STOP BLUSHING - WITH COGNITIVE BEHAVIOR THERAPY (CBT)
Cognitive Behavior Therapy (CBT) - this treatment aims to help people change the way they think, feel and behave in social situations. Cognitive behavior therapy combines two very effective kinds of psychotherapy — cognitive therapy and behavior therapy.
Behavior therapy helps you weaken the connections between troublesome situations and your habitual reactions to them. Reactions such as fear, depression or rage, and self-defeating or self-damaging behavior. It also teaches you how to calm your mind and body, so you can feel better, think more clearly, and make better decisions.
Cognitive therapy teaches you how certain thinking patterns are causing your symptoms — by giving you a distorted picture of what's going on in your life, and making you feel anxious, depressed or angry for no good reason, or provoking you into ill-chosen actions.
When combined into CBT, behavior therapy and cognitive therapy provide you with very powerful tools for stopping your symptoms and getting your life on a more satisfying track.
Confronting fears - with the guidance of a professional, the person ranks their social fears in order of 'threat', then confronts less threatening fears first.
It is a way of talking about:
How you think about yourself, the world and other people
How what you do affects your thoughts and feelings.
CBT can help you to change how you think (“Cognitive”) and what you do (“Behavior)”. These changes can help you to feel better. Unlike some of the other talking treatments, it focuses on the “here and now” problems and difficulties. Instead of focusing on the causes of your distress or symptoms in the past, it looks for ways to improve your state of mind now.
CBT has been found to be helpful in:
- Anxiety
- Depression
- Panic
- Agoraphobia and other phobias
- Social phobia
- Bulimia
- Obsessive compulsive disorder
- Post traumatic stress disorder
- Schizophrenia
How does it work?
CBT can help you to make sense of overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you. These parts are:
A Situation - a problem, event or difficult situation
From this can follow:
Thoughts
Emotions
Physical feelings
Actions
CBT can help you to break this vicious circle of altered thinking, feelings and behavior. When you see the parts of the sequence clearly, you can change them – and so change the way you feel. CBT aims to get you to a point where you can “do it yourself”, and work out your own ways of tackling these problems.
"Five areas" Assessment
This is another way of connecting all the 5 areas mentioned above. It builds in our relationships with other people and helps us to see how these can make us feel better or worse. Other issues such as debt, job and housing difficulties are also important. If you improve one area, you are likely to improve other parts of your life as well.
What does CBT involve?
The sessions
CBT can be done individually or with a group of people. It can also be done from a self-help book or computer program. If you have individual therapy:
You will usually meet with a therapist for between 5 and 20, weekly, or fortnightly, sessions. Each session will last between 30 and 60 minutes. In the first 2-4 sessions, the therapist will check that you can use this sort of treatment and you will check that you feel comfortable with it. The therapist will also ask you questions about your past life and background. Although CBT concentrates on the here and now, at times you may need to talk about the past to understand how it is affecting you now. You decide what you want to deal with in the short, medium and long term. You and the therapist will usually start by agreeing on what to discuss that day.
The Work
With the therapist, you break each problem down into its separate parts, as in the example above. To help this process, your therapist may ask you to keep a diary. This will help you to identify your individual patterns of thoughts, emotions, bodily feelings and actions.
Together you will look at your thoughts, feelings and behaviors to work out:
- if they are unrealistic or unhelpful
- how they affect each other, and you.
The therapist will then help you to work out how to change unhelpful thoughts and behaviors. It's easy to talk about doing something, much harder to actually do it. So, after you have identified what you can change, your therapist will recommend "homework" - you practice these changes in your everyday life. Depending on the situation, you might start to:
- Question a self-critical or upsetting thought and replace it with a positive (and more realistic) one that you have developed in CBT
- Recognize that you are about to do something that will make you feel worse and, instead, do something more helpful.
At each meeting you discuss how you've got on since the last session. Your therapist can help with suggestions if any of the tasks seem too hard or don't seem to be helping. They will not ask you to do things you don't want to do - you decide the pace of the treatment and what you will and won't try. The strength of CBT is that you can continue to practice and develop your skills even after the sessions have finished. This makes it less likely that your symptoms or problems will return.
