Find cognitive behavioral therapy
Find a CBT Therapist | Association for Behavioral and Cognitive Therapies
ABCT's Find-a-Therapist service gives you access to therapists schooled in cognitive and behavioral techniques.
The therapists listed in Find-a-Therapist are licensed professionals who have met the requirements of membership in ABCT and who have chosen to appear in this directory. Primarily psychologists, psychiatrists, and clinical social workers, the practitioners that participate in this service practice in private practice, clinics, hospitals, and community mental health settings.
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[select one or more]Addiction (Alcohol / Drugs / Nicotine / etc. )AgingAnger and AggressionAnxiety (Generalized Anxiety Disorder / Panic / Phobias / Worry / etc.)Assertiveness & Social SkillsAssessmentAttention-Deficit/Hyperactivity Disorder (ADHD)Autism Spectrum Disorder (ASD)Bipolar DisorderBody Dysmorphic Disorder (BDD) & Body ImageBullyingDepressionDisabilities (Developmental and Intellectual / Physical)Disruptive Behaviors (Conduct Disorder / Oppositional Defiant Disorder / etc.)Dissociative DisordersDivorce/SeparationEating Disorders (Anorexia / Bulimia / etc.)Elimination Disorders (Bed-Wetting / etc.)Financial Stress and Employment IssuesGrief and BereavementHealth Conditions (Cancer / Cardiac Rehabilitation / Diabetes / etc.)HoardingLGBTQ+Obsessive-Compulsive Disorder (OCD)Pain/Pain ManagementParenting Personality Disorders (Borderline Personality Disorder / Narcissism / etc.)Religion and SpiritualitySchizophrenia and Psychotic DisordersSchool RefusalSelf-Harm and Self Injurious BehaviorSexual DysfunctionSleep Disorders (Insomnia / etc.
)Sport PsychologySuicideTic Disorders and Tourette SyndromeTrauma (PTSD / Child Abuse / Intimate Partner Violence / etc.)Trichotillomania & Body Focused Repetitive Behaviors (Hair Pulling / Skin Picking / etc.)
Therapy Offered
[select one or more]Acceptance and Commitment TherapyApplied Behavior AnalysisCognitive Behavior TherapyCognitive Processing TherapyDialectical Behavior TherapyExposure and Response Prevention (Exposure Therapy)Eye Movement Desensitization and ReprocessingIn-Patient TreatmentInterpersonal TherapyMindfulnessOccupational TherapyParent-Child Interaction Therapy (PCIT)Premarital TherapyProblem Solving TherapyProlonged ExposureRational Emotive Behavior TherapyResidential Behavior TreatmentSpeech TherapySystematic DesensitizationVirtual Reality Therapy
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How Do I Choose a Therapist? - ABCT
Guidelines for Choosing a Therapist
There are so many therapists out there, and it can be hard to find the right provider for you.
This guide will give you information about how to choose a therapist that provides evidence-based care, including what questions to ask and what to look for.
First – please know that you have certain rights as a patient.
- You have the right to work and make decisions collaboratively with any provider.
- You also have the right to receive care that is informed by the best available research.
- You have the right to receive care that carefully considers your values, preferences, and culture, and tracks progress to determine the effectiveness of care.
To read more about your rights as a patient, please check out the mental healthcare bill of rights, here: https://www.patientbillofrights.org/
Therapy is a relationship between two people – you need to feel comfortable. The best way to figure out if your needs will be met is to ask questions. Don’t be concerned about insulting a new provider with any questions that you may have. If a provider is insulted by you asking, they’re probably not the right therapist for you.
Therapists have different processes for seeing new patients. You may speak to the therapist on the phone before an initial consultation, or, you might speak to an intake coordinator initially, and your first meeting with the therapist will be your opportunity to get all your questions answered.
Treat your first session with a therapist as a consultation – you are not obligated to continue seeing the therapist if it isn’t the right fit for you. At this first meeting, the therapist will likely ask a number of questions to get a clear idea of the problem. The goals in the first session should be to find out whether this particular therapist is likely to be helpful to you and if you feel comfortable and confident with the therapist. During this session you may want to discuss some of the following concerns, described in more detail below:
- Therapeutic approach
- Logistics
- Fees
- Qualifications and Training
Therapeutic approach:
What is your therapist’s perspective with regard to treatment? What therapeutic approaches do they use? Even within evidence-based treatment and Cognitive Behavioral Therapy (CBT), there is a broad range of approaches.
Find out what they do, and how this approach might fit with the problem that you’re having.
Be aware that many CBT therapists are specialized in different areas of CBT. Therapists may also practice many different types of modalities (CBT, psychodynamic, etc). If a provider says they specialize in many different modalities but can use CBT if that’s your preference, this may suggest that the provider is not actually a CBT specialist. If a provider tells you that they use an “eclectic approach,” which means they practice different therapy approaches as necessary, this is also a sign that they might not specialize in evidence based approaches.
One way to determine if a provider is an expert in evidence based practice is to ask what manuals they tend to use in therapy. Manuals are step-by-step guides to specific treatments, and their answer may help you figure out the approach the provider will take to your care.
