A form of psychological treatment that addresses anxiety disorders. The philosophy underlying this form of treatment is that anxiety disorders are caused by certain mechanical thinking patterns, and that rather than trying to find an explanation for them by analysing the patient, the patient should instead be taught to undo those harmful patterns.

The cognitive part of the therapy teaches the patient how to put things into prespective, as the origin of many anxiety bouts lies in misinterpreting or exaggerating the value of common life occurences. The behavioral part of the therapy teaches the patient how to mechanically train their minds to stop the harmful thinking patterns.

Cognitive behavioral therapy has proven to be extremely successful in the treament of anxiety-related disorders, and is often done in conjuction with SSRI drug treatment.

I would offer some examples, to make this more concrete (although when I say concrete, I'm referring to something that fills my imagination with life and light, and gives me hope for the future of humanity).

CBT consists of two general branches, although in a more nuanced understanding they blend inextricably. These are cognitive techniques and behavioral techniques. Cognitive techniques rest on the premise that the bulk of our emotional reactions come from our interpretations of events, rather than the events themselves. For example, being snapped at by Brandon is a negative event for almost anyone. But one person might burst into tears and let it ruin his whole day, while another could shrug it off. The theory (which has extensive experimental evidence) is that the first person interprets the event as meaning something like "I'm impossible to be around, and I make everyone's life hell," while the other thinks "Brandon probably had a bad day." So, cognitive techniques focus on determining how one interprets events, looking for factual evidence to confirm or refute thoughts that lead to negative emotional states, and replacing those thoughts with ones that are realistic and contribute to good coping.

One example is the downward arrow exercise. In this, the user writes down the thought or idea that is making him unhappy / anxious / crazy, as nearly as possible. For example:

Making Brandon angry is terrible.

Then, he asks "what's so bad about that?" or "if that's true, what would it mean?"

That means that Brandon doesn't love me anymore

This continues...
That would mean that I'm a fundamentally obnoxious person
That would mean that I can't have friends or contribute anything to people's happiness

The goal is to get down to a level at which anyone would be despondent. Then we start at the top, questioning the observations and this links:

How can I tell that Brandon is even angry at me? I sometimes get annoyed at people when they haven't really done anything wrong, and I've seen other people do it too.
And even if Brandon is angry at me, that won't blot out all the years we've been friends. People have fights all the time, and then they get over it.
And even if Brandon does decide to hate me, that's his problem and not mine. There's a huge variety of people in the world, and if he doesn't like me that doesn't mean that no one else ever will.

So, what was once a prediction of doom becomes a more realistic observation, with checks and qualifications at every level of worst case scenario. Many people think that an analytic stance like this can't really help emotional problems, but the distance from the immediate maelstrom of emotions seems to be part of what helps. Over time, you can train your emotional outlook to be more like the healthy one described in the exercise, and feel this way without having to distance yourself from events.

The behavioral side of the discipline is based on the idea that familiar actions are easier than unfamiliar ones, and actions that have been rewarded are easier than ones that have been punished. One common exercise is "acting as if," or pretending that you already have the qualities you want. So if you want to be less afraid of dogs, sometimes it can help simply to pretend that you're not afraid of them, and do things that a (non-stupid) person who isn't afraid of dogs would do, such as walking by backyards that have barking dogs in them, or petting dogs on the street that are leashed and evidently tame. This is a form of exposure therapy and by itself will help you unlearn the disastrous predictions that lead to dog-phobia. Behavioral exercises also include simple reinforcement, as when a very shy person gives himself a reward every time he talks to a friend or meets a new person. The goal, of course, is not just to create an artificial proclivity but to undergo behavioral trapping -- that is, to encourage himself to do it enough that it becomes rewarding in and of itself, because having friends does have its own intrinsic rewards.
Cognitive-behavior therapy is often abbreviated as CBT. This form of therapy is used to treat many different types of mental health problems. The aim of this type of therapy is to change the way that you think, the way that you feel, as well as the way that you behave. This is actually a combination of two schools of therapy. Cognitive therapy and behavioral therapy.

Briefly, cognitive therapy is a type of therapy in which the therapist helps the client understand current thought patterns, especially to identify any harmful, unhelpful, and 'false' ideas or thoughts that make the person depressed, anxious, etc. The goal is to change the ways in which the person thinks to avoid these ideas. It is supposed to help make the thought patterns be more realistic and helpful. Behavior therapy focuses on changing harmful or simply unhelpful behaviors. Cognitive behaviour therapy combines those two therapies because how we behave is often a reflection of how we think.