How effective is CBT?
It is one of the most effective treatments for conditions where anxiety or depression is the main problem
It is the most effective psychological treatment for moderate and severe depression
It is as effective as antidepressants for many types of depression
What other treatments are there and how do they compare?
CBT is used in many conditions, so it isn't possible to list them all in this leaflet. We will look at alternatives to the most common problems - anxiety and depression.
CBT isn't for everyone and another type of talking treatment may work better for you.
CBT is as effective as antidepressants for many forms of depression. It may be slightly more effective than antidepressants in treating anxiety.
For severe depression, CBT should be used with antidepressant medication. When you are very low you may find it hard to change the way you think until antidepressants have started to make you feel better. Tranquillizers should not be used as a long term treatment for anxiety. CBT is a better option.
Problems with CBT
If you are feeling low and are having difficulty concentrating, it can be hard, at first, to get the hang of CBT - or, indeed, any psychotherapy. This can make you may feel disappointed or overwhelmed. A good therapist will pace your sessions so you can cope with the work you are trying to do. It can sometimes be difficult to talk about feelings of depression, anxiety, shame or anger
How long will the treatment last?
A course may be from 6 weeks to 6 months. It will depend on the type of problem and how it is working for you. The availability of CBT varies between different areas and there may be a waiting list for treatment.
What if the symptoms come back?
There is always a risk that the anxiety or depression will return.
If they do, your CBT skills should make it easier for you to control them. So, it is important to keep practicing your CBT skills, even after you are feeling better.
There is some research that suggests CBT may be better than antidepressants at preventing depression coming back. If necessary, you can have a “refresher” course.
So what impact would CBT have on my life?
Depression and anxiety are unpleasant. They can seriously affect your ability to work and enjoy life. CBT can help you to control the symptoms. It is unlikely to have a negative effect on your life, apart from the time you need to give up to do it.
What will happen if I don't have CBT?
You could discuss alternatives with your doctor. You could also:
Read more about the treatment and its alternatives
If you want to "try before you buy", get hold of a self-help book or CD-Rom and see if it makes sense to you.
Wait to see if you get better anyway - you can always ask for CBT later if you change your mind.
Behavior therapy helps you weaken the connections between troublesome situations and your habitual reactions to them. Reactions such as fear, depression or rage, and self-defeating or self-damaging behavior. It also teaches you how to calm your mind and body, so you can feel better, think more clearly, and make better decisions.
Cognitive therapy teaches you how certain thinking patterns are causing your symptoms — by giving you a distorted picture of what's going on in your life, and making you feel anxious, depressed or angry for no good reason, or provoking you into ill-chosen actions.
When combined into CBT, behavior therapy and cognitive therapy provide you with very powerful tools for stopping your symptoms and getting your life on a more satisfying track.
Confronting fears - with the guidance of a professional, the person ranks their social fears in order of 'threat', then confronts less threatening fears first.
It is a way of talking about:
How you think about yourself, the world and other people
How what you do affects your thoughts and feelings.
CBT can help you to change how you think (“Cognitive”) and what you do (“Behavior)”. These changes can help you to feel better. Unlike some of the other talking treatments, it focuses on the “here and now” problems and difficulties. Instead of focusing on the causes of your distress or symptoms in the past, it looks for ways to improve your state of mind now.
CBT has been found to be helpful in:
- Anxiety
- Depression
- Panic
- Agoraphobia and other phobias
- Social phobia
- Bulimia
- Obsessive compulsive disorder
- Post traumatic stress disorder
- Schizophrenia
How does it work?
CBT can help you to make sense of overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you. These parts are:
A Situation - a problem, event or difficult situation
From this can follow:
Thoughts
Emotions
Physical feelings
Actions
CBT can help you to break this vicious circle of altered thinking, feelings and behavior. When you see the parts of the sequence clearly, you can change them – and so change the way you feel. CBT aims to get you to a point where you can “do it yourself”, and work out your own ways of tackling these problems.