Logistics:
- How long is a typical course of therapy?
The provider might not be able to give you a definite answer, but you’ll have an idea for how long therapy with this normally takes.
- How long is each therapy session?
Typical sessions are anywhere from 45 minutes to an hour, but some therapists do longer, more intensive sessions.
- How often should you expect to be seen?
Is therapy weekly, biweekly, or more intensive?
- Does the therapist assign homework or out of session practice?
For evidence based practitioners, it is typical to assign out of session work?
- How will you know when you’re ready to end therapy?
Some therapists end therapy after a specific amount of sessions, while others continue until your goals are achieved. If you want to continue therapy after your goals have been reached, be sure to ask the therapist how they approach this situation.
- How can you reach your therapist outside of session if necessary?
Many providers feel comfortable communicating via text or email outside of session, but others do not.
It’s important to know whether your therapist’s approach is a good fit for your needs.
Fees:
It can be uncomfortable to talk about money, but without this information, it will be difficult for you to decide what is in your own best interests.
Be aware that many therapists practicing evidence-based therapy do not accept insurance. Mental healthcare can be expensive, but there are some ways you can find an affordable quality therapist.
You might want to know:
- How much does therapy cost per session? Is this different for an initial session?
- Does the therapist offer a sliding scale, where they change their fees based on income?
- What is the therapist’s cancellation policy?
- Does the therapist take insurance?
- If a therapist does not take insurance, will they provide superbills for out of network reimbursement?
If you cannot afford out of pocket mental health treatment, university medical centers are also good options.
Typically, they have training clinics where experts will supervise graduate students and junior clinicians. This allows these clinics to offer lower fees than other providers. Typically, externs and interns will have the lowest therapy rates.
Qualifications and training:
- What degree(s) do your therapist hold?
CBT is not a degree-specific therapy. Be aware that there are many different paths to becoming an effective evidence based therapist.
The emphasis on CBT and evidence-based care varies within different training programs. Therapists with a strong foundation in CBT will not mind being asked questions about their qualifications and will freely give you any professional information that you request. If a therapist does not answer your questions to your satisfaction, or refuses to answer your questions, you should consult another therapist.
Therapists with the most graduate training have a doctoral level degree in clinical psychology (Ph.
D. or Psy.D.) from an accredited institution. Therapists may have doctoral degrees in social work or counseling psychology as well.
Many therapists have masters level degrees. Typical degrees for masters level clinicians are masters in social work (MSW), mental health counseling (MHC), marriage and family counseling, and school psychology. These are shorter graduate level training programs and might not focus on evidence based therapy. The therapist might be well trained, but you might need to ask more questions about post graduate education.
Psychiatrists have a medical degree (MD). They typically prescribe medications, and do not usually provide therapy.
- Is your provider independently licensed?
Note that to practice independently, therapists are required to have their own license. In the United States, the process is overseen by a state licensing board. You can look up your provider’s license on your state’s Office of Professions website.
- If your provider is not licensed, who will be signing off on your care?
All unlicensed therapists must have a licensed provider signing off on their care. Many graduate students will offer care in the context of their training, and this training extends even after a provider obtains their degree. For doctoral degrees, therapists will have a one year post-doctoral training period before they get their license. For masters level clinicians, this period of training post-degree is longer.
In all these cases, their therapy work must be supervised by a licensed clinician. Ask about their supervision, and feel free to ask for their supervisor’s contact information and expertise as well.
Other questions about qualifications that may be useful:
- What is the specific training they have received to effectively treat the problems that you are dealing with?
- How long have they been practicing?
What to Expect from Therapy
Initial Sessions:
An evidence-based therapist will spend the first few sessions assessing the extent and causes of the concerns you have.
Generally, your therapist will be asking specific questions about the problems causing you distress.
Your therapist will also ask you about your goals, and generally, coming up with these goals is a collaborative process. If you can’t agree on the goals of therapy, you should consider finding another therapist.
As Therapy Continues
Once you decide on goals, you can expect the therapist to discuss with you one or more approaches for helping you reach your goals. Central to CBT is home-based work and out-of-session practice. This practice occurs at a pace that is individual to you.
As you continue therapy, you can expect your therapist to evaluate your progress toward your goals. If you are not progressing, or if progress is too slow, your therapist will most likely suggest modifying or changing the treatment approach.You might what to consider the following:
- Do you understand what your therapist has asked you to do?
- Does therapist’s advice seem relevant to your goals?
- Do you believe that following this advice will help you make progress?
- Has your therapist given you a choice of alternative therapy approaches?
- Has the therapist explained possible side effects of the therapy?
- First talk to your therapist about the problems! A good therapist will be open to hearing your concerns.
- Consider Changing Therapists. Good therapists recognize that they might not be the best fit for everyone. If you don’t think you’re moving in the right direction, you have the right to consult another therapist.
