Conditions Effectively Managed with CBT Cognitive Behavior Therapy (CBT) has been shown in more than 1,000 research studies to be effective for many different disorders and problems. For all disorders, the CBT therapist starts by educating clients about their diagnosis and about CBT, helps clients set treatment goals, and teaches clients essential thinking and behavioral skills.
What are the symptoms of anger? When we are angry, our thoughts focus on our perceptions that other people are hurting us, threatening us, breaking the rules, or being unfair. Anger is characterized by muscle tension, increased heart rate, increased blood pressure, and defensiveness or attack. What is CBT for anger like? Treatment begins with psychoeducation: How angry we feel is influenced by our interpretation of the meaning of events, our expectations for other people, and whether or not we thought the other person's behavior was intentional or not. We help clients learn to monitor their anger, rate its intensity, and identify the thoughts/beliefs that fuel it. Methods that are effective in controlling anger include testing angry thoughts, using imagery to anticipate and prepare for events in which you are at a high risk for anger, recognizing the early warning signs of anger, timeouts, assertion, forgiveness, and couples or family therapy.
What are the symptoms of bipolar disorder? Bipolar disorder is characterized by a manic episode followed by either a depressive or hypomanic episode. People caught in a depressive episode experience at least two weeks of feeling sad, empty, or hopeless. They lose interest in activities they once enjoyed and may lose weight, have difficulty sleeping, or may spend more than half the day in bed. They may feel both exhausted and agitated, worthless, excessively guilty, and lose their ability to concentrate or make simple decisions. And most dangerously, they may lose their will to live, and even seek ways to end their life. People in the midst of a manic episode experience at least a week of persistently elevated or irritable mood. They may be expansive — seeing themselves as possessing special powers or abilities. They may shout at or start arguments with people they don’t know. They may lose their need for sleep — feeling fully rested after only 3 hours of sleep. They may be so talkative that people have trouble interrupting them. They may experience their thoughts as racing, so much so that they are incapable of keeping their mind focused on one thing. They may be so active that friends and family are worried about them. And they may be so impulsive and reckless that they put their physical and financial health at risk. Depressive and manic episodes can vary in frequency, intensity, and duration. Bipolar I disorder is characterized by intense manic episodes. At their worst, people may require hospitalization. Bipolar II disorder is characterized by more brief (4 days), less intense episodes of mania, which is called hypomania.
What is treatment for bipolar disorder like? Therapists use many of the same interventions for these clients as with clients who are depressed but also provide clients with bipolar disorder tools to recognize the warning signs of mania and cope with its effects. CBT therapists also help clients manage their medication with their psychiatrist, communicating the effects, both positive and negative, that medication has on their life. Therapists teach clients with bipolar disorder strategies to help regularize their sleep, as too much time in bed can trigger depression; too little can trigger mania. Therapists focus on identifying some of the hyper-positive thinking (“I can do no wrong”) and the impulsivity (“I want what I want when I want it and I want it now”) that can characterize their thinking. CBT therapists teach ways to delay gratification, maintain awareness of their actions, slow down, plan activities, be more conscious of the consequences of their actions, and distance them from the emotional tug of mania. The tools for depression focus on enabling clients to see the best in themselves, their personal world, and their future. They learn to take constructive action to their own benefit in the absence of motivation, interest, and energy. And they learn that such action can increase motivation, energy, and interest.
What are the symptoms of chronic pain? Chronic pain is defined as pain that does not go away as expected after an illness or injury. Whereas acute pain is a normal sensation that alerts us to possible injury, chronic pain is different and may persist for months or longer. Individuals with chronic pain may report feeling discomfort, soreness, tightness, or stiffness, and experience pain as shooting, burning, or aching. Chronic pain can lead to other problems, such as fatigue, which can cause a loss of motivation. Sleeping problems are commonplace followed by withdrawal from activities due to an increased need to rest. Irritability, depression, and anxiety are also typical symptoms of chronic pain.
What is CBT for chronic pain like? When working with clients with chronic pain, the CBT therapist not only puts special emphasis on identifying and modifying maladaptive behaviors that have a role in maintaining pain, but they also work on identifying and increasing adaptive behaviors. Individuals are also helped to identify and correct maladaptive thoughts and beliefs, and increase self-efficacy for managing pain. Additionally, many individuals with chronic pain have depression, anxiety, and sleep disorders, and CBT is also used to treat these conditions.
