic attacks, or depression, you may be put off by pill-popping treatments. Maybe you had a bad experience in the past or you’re concerned about side effects. All in all, you’d rather not feel nostalgic about your libido or gain a single ounce.

You know that psychotherapy makes the most sense, that having someone to talk to just feels right. In fact, talk therapy may have helped you in the past, but you wonder if you’re ready to start again. Do you really want to review your crappy childhood once more or bring up best-forgotten relationships? Are you prepared for months or even years of reporting to a shrink the details of the endless soap opera that is your life?

Improvement, yes, but oh so slowly.

And then there’s the money issue. Maybe you hadn’t noticed, but lately with many health insurance policies you’re allowed only a specific number of sessions (usually about ten) each year. This means get well quickly or get well on your own.

WHC therapies
We use three forms of therapy for anxiety and depression at WholeHealth Chicago, all of which are effective and work faster than conventional talk therapy. The best known of these is cognitive behavioral therapy (CBT), widely used in the UK where the government actually underwrites CBT training for psychologists.

I’ll cover the two others, EMDR (Eye Movement Desensitization and Reprocessing) and EFT (Emotional Freedom Technique), in a future Health Tip.

Drs. Janet Chandler and Meghan Roekle at WHC both incorporate CBT into their practices. 

Cognitive behavioral therapy
You can tell from its name that CBT focuses on how you think (cognitive, from cognition) and how you act (behavioral). What you learn in CBT, a process that’s highly educational for most of us, is how your thoughts about a situation–a forthcoming job interview, starting/ending a relationship, etc.–affect how you feel, both physically and emotionally.

You, as a unique individual, have applied a meaning to any situation that triggers your anxiety, panic, or depression. But the situation itself is neutral. Other people have job interviews and begin and end relationships. Why these are so painful for you and how you can equip yourself to cope with them is really the basis of CBT.

For example, let’s say at the thought of an upcoming job interview you’re reduced to a quivering ball of fear. You can’t think straight and worry that you might even throw up on the interviewer’s desk. You might awaken the morning of the interview too tired to show up, or you stop at toilets along the way with sudden abdominal cramps and diarrhea. Yet the very next person being interviewed regards the meeting as a positive challenge, is able to present her qualifications clearly, and sails into the job. In a nutshell, CBT teaches how you can be like her.

A new way of viewing challenges
With CBT, you learn a new way of understanding and thinking about your problems. Once you have a better knowledge of yourself and how your anxiety or depression works, you learn steps to manage it all better.

To accomplish this, you acquire a fresh set of skills: new ways of thinking and behaving to help you master your anxiety or depression. When we’re anxious
or depressed, we look at the world in a negative way, and our natural defense to the negative is avoidance.

CBT teaches you how to think in a more balanced way, see any situation in a positive light, and approach it in ways that reduce anxiety and the smorgasbord of physical symptoms that accompany it.

Unlike conventional psychotherapy, CBT is goal oriented. You and your therapist establish specific goals and work toward them. Studies using CBT have shown that most of us will take the necessary steps toward wellness if we grasp where we’re going and how to get there.

“I want someone to tell me what to do,” is a phrase I hear frequently from anxious and depressed patients. CBT provides this guidance.

Instead of dwelling on the past, peeling back the endless layered questions about how you arrived where you are, CBT focuses on the here and now. Sure, it can be interesting to remember how being bullied as a young child contributed to your social anxiety, but knowing this doesn’t fix the problem.

CBT re-orients you toward thinking about your unhelpful thoughts and how your response
 to them allowed your social anxiety to survive, in some people decade after decade. Then you’re taught alternative ways of thinking. You’re given actual exercises to teach yourself in order to recognize useless patterns and change them into positive actions.

Unlike virtually all forms of therapy, CBT emphasizes homework. You’ll be taught new skills and be advised to practice…practice…practice. If you don’t practice, you won’t learn to incorporate these new skills into your daily life. By rehearsing your CBT skills regularly, you’ll also learn to recognize trouble-ahead signals and pull out your CBT strategies to get back on track.

More on CBT
Further background on this effective treatment:

  • Numerous clinical studies have proven that CBT is as effective as prescription medication. In the UK, the National Health Service recommends that general practitioners refer patients for CBT before considering antidepressants or anti-anxiety meds.
  • In addition to anxiety and depression, CBT has been shown effective for obsessive-compulsive disorder (OCD), panic attacks, post-traumatic stress disorder (PTSD), phobias, eating disorders, chronic pain, chronic fatigue, insomnia, and alcohol misuse.
  • Unlike conventional psychotherapy, CBT is not a “forever” treatment. Usually, you’re discharged by your therapist after 10 to 15 sessions.
  • During a session, you’ll learn to break down your problems into separate parts (thoughts, physical feelings, actions) and then you’ll analyze these as potential areas for change, ridding yourself of unhelpful thoughts or actions.
  • After working out what you can change, you’ll learn how to practice these changes in your daily life

Those are the upsides of CBT. The only real downside is that you must commit yourself to the process. This means you’ll need to attend your CBT sessions and carry out the extra work between them.

You’ll be confronting your emotions and anxieties, and you may initially experience increased anxiety as you learn about aspects of yourself you were reluctant to confront.

Patients who have successfully completed CBT often notice changes in family/interpersonal dynamics. People who knew you as chronically anxious or timid and fearful may be uncomfortable with the new you. Change requires courage.