How to Find an Evidence Based Therapist:
Here are some suggestions to finding a quality therapist in your area:
- Check out ABCT’s Find-A-Therapist, available here and search by zip-code
- For child and adolescent effective therapy information, check out effectivechildtherapy.org
- If you live near a university hospital, check out local university medical center clinics. They are often staffed by trainees who are supervised by highly trained psychologists. They often take insurance or have low fee or sliding scale options.
Look for telehealth options. If you can’t find an affordable CBT provider in your area, try telehealth. Often, therapists practicing outside urban areas provide therapy at lower rates.
Cognitive Behavioral Therapy (CBT) or Cognitive Behavioral Psychotherapy (CBT)
FIND A PSYCHOLOGIST
We tell you how one of the most popular psychotherapy techniques works, which allows you to correct thinking and emotional reactions.
alter
DIRECTION GUIDE
Contents
Behaviorism and cognitivism
Basic concepts
Techniques and exercises
When will CBT help?
Course duration
Evidence-based medicine and CBT
Medical therapy and CBT
Case studies
What to read
What is CBT?
Cognitive Behavioral Therapy (or CBT) is a technique that highlights a person's unconscious motivations, transfers them to a conscious level, helps to change beliefs and behavior that cause neurotic and other pathological conditions. nine0003
From the name it is clear that CBT combines two scientific psychological approaches: cognitive and behavioral (behavioristic).
The first states that psychological problems and neuropsychiatric disorders are caused by thoughts and beliefs, stereotypes of thinking acquired during life. The second argues that human (as well as animal) behavior can be changed by encouraging desirable forms of action and not reinforcing undesirable behavior.
Behaviorism and cognitivism
The theory of behaviorism (from the English behavior - behavior) was developed in the early twentieth century. It considers behavior as a set of reactions (reflexes) to environmental stimuli. One of the basic concepts of behaviorism is positive and negative reinforcement. Positive reinforcement, or encouragement, is applied when the individual has done the right thing, and helps to reinforce the desired form of behavior. Negative reinforcement implies a negative reaction to the undesirable behavior of the trainee. As a rule, the first form of reinforcement is used in CBT: it works faster, clearly indicates what needs to be achieved.
nine0005
Cognitivism is a scientific movement that originated in the 1960s. It focuses on mental processes: how people perceive, think, remember, learn, solve problems, where they direct their attention. Cognitions are any thoughts and ideas that become the fruits of our thinking. According to the cognitive approach, it is inefficient to work only with a person’s behavior to solve his psychological problems: first, you need to identify beliefs, ideas and thoughts that make him act destructively or feel discomfort, get rid of them, and only then work on the behavioral aspect. nine0005
“Cognitions are basically all mental processes, both adequate and dysfunctional. When children are born, they don't know anything about the world yet. Over time, they begin to encounter people and their ideas about the environment. Parents and society help them formulate both adequate and dysfunctional beliefs. Dysfunctional and maladaptive views make it difficult to adequately assess life situations.
Fears, complexes are formed, the child has a feeling that he is doing something wrong. It is this feeling that in the future leads to neurotic and other psychological problems. nine0005
Anastasia Afanasyeva, Psychotherapist KPT:
Historically, the development of KPT is divided into 4 waves:
The first wave
(1910s-1950s)
Behavioral therapy
Second wave
(1960s)
Classical approach of CBT and rational-emotive psychotherapy
Third wave
(1990s)
Development of new currents within CBT: dialectical-behavioral psychotherapy, schema therapy, mindfulness therapy, acceptance and obligation therapy (ACT)
The fourth wave
(2010s)
The emerging stage associated with the use of modern technologies in therapy: augmented reality gadgets and software applications
In 1913, the American psychologist John Watson publishes the first articles on behaviorism.
He urges his colleagues to focus exclusively on the study of human behavior, the study of the connection "external stimulus - external reaction (behavior)". Instead of analyzing the structural components of consciousness, behaviorists looked for reproducible connections between observed events, in particular between stimuli (environment) and responses (observed and measured reactions of people or animals to stimuli). Learning theories were the main model in the psychology of that time. Behaviorists have tried to formulate an explanation for how an organism establishes new connections between stimulus and response. Despite its early and sustained success, the behavioral approach placed many limitations on the therapy process. nine0003
In 1955, the founder of rational-emotional psychotherapy, Albert Ellis, announced the influence of our thoughts and ideas (cognitions) on mental processes. His colleague Aaron Beck begins to study the field of knowledge. After evaluating the results of various methods of therapy, he comes to the conclusion that our emotions and behavior depend on the way we think.
Despite attempts by behavioral therapists to maintain their position in the late 1950s and early 1960s, the ideas of cognitivism became increasingly influential. Publication of the book by A.T. Beck on Cognitive Therapy for Depression (Beck et al., 1979), as well as studies showing that cognitive therapy treats depression as effectively as antidepressants (Rush, Beck, Kovacs & Hollon, 1977), changed psychotherapy forever. In subsequent years, behavioral and cognitive therapy developed together and influenced each other so strongly that they eventually merged into a single cognitive-behavioral approach.