What are the symptoms of depression? Depression, also known as major depressive disorder, is characterized by a depressed mood, which can be experienced as feeling sad, empty, or hopeless, or a loss of interest or pleasure. Additional symptoms may include:
weight loss or gain,
insomnia or hypersomnia,
being physically agitated or slowed down,
feeling fatigued or low energy,
poor concentration or difficulty making decisions,
thoughts of death or suicide,
feelings of worthlessness or guilt.
What is Cognitive Behavioral Therapy (CBT) for depression like? CBT interventions for depression generally focus on helping clients become more engaged in activities that they value and have given up since becoming depressed. Treatment also involves helping clients evaluate negative beliefs about themselves, the world, and the future that lead to them feeling depressed. CBT for depression can also be adapted depending on the client’s characteristics. For instance, in working with older adults, CBT may focus more on helping clients maintain a socially active and fulfilling life, evaluate beliefs about aging, and learning how to cope with changes in health.
Generalized Anxiety Disorder
What are the symptoms of generalized anxiety disorder? The Diagnostic Statistic Manual of Mental Disorders states the main characteristics of generalized anxiety disorder are excessive worrying and difficulty controlling the worry. Additional symptoms may include:
feeling restless or on edge
being easily fatigued
difficulties with sleep.
What is CBT treatment for generalized anxiety disorder like? CBT techniques for anxiety focus on helping clients reduce their worrying, evaluate predictions about future disasters, and learn how to handle problems when they do arise.
Guilt and Shame
What are the symptoms of guilt and shame? Guilt and shame are closely connected emotions. We tend to feel guilty when we believe we have violated rules that are important to us, or when we have not lived up to standards that we have set for ourselves. Shame also involves the perception that we have done something wrong, but also that we need to keep it a secret, and that what we have done means something terrible about us. What is CBT for guilt and shame like? Overcoming guilt and shame does not necessarily mean letting yourself off the hook if you believe you have done something wrong. It does mean taking an appropriate amount of responsibility and coming to terms with whatever led you to feel this way. Some of the tools that your therapist will teach you in CBT for guilt/shame include:
assessing the seriousness of your actions
weighing personal responsibility
making reparations for any harm you caused
breaking the silence surrounding shame
What are the symptoms of health anxiety? Health anxiety, also known as illness anxiety disorder and hypochondriasis, is characterized by concern about having or developing a serious illness despite not having any symptoms or experiencing only mild physical symptoms. In response to the health concerns, people excessively check their symptoms or try to avoid experiencing symptoms or make excessive medical appointments.
What is CBT treatment for health anxiety like? For clients diagnosed with health anxiety, CBT focuses on helping clients reduce their worry about their health and their preoccupation with symptoms; clients learn to view physiological sensations in a less anxious manner. Treatment also involves helping clients spend less time checking their physical symptoms and more time engaged in activities they value.
What are the symptoms of hoarding? Hoarding Disorder is characterized by the acquisition of, and failure to discard a large number of objects that appear useless or of limited value. It results in unusable living spaces and significant distress or impairment.
What is CBT for hoarding like? Therapy begins with helping clients develop a personalized understanding of why they hoard and how they would like their home environment to be different. Treatment focuses on skills to address hoarding problems, strategies to work on setbacks, and possible barriers to the decluttering process. In vivo sessions (“home visits” either in-person or video conference) emphasize the practice of decluttering skills with assistance, while challenging associated thoughts and feelings in the moment and developing situation-specific strategies. Finally, your therapist addresses specific issues that relate to the process of decluttering and the maintenance of a clutter-free space.
Cognitive Behavioral Therapy for Insomnia (CBT-I) is the frontline treatment for insomnia and other sleep disorders. It has also been shown to be a very effective transdiagnostic treatment across mood and anxiety disorders. CBT-I uses strategies such as sleep monitoring, behavior modification and cognitive interventions to change dysfunctional sleep patterns and habits.
The first step in treating sleep difficulties with CBT-I is to identify the underlying causes of insomnia. This involves completing a thorough clinical interview with the therapist and utilizing a sleep diary to evaluate sleep patterns and other factors that influence falling and staying asleep. Specific patterns of thoughts and behaviors are identified and addressed in ongoing treatment.