"Five areas" Assessment
This is another way of connecting all the 5 areas mentioned above. It builds in our relationships with other people and helps us to see how these can make us feel better or worse. Other issues such as debt, job and housing difficulties are also important. If you improve one area, you are likely to improve other parts of your life as well.
What does CBT involve?
The sessions
CBT can be done individually or with a group of people. It can also be done from a self-help book or computer program. If you have individual therapy:
You will usually meet with a therapist for between 5 and 20, weekly, or fortnightly, sessions. Each session will last between 30 and 60 minutes. In the first 2-4 sessions, the therapist will check that you can use this sort of treatment and you will check that you feel comfortable with it. The therapist will also ask you questions about your past life and background. Although CBT concentrates on the here and now, at times you may need to talk about the past to understand how it is affecting you now. You decide what you want to deal with in the short, medium and long term. You and the therapist will usually start by agreeing on what to discuss that day.
The Work
With the therapist, you break each problem down into its separate parts, as in the example above. To help this process, your therapist may ask you to keep a diary. This will help you to identify your individual patterns of thoughts, emotions, bodily feelings and actions.
Together you will look at your thoughts, feelings and behaviors to work out:
- if they are unrealistic or unhelpful
- how they affect each other, and you.
The therapist will then help you to work out how to change unhelpful thoughts and behaviors. It's easy to talk about doing something, much harder to actually do it. So, after you have identified what you can change, your therapist will recommend "homework" - you practice these changes in your everyday life. Depending on the situation, you might start to:
- Question a self-critical or upsetting thought and replace it with a positive (and more realistic) one that you have developed in CBT
- Recognize that you are about to do something that will make you feel worse and, instead, do something more helpful.
At each meeting you discuss how you've got on since the last session. Your therapist can help with suggestions if any of the tasks seem too hard or don't seem to be helping. They will not ask you to do things you don't want to do - you decide the pace of the treatment and what you will and won't try. The strength of CBT is that you can continue to practice and develop your skills even after the sessions have finished. This makes it less likely that your symptoms or problems will return.
How effective is CBT?
It is one of the most effective treatments for conditions where anxiety or depression is the main problem
It is the most effective psychological treatment for moderate and severe depression
It is as effective as antidepressants for many types of depression
What other treatments are there and how do they compare?
CBT is used in many conditions, so it isn't possible to list them all in this leaflet. We will look at alternatives to the most common problems - anxiety and depression.
CBT isn't for everyone and another type of talking treatment may work better for you.
CBT is as effective as antidepressants for many forms of depression. It may be slightly more effective than antidepressants in treating anxiety.
For severe depression, CBT should be used with antidepressant medication. When you are very low you may find it hard to change the way you think until antidepressants have started to make you feel better. Tranquillizers should not be used as a long term treatment for anxiety. CBT is a better option.
Problems with CBT
If you are feeling low and are having difficulty concentrating, it can be hard, at first, to get the hang of CBT - or, indeed, any psychotherapy. This can make you may feel disappointed or overwhelmed. A good therapist will pace your sessions so you can cope with the work you are trying to do. It can sometimes be difficult to talk about feelings of depression, anxiety, shame or anger
How long will the treatment last?
A course may be from 6 weeks to 6 months. It will depend on the type of problem and how it is working for you. The availability of CBT varies between different areas and there may be a waiting list for treatment.
What if the symptoms come back?
There is always a risk that the anxiety or depression will return.
If they do, your CBT skills should make it easier for you to control them. So, it is important to keep practicing your CBT skills, even after you are feeling better.
There is some research that suggests CBT may be better than antidepressants at preventing depression coming back. If necessary, you can have a “refresher” course.
So what impact would CBT have on my life?
Depression and anxiety are unpleasant. They can seriously affect your ability to work and enjoy life. CBT can help you to control the symptoms. It is unlikely to have a negative effect on your life, apart from the time you need to give up to do it.
What will happen if I don't have CBT?
You could discuss alternatives with your doctor. You could also:
Read more about the treatment and its alternatives
If you want to "try before you buy", get hold of a self-help book or CD-Rom and see if it makes sense to you.
Wait to see if you get better anyway - you can always ask for CBT later if you change your mind.