Historical reference
Basic concepts: automatic thoughts, cognitive distortions
Search and awareness automatic thoughts - the basis of the CBT method. About 20 thousand of such quick thoughts arise in our head per day, which are a response to what is happening to us. They are always appreciated. Evolutionarily automatic thoughts are necessary so that we can quickly respond to changes in the environment.
Most of them we do not have time to realize. These thoughts trigger our emotional response. In order to understand why our state has changed (anxiety, fear appeared, mood fell), it is necessary to identify what kind of thought caused this change. CBT suggests looking for quick thoughts in order to process them and translate your judgments into a rational channel. nine0005
“There is always a situation that triggers a state change. For example, a person is walking in the dark and hears something rustling in the bushes. He becomes anxious. Most likely, the thought flashed that there was a danger nearby. In response to this thought and feeling of anxiety, the person decides to leave quickly. However, a quick thought and a reaction to it are not always rational. For example, you are doing a work task and realize that you do not have time to complete it on time. A neurotic person may have automatic thoughts: I am not responsible enough, I will be fired. The emotional response to them is anxiety, fear.
Although if you think rationally, it is unlikely that one missed deadline will negatively affect your entire career. nine0005
Anastasia Afanasyeva, psychotherapist CBT:
Cognitive Behavioral Therapy works on cognitive distortions (or errors) that arise from automatic thoughts. Cognitive distortions are erroneous conclusions, irrational ideas that ultimately lead a person to psychological problems. There are over 100 types of cognitive distortions. Here are just a few examples:
Generalization
“I never have relationships”, “I always ruin everything”, “I always have bad luck”. nine0107 A person carries over the characteristics of a single incident for life.
Catastrophe
“Everything is very bad”, “This is a failure”, “Irreparable happened”. Under the influence of negative judgments and emotions, the feeling of the situation is pumped up to complete hopelessness.
Duty
“I owe”, “They owe me”, “Everything should have turned out this way and not otherwise.
” Social roles and responsibilities become immutable truths, neither the specifics of the situation, nor the state of the person, nor the complexity of relationships are taken into account. nine0003
Conformity
“Everyone does/behaves like this. Those who do otherwise are bad/inferior, etc.” Ideas about norms received from outside cause one to stigmatize the slightest deviation in oneself and others.
The task of the CBT therapist is to identify cognitive distortions that negatively affect the client's quality of life and help develop rational, constructive thought patterns in their place.
Techniques and exercises
One of the main techniques of the method is keeping a CBT diary . Usually it is a table in which you need to enter daily events that caused a strong emotional reaction, and analyze them according to the proposed scheme. Further cases are discussed with the therapist at the session.
An example of what columns a CBT diary can contain. Each therapist offers his own diary system.
“After the client has learned to identify his automatic thoughts, he begins to keep a diary for a week. We look at what thoughts most often arise in different situations. This may be the fear that the person will look in someone's eyes as optional (that is, bad), or a feeling that he is not successful, or a feeling that he is vulnerable and will not cope. From the automatic thoughts we recognize, core beliefs begin to emerge. Not quick, superficial thoughts, but the foundation on which the human psyche is based. We are working on changing this array of beliefs in a rational direction.” nine0005
Anastasia Afanasyeva, CBT psychotherapist:
Another important technique for CBT is exposure . It is especially useful in all kinds of phobias. Exposure helps the client learn not to avoid disturbing situations, but to experience them.
For example, a person is afraid to enter an elevator. When using the exposure technique, the client and therapist approach the booth, stop, and begin to observe the client's reaction. When the anxiety rises, they do exercises with the therapist to help them cope with the anxiety. If the reaction is managed, the client and therapist move on to the next step: they enter the elevator together. The level of anxiety rises again, the therapist again works out with the client his condition. The intensity of the situation gradually increases until the client receives all the necessary skills in order to be aware and rationally assess his condition, to cope with it. nine0005
When will CBT help?
The effectiveness of the CPT is proved for the following states:
All types of phobia
Alarm
Panic disorder and panic attacks
Depression
Occupation and compulsive disorders (OKR)
9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 thoughts, actions, rituals
Psychosomatic disorders
irritable intestine, headaches and another
post -traumatic stress disorder
Eating disorder
Difficulties with communication, building contacts and their maintenance, constancy in the work and family relations
Dependence 9000
Physical and physical mental
Aggressive behavior
CBT in panic attacks
Panic attacks are spontaneous panic attacks that are accompanied by rapid breathing, palpitations, dizziness, tremor, nausea, sweating and other somatic manifestations.
nine0003
A panic attack may be the result of other psychiatric disorders rather than a single illness. Recurrent panic attacks without other symptoms may be manifestations of panic disorder. Cognitive behavioral therapy is the proven and most effective treatment for it.
“Panic attacks can occur in depressive disorders, generalized anxiety disorder, and hypochondriacal disorders. This is a very non-specific symptom, such as fever. It is found in various diseases. To make an accurate diagnosis, before starting treatment, you need to be diagnosed by a psychiatrist or psychotherapist. nine0005
Anastasia Afanasyeva, psychotherapist CBT:
The exposure technique mentioned above is very well the main tool for dealing with panic attacks. The psychotherapist teaches the patient to recognize what is happening to him at the time of the attack, how and to what his body reacts. Gradually, the patient learns to cope with his condition.
