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.
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.
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.
David Edelberg, MD