A CBT-I treatment plan generally combines psychoeducation about improving “sleep hygiene” behaviors, relaxation training and cognitive therapy. More complex cases may utilize sleep restriction or stimulus control. Sleep restriction may be appropriate for individuals who have difficulty falling asleep. Stimulus control involves strategies such as learning to leave the bed if awake for more than twenty minutes and to move to a quiet place to read or relax until sleepy. The goal of CBT-I is to gently reshape sleep habits and thoughts about sleep, and to increase confidence in one’s ability to fall and stay asleep without medication. CBT-I has been widely studied and demonstrated to be highly effective. It is a time-limited treatment that can be effective in as a few as 4-5 sessions.
What are the symptoms of loneliness?
Loneliness is fundamentally a state of mind. There are actually two types of loneliness. Situational loneliness lasts for only a brief time and occurs in response to external circumstances such as the end of a close relationship, a sudden change in living environment, a temporary increase in the need for intimacy due to stress, or at normal phases in the life cycle (adolescence, retirement). This kind of loneliness is healthy and motivates productive action. In contrast, chronic loneliness persists for months or years and results from problems such as shyness, social anxiety, bitterness, or low self-esteem. Chronic loneliness may be at the root of why a client finds it hard to grow and to get close to others. It can become a permanent habit of unhappiness, pessimism and mistrust.
What is CBT for loneliness like?
When working with clients with loneliness and relationship problems, the CBT therapist helps change the patterns of perception that create and perpetuate it ("It's a couples world," "I don't feel close to anyone," "there isn't really anything special about me."). Next, the therapist helps the client create more balanced/realistic beliefs that build your self-esteem ("Being shy or nervous doesn't make me 'a socially inept loser'," "I don't have to maintain any 'image'-I can date as much or as little as I want."). Your therapist helps you cultivate the following skills:
learn how lonely you are and pinpoint the attitudes that prevent you from getting close to others.
understand how to meet others and develop more satisfying relationships. Specific techniques range from ways to feel and look attractive to sharing inner feelings.
realize why many single people feel trapped by intimacy, and discover that love can be an adventure instead of a burden.
find out how to overcome common sexual problems including performance anxiety or body image disturbance.
learn how to resist romantic temptations that aren't in your own best interest.
discover the steps to loving and accepting others.
Obsessive Compulsive Disorder
What are the symptoms of OCD? Obsessive Compulsive Disorder (OCD) consists of intrusive thoughts so terrifying that clients become debilitated in their efforts to neutralize them. The obsessions are intrusive and persistent thoughts, images and urges. The thoughts may concern danger, contamination, or reckless activity. The client fears them, tries to suppress them, but the fear of these thoughts lead to increased frequency, intensity, and duration. Clients develop a catastrophic view of these intrusions. Compulsions are repetitive behaviors, mental acts, or rules. They may involve activities like hand washing, checking, ordering, counting, or repeating words internally. They serve to temporarily eliminate these intrusions, but ultimately lead to more obsessions.
What is CBT treatment for Obsessive Compulsive Disorder like? Treatment of obsessions involves testing the client’s catastrophic beliefs about them. They may believe, for example, that their intrusions means they are bad, out of control, or defective. They may fear the intensity of their obsessive thinking could rise infinitely high, or last infinitely long. They may even fear that thinking something awful is as bad as doing something awful. They may believe the distress from having these thoughts is intolerable. They may also place undue weight on the significance of these thoughts. The CBT therapist works with the client to develop ways to test and modify these beliefs. Clients learn how to prevent themselves from responding to obsessions with compulsive behavior. When clients reduce their compulsions, accept the urges, and engage in pleasurable and productive activity, their anxiety and the degree of belief in their obsessions reduces.
What are the symptoms of panic disorder? Panic disorder is characterized by seemingly un-triggered unexpected anxiety. The client experiences a sudden upsurge of sensations, such as palpitations, sweating, trembling, shaking, shortness of breath, chest pain, nausea, dizziness, chills, and numbness. They may fear that they are in imminent danger of going crazy, losing touch with reality, fainting, losing control of their bowels, having a heart attack or stroke, or dying. If combined with agoraphobia, they may avoid crowds, travel, driving, exercise, standing in line, or any situation where they perceive that escape might be difficult. Panic attacks are uncomfortable, but not dangerous. To earn a diagnosis of panic disorder, clients spend at least one month worrying about having more panic attacks, worrying about the consequences of panic attacks and avoiding activities that they value or once enjoyed.