“First, there is a stage of psycho-education: we tell what happens in the patient's body at the time of the attack.
We analyze cycles, thoughts, emotions, behavior, we are looking for the reason that starts the process. Further work is based on the fact that in the office we learn to cause symptoms: dizziness, palpitations, hyperventilation. We practice techniques to endure the anxiety that these symptoms cause. Thus, gradually we build tolerance. Anxiety decreases and eventually disappears. nine0003
Shortness of breath can be caused by hyperventilation - rapid shallow breathing. Dizziness - spinning in place. Palpitations - squats or running up the stairs. All exercises are performed together with the therapist. We say that it is not dangerous, the person understands this. When during the session I breathe with the patient, he sees that I normally endure this state. In doing so, he observes what happens to his own sensations.
The essence of a panic attack is that it always goes away. The fear that it will start, most often becomes the trigger for its start. It brings other problems as well, such as avoiding certain situations or carefully checking one's condition.
" nine0005
Anastasia Afanasyeva, psychotherapist CBT:
Duration of the course
CBT is considered a short-term therapy, but the duration of the course depends on many factors. For a specific request, such as a phobia or difficulty falling asleep, about 10 sessions are needed. However, this format involves solving only one problem. For multiple problems and more complex conditions, the course will last from a few months to a year. Treating personality disorders will require even longer work. nine0003
Therapy involves a meeting once a week, at a pre-selected time. The duration of the session is 50 minutes. Outside of sessions, the client does homework.
Each session has a structure: agenda, checking homework, discussing specific requests, working through them, debriefing, receiving homework, feedback.
« Terms are always individual and depend on the severity of the condition.
For panic attacks or depression, this is six months to a year. For complex diseases or personality disorders, therapy can be very long. In addition to the form and severity of the disease, the ability and desire of a person to get involved in work play a role. There are people who are more prone to reflection, it is easier for them to realize their own mental processes. There are people who find it harder. nine0003
As with any therapy, one should not expect miracles from CBT. You cannot change in a couple of months, and even in six months. But you can learn to see the relationship between your thoughts, emotions and behavior, and this will allow you to weed out unnecessary thoughts, change reactions, not be led by your beliefs left by your parents and the outside world, and not let anxiety and fear rule your life.
Anastasia Afanasyeva, CBT psychotherapist:
Evidence-based medicine and CBT
Cognitive Behavioral Therapy (CBT) is one of the most researched methods of psychotherapy.
In 2012, a Boston University Department of Psychology Working Group released a seminal systematic review of meta-analyses (1) of various studies, which is the most comprehensive scientific paper on the effectiveness of CBT to date. Based on 269 papers, the researchers concluded that the referral was extremely effective in dealing with anxiety and mood disorders, highly effective in treating phobias, insomnia, and significantly effective in reducing workplace stress. The full text of the review in English can be found here. nine0005
1 Meta-analysis is a type of data analysis in which the results of a number of randomized clinical trials are combined and analyzed as a single large study. In evidence-based medicine, meta-analysis is assigned the highest level of evidence (IA).
Medication and CBT
There are a number of conditions that can be treated with non-medicated CBT, such as mild generalized anxiety disorder, panic disorder, mild OCD, mild depression.
However, in a number of conditions, it is recommended to combine psychotherapy with pharmacotherapy. These include moderate depression and severe depression. nine0005
« Fear of pharmacotherapy is quite common and I deal with it regularly. I can say that many fears are unfounded. There is a myth that antidepressants are addictive. According to all studies, no antidepressant causes either mental or physical dependence.
If you have a fear of medication, see a qualified doctor who is trained in psychotherapy and pharmacotherapy. He will conduct a medical diagnosis, decide whether it is really necessary to carry out drug therapy, and help work through your fear using CBT techniques.” nine0005
Anastasia Afanasyeva, psychotherapist CBT:
Case reports
“A young man asked for help: after breaking up with a girlfriend, he suffered from depressed mood, anxiety, difficulty falling asleep, obsessive thoughts before going to bed, loss of appetite .
In the course of therapy, we uncovered the hidden beliefs that generated these reactions. He believed that if he could not "keep" the relationship, then this indicates his unreliability, if he failed to choose an "adequate" partner, this indicates weakness. Also, the client could not understand what he needed, he relied on ideas about how "should be". nine0003
During three months of work, the client has learned to be aware of his needs, desires, track thoughts and engage in polemics with them. The young man was able to emotionally distance himself from obsessive thoughts, the mood background leveled off. He built his schedule in accordance with his own goals and values, acquired awareness skills.
Anastasia Afanasyeva, psychotherapist CBT:
What to read?
Cognitive Behavioral Therapy for Anxiety, Fear, Worry and Panic. Michelle Skin, Matthew McKay, Patrick Fanning
This book is for those who are already in therapy and want to understand the basics of the method and get the most out of CBT.