Be well,
David Edelberg, MD


Leave a Comment

  1. Michelle Taufmann says:

    Like all psychotherapy, CBT is a superficial fix to a much deeper problem. It’s a band-aid. The deeper problem is that we think that external “stuff,” i.e., like a certain job, relationship or income — will make us feel whole, grounded and happy. Not true. Nothing external will make us happy. Only understanding that we are not our thoughts, mind, body, role, accomplishments, relationships, connections, etc., but that we are consciousness-life itself–will bring us peace and happiness. CBT might be a start, but it will not end the continual cycle of wanting-getting-wanting more that is the root cause of dissatisfaction for all of us. Furthermore, comparing oneself to someone else who “sails through” an interview or appears to have it better/easier than us, is another widespread root cause of unhappiness in our society.

  2. Addie says:

    I agree with Michelle. Fortunately I worked on a form of CBT (Rational-Emotive Therapy at the Albert Ellis Institute in New York) at the same time I was studying metaphysics. My therapist had much experience with people in religious vocations, and was sensitive to, even helpful with, my other practice. They are not mutually exclusive, but without my metaphysical studies, the CBT might not have been as effective.

  3. Tara says:

    I agree that CBT can potentially help someone with anxiety, depression or PTSD, however finding qualified practitioners is difficult. When I was diagnosed by my primary care physician with Chronic Fatigue Syndrome (now called Systemic exertion intolerance disease) the only treatment or testing he recommended was CBT. The counselor may have had a course in this but she knew nothing of my condition or why and how CBT should be used for CFS/SEID and neither did I. It was useless. I agree with Michelle, this is a simplistic band aid for an extremely complex condition. Sure you can cure PTSD from a car crash or other isolated event with some of these therapies, and you can affect change for minor, situationally caused depression, but it will not address the deep issues connected with complex PTSD, chronic anxiety, or clinical depression with these therapies. Also, I am beginning to believe my anxiety has a physical as well as psychological cause and all these therapies won’t help that and I positively know that my depression is physical not mental so I feel counseling won’t help with the depression. Suggesting that all anxiety and depression can be treated with counseling is perpetuating the belief that these are psychological afflictions not physical and I don’t believe that is true. We are physical and spiritual beings and as Michelle and Addie have pointed out effective treatment must include addressing the issues on all levels. Most metaphysical teachers will tell you that illness begins on the mental plane and moves to the body if it is not resolved. So you must treat the physical but also the mental, emotional and spiritual. If the patient is properly trained, I believe a personal meditation/devotional practice combined with the appropriate medical care is more helpful than these other therapies. Recommending psychological approaches for these conditions can become an easy way for busy doctors to pass off patients with difficult to understand and treat conditions. It is what my doctor did when he diagnosed me with CFS. Four years ago he read the CDC website that recommended CBT for chronic fatigue so he referred me for counseling and washed his hands of the entire situation. In four years I have become housebound and bedridden and the only thing this doctor or any other doctor in my community had done for me is to suggest psychological counseling. It is insulting considering I was a college educated, fully functional mid-level manager of a scientific program in a high profile government job prior to becoming ill. I am not crazy. This business of sending patients to counseling when you don’t know how else to help them is very detrimental for the patient. Doctors often resort to this approach without having done proper testing and treating of the underlying medical issue. Headlines such as the one for this blog imply CBT can cure these conditions and it can’t. Adopting a conscious, goal oriented approach to problems is helpful and CBT does have a place, but these are first and foremost medical problems. And as Michelle pointed out: …comparing oneself to someone else who “sails through” an interview or appears to have it better/easier than us, is another widespread root cause of unhappiness in our society.” This article trivializes the conditions by suggesting that you can find a resolution for deep seated issues such as these in “10-15 sessions”. Headlines like this can make someone like myself who has struggled for years with these issues feel like a failure since I haven’t been unable to find relief or affect a “cure”. This statement: ” In the UK, the National Health Service recommends that general practitioners refer patients for CBT before considering antidepressants or anti-anxiety meds.” I want to point out that this is not necessarily a good thing. Patients diagnosed and critically ill with CFS have actually been committed to mental wards in the UK rather than receiving medical attention for the disease. It is becoming a national disgrace. I believe much of this is motivated by cost cutting and driven by directives from insurance companies on how to diagnose and treat. Why spend thousands of dollars on obscure tests to determine the etiology of the disease, when you can just shuttle the patient off to a counselor and be done with it.

  4. Lynn Licastro RN says:

    Thank you again Doc for your insights…do you have any more info on PTSD…have many autoimmune disorders,,more each few years. Not just fibromyalgia anymore. Does Fibro attack the GI system? Scopes showed inflammation despite good diet. Gird. Ulcer. NBS?

  5. Dr E says:

    Hi Lynn
    PTSD upsets the entire body, physically, emotionally, immunlogically, and is responsible for a wide variety of symptoms. Trying to deal with the symptoms without exploring the root cause is like the ‘whack-a-mole’ games you see at carnivals. Hit one mole and two others pop up. In a PTSD setting, working on one symptom, then two more appear. If any situation necessitates exploration of the root cause, it’s PTSD.

  6. Eileen Mackey says:

    Dr. E,
    Thank you for this article.
    I have Bipolar Disorder II, and the CBT work I did with my therapist shortly after being diagnosed has been the most far reaching, long lasting treatment I’ve received in terms of continued efficacy.It took a lot of work but now I cycle through the cognitive steps of CBT as an automatic response most times I am confronted by a serious stressor. I strongly recommend it to my loved ones & anyone else who will listen that is suffering with or newly diagnosed with an anxiety and/or mood disorder.

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