What is CBT for panic disorder like? CBT therapists teach clients that panic attacks arise from an unexpected sensation and a catastrophic misinterpretationon of that sensation. Therapy teaches clients to normalize, if not embrace, anxiety, to mindfully watch it from a distance, and act constructively with it. Rather than viewing anxiety as an obstacle, they are taught to see it as an incentive. CBT therapists also have clients note the subtle ways that they maintain their catastrophic beliefs about anxiety. Through exposure, they learn that anxiety does not cause physical or psychological harm. Clients learn that they can walk, talk, work, and drive with anxiety. They learn to do everything with anxiety, and thereby lose their fear of anxiety.
Post-Traumatic Stress Disorder
What are the symptoms of post-traumatic stress disorder? Posttraumatic stress disorder, also known as PTSD, is characterized by being exposed to an event that threatens death, serious injury, or sexual violence, and afterwards experiencing intrusive symptoms, avoidance, changes in thoughts or mood, and heightened arousal. Intrusive symptoms include distressing memories or nightmares of the event, flashbacks or feelings of reliving the event, and distressing emotions and physiological symptoms upon experiencing cues similar to the event. Symptoms may include
Attempts to avoid internal experiences related to the trauma, like thoughts, memories, or feelings, as well as external reminders, like places, people, or activities.
Changes in thoughts involving distressing beliefs about oneself, others, and the world, a heightened sense of danger, and blaming oneself for the event.
Emotionally, there’s a persistent negative mood, diminished interest in normal activities, feeling detached from others, and an inability to experience positive emotions.
Heightened arousal includes irritability and anger outbursts, reckless behavior, a focus on potential danger, an exaggerated startle response, and problems with sleep.
What is CBT treatment for posttraumatic stress disorder? For clients diagnosed with PTSD, CBT focuses on helping clients cope with thoughts and sensations related to the trauma and evaluate beliefs about themselves and the world that have changed since the trauma. We also help clients change the story that they have been telling themselves about the traumatic event. Clients also work on becoming more involved in meaningful activities that they have given up and learn how to reconnect with other people.
What are the symptoms of procrastination? We all procrastinate from time to time– taxes, holiday shopping, paying bills. However, when an individual procrastinates often enough or in multiple arenas, this seemingly innocent delaying behavior readily becomes problematic. The three primary themes seen with procrastination are avoidance, indecision, and thrill-seeking.
Avoidant behaviors are typically seen in association with depression and anxiety. When there’s a fear of failure, it’s much more comfortable in the moment to put off the task.
Indecision and procrastination can be manifestations of broader-reaching executive functioning deficits. These include: difficulty sustaining attention, failing to finish tasks, difficulty organizing, avoiding tasks that require sustained mental effort, being easily distracted, and being forgetful. For some individuals, waiting until the last minute can be quite exhilarating. There is the mistaken belief often held by procrastinators that the pressure of the last minute helps with creativity and ultimately better results. Studies have indicated that college students who procrastinated on their coursework did not perform any better and were not viewed as being any more creative than those who started well in advance. This also applies to non-academic settings, whether it’s completing a project for the boss at work or finishing an activity with children at home.
What is CBT for procrastination like? Cognitive Behavior Therapy (CBT) approaches have been empirically-supported to be able to effectively challenge procrastination by helping the individual to:
Identify the areas where procrastination is occurring
Define goals and benefits for challenging procrastination-related behaviors
Create a schedule and follow it instead of your mood
Learn to predict, and then measure, the level of pleasure, accomplishment, and difficulty associated with various avoided tasks
Improve time management skills
Set limits regarding expectations and to-do lists
What are the symptoms of sexual dysfunctions? Sexual dysfunctions interfere with a client’s ability to initiate, experience, and enjoy sexual activity. They can include premature ejaculation, painful intercourse, erectile dysfunction, and female orgasmic disorder.