The authors dwell on techniques and exercises that help to cope with the manifestations of anxiety and symptoms of panic attacks.
Cognitive Behavioral Therapy for Dummies. Rena Branch, Rob Wilson
A book from practicing therapists that explains CBT principles, concepts and how to deal with various disorders in simple language. In addition to practical advice and exercises, you will find many examples from the practice of the authors in it. nine0005
FIND A CBT PSYCHOLOGIST
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Cognitive Behavioral Therapy (CBT) or Cognitive Behavioral Psychotherapy (CBT)
FIND A PSYCHOLOGIST
We tell you how one of the most popular psychotherapy techniques works, which allows you to correct thinking and emotional reactions.
alter
DIRECTION GUIDE
Contents
Behaviorism and cognitivism
Basic concepts
Techniques and exercises
When will CBT help?
Course duration
Evidence-based medicine and CBT
Medical therapy and CBT
Case studies
What to read
What is CBT?
Cognitive Behavioral Therapy (or CBT) is a technique that highlights a person's unconscious motivations, transfers them to a conscious level, helps to change beliefs and behavior that cause neurotic and other pathological conditions.
nine0003
From the name it is clear that CBT combines two scientific psychological approaches: cognitive and behavioral (behavioristic). The first states that psychological problems and neuropsychiatric disorders are caused by thoughts and beliefs, stereotypes of thinking acquired during life. The second argues that human (as well as animal) behavior can be changed by encouraging desirable forms of action and not reinforcing undesirable behavior.
Behaviorism and cognitivism
The theory of behaviorism (from the English behavior - behavior) was developed in the early twentieth century. It considers behavior as a set of reactions (reflexes) to environmental stimuli. One of the basic concepts of behaviorism is positive and negative reinforcement. Positive reinforcement, or encouragement, is applied when the individual has done the right thing, and helps to reinforce the desired form of behavior. Negative reinforcement implies a negative reaction to the undesirable behavior of the trainee.
As a rule, the first form of reinforcement is used in CBT: it works faster, clearly indicates what needs to be achieved. nine0005
Cognitivism is a scientific movement that originated in the 1960s. It focuses on mental processes: how people perceive, think, remember, learn, solve problems, where they direct their attention. Cognitions are any thoughts and ideas that become the fruits of our thinking. According to the cognitive approach, it is inefficient to work only with a person’s behavior to solve his psychological problems: first, you need to identify beliefs, ideas and thoughts that make him act destructively or feel discomfort, get rid of them, and only then work on the behavioral aspect. nine0005
“Cognitions are basically all mental processes, both adequate and dysfunctional. When children are born, they don't know anything about the world yet. Over time, they begin to encounter people and their ideas about the environment. Parents and society help them formulate both adequate and dysfunctional beliefs.
Dysfunctional and maladaptive views make it difficult to adequately assess life situations. Fears, complexes are formed, the child has a feeling that he is doing something wrong. It is this feeling that in the future leads to neurotic and other psychological problems. nine0005
Anastasia Afanasyeva, Psychotherapist KPT:
Historically, the development of KPT is divided into 4 waves:
The first wave
(1910s-1950s)
Behavioral therapy
Second wave
(1960s)
Classical approach of CBT and rational-emotive psychotherapy
Third wave
(1990s)
Development of new currents within CBT: dialectical-behavioral psychotherapy, schema therapy, mindfulness therapy, acceptance and obligation therapy (ACT)
The fourth wave
(2010s)
The emerging stage associated with the use of modern technologies in therapy: augmented reality gadgets and software applications
In 1913, the American psychologist John Watson publishes the first articles on behaviorism.
He urges his colleagues to focus exclusively on the study of human behavior, the study of the connection "external stimulus - external reaction (behavior)". Instead of analyzing the structural components of consciousness, behaviorists looked for reproducible connections between observed events, in particular between stimuli (environment) and responses (observed and measured reactions of people or animals to stimuli). Learning theories were the main model in the psychology of that time. Behaviorists have tried to formulate an explanation for how an organism establishes new connections between stimulus and response. Despite its early and sustained success, the behavioral approach placed many limitations on the therapy process. nine0003
In 1955, the founder of rational-emotional psychotherapy, Albert Ellis, announced the influence of our thoughts and ideas (cognitions) on mental processes. His colleague Aaron Beck begins to study the field of knowledge. After evaluating the results of various methods of therapy, he comes to the conclusion that our emotions and behavior depend on the way we think.
Despite attempts by behavioral therapists to maintain their position in the late 1950s and early 1960s, the ideas of cognitivism became increasingly influential. Publication of the book by A.T. Beck on Cognitive Therapy for Depression (Beck et al., 1979), as well as studies showing that cognitive therapy treats depression as effectively as antidepressants (Rush, Beck, Kovacs & Hollon, 1977), changed psychotherapy forever. In subsequent years, behavioral and cognitive therapy developed together and influenced each other so strongly that they eventually merged into a single cognitive-behavioral approach.