What is CBT for sexual dysfunctions like? CBT for both premature ejaculation and erectile problems focuses on removing the pressure to perform. Anxiety about performance causes men to focus away from their own sensations, develop thoughts of failure, and tense their bodies when sexually aroused. CBT therapists teach these clients relaxation and refocusing tools to heighten awareness of their sensations, to focus on pleasure, to reduce anxiety and the demand to perform. Sensate focus, a form of intimate touch without intercourse, is one tool used to reduce pressure, and is of particular use for erectile dysfunction. A variety of tools (stop, start or squeeze methods) can be used to delay ejaculation. Treatment of painful intercourse centers on the role anxiety has in triggering or exacerbating pain. Clients learn muscle relaxation, coping statements, communication skills, guided imagery, and mindful awareness to reduce the muscle tension and negative self-focus associated with pain. Similar interventions may be used with orgasmic difficulties, with a special emphasis on overall stress reduction, as well as examining beliefs that lead to feelings of shame, embarrassment or guilt. In all cases, couples therapy may also be used to explore issues in communication, to offer practice in listening and self-expression skills, and to examine beliefs the partners have about themselves and their relationship.
What are the symptoms of social phobia? Social phobia, also called social anxiety disorder, is characterized by a fear of social situations where there’s the possibility of being judged by others, specifically that one will act in a way or show symptoms of anxiety that will be evaluated negatively. The fear or anxiety is disproportionate to the actual level of threat in the situation, and the situation is either avoided completely or endured with intense fear or anxiety. What is CBT for social phobia? For clients diagnosed with social phobia, CBT focuses on evaluating beliefs about their social ability and other peoples’ perception of them. Treatment also involves helping clients become more involved in social activities that they value but have given up because of anxiety, and clients learn how to be more effective or skilled in social situations.
What are the symptoms of substance use disorders? Substance use disorders center around a dependence on drugs and alcohol that compromises a client’s ability to work and form relationships. It is characterized by prolonged use, unsuccessful efforts to quit, excessive time recovering from the effects, and a life that is centered around use. Priorities reverse, with family, education, work, and health taking a back seat. As the condition progresses, the client builds up a tolerance, requiring more and more of the substance to get the same effect causing changes to the circuitry of the brain. Efforts to quit may be met with debilitating or dangerous withdrawal symptoms, and may require inpatient detoxification and treatment.
What is CBT treatment for substance use disorders like? In treating substance use disorders, the CBT therapist may follow-up after the client has completed residential or intensive outpatient treatment. Clients are encouraged to continue with support groups and sponsors-such as 12-step or SMART recovery-as part of their recovery team. The CBT therapist:
provides clients a framework to organize their recovery efforts and tools to help prevent relapse
works with clients to detail the costs and benefits of use and recovery
helps clients identify points of intervention in relapse prevention including strategies to deal with triggers for use, which may consist of negative mood states (anxiety, boredom, depression), interpersonal pressure to use, or interpersonal conflicts
helps clients respond to the beliefs and automatic thoughts activated by these triggers
teaches how to mindfully observe their urges as they rise and fall
provides tools to modify permission-giving beliefs — rationalizations that turn urges into action
helps clients circumvent their strategies — to buy time, contact their support system, to eliminate easy access
prepares clients to recover if they do have a lapse, to prevent a full-fledged relapse.
Body Focused Repetitive Behaviors (BFRBs) such as Trichotillomania (Hair Pulling) and Skin Picking
The treatment goal for problems with body focused repetitive behaviors (BFRBs) is learning how to reduce and manage your symptoms. Symptoms typically don’t remit permanently, but with increased awareness of problem components and a willingness to practice strategies regularly, patients can reduce symptoms.
Treatment begins with detailed self-monitoring of the problem behavior, including its antecedents and consequences. Monitoring increases self-awareness of problem components and guides the selection of interventions.
Habit Reversal Training (HRT) has been used for many years to increase awareness of precursors to engaging in BRFBs and situations where the behaviors are likely to occur, develop relaxation skills to reduce feelings that trigger pulling or picking, practice responses that are incompatible with pulling and picking (habit reversal), and increase social support to enhance motivation.
In recent years, a comprehensive model for behavioral treatment of trichotillomania (ComB) has expanded upon the interventions in HRT by identifying problem components across five domains: sensory, cognitive, affective, motoric, and place. Interventions are individually tailored to address problems within these domains. For example, interventions may include using sensory substitutes such as toys to fidget with, talking back to problematic thoughts, learning emotion and arousal regulation strategies, using stimulus control strategies (e.g., covering mirrors, removing tweezers), and blocking automatic motor responses (e.g., wearing gloves, changing hand positions). Creative solutions are encouraged to help individualize strategies. Acceptance-based strategies, such as those used in Acceptance and Commitment Therapy (ACT) and emotion-regulation strategies from Dialectic Behavior Therapy (DBT) are also beneficial when learning to manage problems with BFRBs.