Historical reference
Basic concepts: automatic thoughts, cognitive distortions
Search and awareness automatic thoughts - the basis of the CBT method. About 20 thousand of such quick thoughts arise in our head per day, which are a response to what is happening to us. They are always appreciated. Evolutionarily automatic thoughts are necessary so that we can quickly respond to changes in the environment.
Most of them we do not have time to realize. These thoughts trigger our emotional response. In order to understand why our state has changed (anxiety, fear appeared, mood fell), it is necessary to identify what kind of thought caused this change. CBT suggests looking for quick thoughts in order to process them and translate your judgments into a rational channel. nine0005
“There is always a situation that triggers a state change. For example, a person is walking in the dark and hears something rustling in the bushes. He becomes anxious. Most likely, the thought flashed that there was a danger nearby. In response to this thought and feeling of anxiety, the person decides to leave quickly. However, a quick thought and a reaction to it are not always rational. For example, you are doing a work task and realize that you do not have time to complete it on time. A neurotic person may have automatic thoughts: I am not responsible enough, I will be fired. The emotional response to them is anxiety, fear.
Although if you think rationally, it is unlikely that one missed deadline will negatively affect your entire career. nine0005
Anastasia Afanasyeva, psychotherapist CBT:
Cognitive Behavioral Therapy works on cognitive distortions (or errors) that arise from automatic thoughts. Cognitive distortions are erroneous conclusions, irrational ideas that ultimately lead a person to psychological problems. There are over 100 types of cognitive distortions. Here are just a few examples:
Generalization
“I never have relationships”, “I always ruin everything”, “I always have bad luck”. nine0107 A person carries over the characteristics of a single incident for life.
Catastrophe
“Everything is very bad”, “This is a failure”, “Irreparable happened”. Under the influence of negative judgments and emotions, the feeling of the situation is pumped up to complete hopelessness.
Duty
“I owe”, “They owe me”, “Everything should have turned out this way and not otherwise.
” Social roles and responsibilities become immutable truths, neither the specifics of the situation, nor the state of the person, nor the complexity of relationships are taken into account. nine0003
Conformity
“Everyone does/behaves like this. Those who do otherwise are bad/inferior, etc.” Ideas about norms received from outside cause one to stigmatize the slightest deviation in oneself and others.
The task of the CBT therapist is to identify cognitive distortions that negatively affect the client's quality of life and help develop rational, constructive thought patterns in their place.
Techniques and exercises
One of the main techniques of the method is keeping a CBT diary . Usually it is a table in which you need to enter daily events that caused a strong emotional reaction, and analyze them according to the proposed scheme. Further cases are discussed with the therapist at the session.
An example of what columns a CBT diary can contain. Each therapist offers his own diary system.
“After the client has learned to identify his automatic thoughts, he begins to keep a diary for a week. We look at what thoughts most often arise in different situations. This may be the fear that the person will look in someone's eyes as optional (that is, bad), or a feeling that he is not successful, or a feeling that he is vulnerable and will not cope. From the automatic thoughts we recognize, core beliefs begin to emerge. Not quick, superficial thoughts, but the foundation on which the human psyche is based. We are working on changing this array of beliefs in a rational direction.” nine0005
Anastasia Afanasyeva, CBT psychotherapist:
Another important technique for CBT is exposure . It is especially useful in all kinds of phobias. Exposure helps the client learn not to avoid disturbing situations, but to experience them.
For example, a person is afraid to enter an elevator. When using the exposure technique, the client and therapist approach the booth, stop, and begin to observe the client's reaction. When the anxiety rises, they do exercises with the therapist to help them cope with the anxiety. If the reaction is managed, the client and therapist move on to the next step: they enter the elevator together. The level of anxiety rises again, the therapist again works out with the client his condition. The intensity of the situation gradually increases until the client receives all the necessary skills in order to be aware and rationally assess his condition, to cope with it. nine0005
When will CBT help?
The effectiveness of the CPT is proved for the following states:
All types of phobia
Alarm
Panic disorder and panic attacks
Depression
Occupation and compulsive disorders (OKR)
9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 thoughts, actions, rituals
Psychosomatic disorders
irritable intestine, headaches and another
post -traumatic stress disorder
Eating disorder
Difficulties with communication, building contacts and their maintenance, constancy in the work and family relations
Dependence 9000
Physical and physical mental
Aggressive behavior
CBT in panic attacks
Panic attacks are spontaneous panic attacks that are accompanied by rapid breathing, palpitations, dizziness, tremor, nausea, sweating and other somatic manifestations.
nine0003
A panic attack may be the result of other psychiatric disorders rather than a single illness. Recurrent panic attacks without other symptoms may be manifestations of panic disorder. Cognitive behavioral therapy is the proven and most effective treatment for it.
“Panic attacks can occur in depressive disorders, generalized anxiety disorder, and hypochondriacal disorders. This is a very non-specific symptom, such as fever. It is found in various diseases. To make an accurate diagnosis, before starting treatment, you need to be diagnosed by a psychiatrist or psychotherapist. nine0005
Anastasia Afanasyeva, psychotherapist CBT:
The exposure technique mentioned above is very well the main tool for dealing with panic attacks. The psychotherapist teaches the patient to recognize what is happening to him at the time of the attack, how and to what his body reacts. Gradually, the patient learns to cope with his condition.
“First, there is a stage of psycho-education: we tell what happens in the patient's body at the time of the attack.
We analyze cycles, thoughts, emotions, behavior, we are looking for the reason that starts the process. Further work is based on the fact that in the office we learn to cause symptoms: dizziness, palpitations, hyperventilation. We practice techniques to endure the anxiety that these symptoms cause. Thus, gradually we build tolerance. Anxiety decreases and eventually disappears. nine0003
Shortness of breath can be caused by hyperventilation - rapid shallow breathing. Dizziness - spinning in place. Palpitations - squats or running up the stairs. All exercises are performed together with the therapist. We say that it is not dangerous, the person understands this. When during the session I breathe with the patient, he sees that I normally endure this state. In doing so, he observes what happens to his own sensations.
The essence of a panic attack is that it always goes away. The fear that it will start, most often becomes the trigger for its start. It brings other problems as well, such as avoiding certain situations or carefully checking one's condition.
" nine0005
Anastasia Afanasyeva, psychotherapist CBT:
Duration of the course
CBT is considered a short-term therapy, but the duration of the course depends on many factors. For a specific request, such as a phobia or difficulty falling asleep, about 10 sessions are needed. However, this format involves solving only one problem. For multiple problems and more complex conditions, the course will last from a few months to a year. Treating personality disorders will require even longer work. nine0003
Therapy involves a meeting once a week, at a pre-selected time. The duration of the session is 50 minutes. Outside of sessions, the client does homework.
Each session has a structure: agenda, checking homework, discussing specific requests, working through them, debriefing, receiving homework, feedback.
« Terms are always individual and depend on the severity of the condition.
For panic attacks or depression, this is six months to a year. For complex diseases or personality disorders, therapy can be very long. In addition to the form and severity of the disease, the ability and desire of a person to get involved in work play a role. There are people who are more prone to reflection, it is easier for them to realize their own mental processes. There are people who find it harder. nine0003
As with any therapy, one should not expect miracles from CBT. You cannot change in a couple of months, and even in six months. But you can learn to see the relationship between your thoughts, emotions and behavior, and this will allow you to weed out unnecessary thoughts, change reactions, not be led by your beliefs left by your parents and the outside world, and not let anxiety and fear rule your life.
Anastasia Afanasyeva, CBT psychotherapist:
Evidence-based medicine and CBT
Cognitive Behavioral Therapy (CBT) is one of the most researched methods of psychotherapy.
In 2012, a Boston University Department of Psychology Working Group released a seminal systematic review of meta-analyses (1) of various studies, which is the most comprehensive scientific paper on the effectiveness of CBT to date. Based on 269 papers, the researchers concluded that the referral was extremely effective in dealing with anxiety and mood disorders, highly effective in treating phobias, insomnia, and significantly effective in reducing workplace stress. The full text of the review in English can be found here. nine0005
1 Meta-analysis is a type of data analysis in which the results of a number of randomized clinical trials are combined and analyzed as a single large study. In evidence-based medicine, meta-analysis is assigned the highest level of evidence (IA).
Medication and CBT
There are a number of conditions that can be treated with non-medicated CBT, such as mild generalized anxiety disorder, panic disorder, mild OCD, mild depression.
However, in a number of conditions, it is recommended to combine psychotherapy with pharmacotherapy. These include moderate depression and severe depression. nine0005
« Fear of pharmacotherapy is quite common and I deal with it regularly. I can say that many fears are unfounded. There is a myth that antidepressants are addictive. According to all studies, no antidepressant causes either mental or physical dependence.
If you have a fear of medication, see a qualified doctor who is trained in psychotherapy and pharmacotherapy. He will conduct a medical diagnosis, decide whether it is really necessary to carry out drug therapy, and help work through your fear using CBT techniques.” nine0005
Anastasia Afanasyeva, psychotherapist CBT:
Case reports
“A young man asked for help: after breaking up with a girlfriend, he suffered from depressed mood, anxiety, difficulty falling asleep, obsessive thoughts before going to bed, loss of appetite .
In the course of therapy, we uncovered the hidden beliefs that generated these reactions. He believed that if he could not "keep" the relationship, then this indicates his unreliability, if he failed to choose an "adequate" partner, this indicates weakness. Also, the client could not understand what he needed, he relied on ideas about how "should be". nine0003
During three months of work, the client has learned to be aware of his needs, desires, track thoughts and engage in polemics with them. The young man was able to emotionally distance himself from obsessive thoughts, the mood background leveled off. He built his schedule in accordance with his own goals and values, acquired awareness skills.
Anastasia Afanasyeva, psychotherapist CBT:
What to read?
Cognitive Behavioral Therapy for Anxiety, Fear, Worry and Panic. Michelle Skin, Matthew McKay, Patrick Fanning
This book is for those who are already in therapy and want to understand the basics of the method and get the most out of CBT.