There are many conditions that are treated with CBT. This type of therapy has been used to treat phobias, panic attacks, panic disorder, and other anxiety disorders, depression, eating disorders, OCD, anger, PTSD, sexual and relationship problems, tics, alcohol and other drug abuse, and some sleep problems. The more specific the problem is the more likely cognitive behavior therapy is to help. The reason for this is because it is a practical therapy which focuses on particular problems and aims to overcome them.

This type of therapy is often used in combination with medication, but not always. This depends on the type and the severity of the condition being treated. It has been shown in research studies that Cognivite behavior therapy is as effective as medication in treating depression and in certain anxiety disorders.

The first session with a CBT therapist will usually include time for the therapist and client to develop a shared understanding of the problem. The reason is mainly to identify how the patient's thoughts, ideas, feelings, attitudes, and behaviors affect day-to-day life. At this point a treatment plan and goals to achieve are worked out. The number of sessions most likely needed is worked out. Each of these sessions lasts fifty minutes to an hour usually. Most CBT clients go once a week. A common amount of time is 10-15 weeks but it can be longer or shorter depending on the issues being treated. In order for this type of therapy to be successful the patient has to take an active part. They are usually given “homework” between sessions. These homework assignments are specific ways of applying the techniques taught in situations to real life situations.

Cognitive behavior therapy is a form of psychotherapy, sometimes called a talking treatment. In some talking therapies the patient is allowed to talk freely about anything. They are often allowed to dwell on events in their past in order to gain insight into their emotional state of mind. This is NOT one of those therapies.

CBT is a “here and now” type of therapy. Its focus is on how your current thoughts and behaviours are affecting you, now. This type of therapy does recognize that events in your past, particularly your thought patterns and the behaviours you learned in childhood, have shaped the way that you currently shape and behave. In CBT, though, one is not to dwell on the past. It aims to find solutions to how to change your thoughts and behaviors that you can function better in the future. There are different approaches to Cognitive –behavioural therapy. These include: Rational Emotive Behavior Therapy, Rational Behavior Therapy, Rational Living Therapy, Cognitive Therapy, and Dialectic Behavior Therapy.

Sources: Cognitive Behaviour Therapy (CBT): http://www.patient.co.uk/showdoc.asp?doc=27000424
Cognitive behavior therapy: http://encyclopedia.thefreedictionary.com/Cognitive-behaviour%20therapy
Psychology Seventh Edition by Carole Wade and Carol Tavris
The World of Psychology Fourth Edition by Samuel E. Wood and Ellen R. Green Wood

Dr. Aaron Beck, father of cognitive behavioral therapy, died this week, November 2021, at age 100.

Oddly enough, the other write ups in this node are the best explanations of cognitive behavioral therapy that I've read. They have been talking at me at medical conferences for years about cognitive behavioral therapy, but they didn't explain it. They said we could do it in clinic. I thought cynically that maybe I could if I knew what the hell it was.

And the explanation by enkidu is oddly similar to what I think of as the angel and devil on my shoulders.

When I react to some event, I let the devil out first. It has a fit about whatever is happening, writes poems, is reactive, paranoid and full of anger and grief. It often imagines over the top terrible things happening to the person or people that did whatever it is. Then the angel wakes up and says, wait. What are you saying? What you are imagining and cursing that person with is WAY worse then what they did. The angel writes the poems of forgiveness.

So I have been doing a homemade form of cognitive behavioral therapy.

However, I would say that it can be overused. We need to listen to patients carefully. If they are in an abusive relationship, it should not be papered over with cognitive behavioral therapy. B and I have been comparing childhoods. His involved being beaten without reason.

I said recently that what people hit with in my family is words. They make grief and fear into stories, funny stories, that make people laugh. Shame and humiliation and reliving the feelings. I said that I am reactive and pay close attention to words. But I have reason, back to age 2. I said that books are my refuge because the words are not about me, they don't shame me, they do not humiliate me, and if I read a book twice, it has the same words. Home, love and safe.

In my maternal family, if I said that I was not comfortable with a comment, I was told that I took things too seriously, that I have no sense of humor, that I can't take a joke. Gaslight and then dismiss any objection. That is how my maternal family loves. I do not like it. Unsurprisingly, they do not love me, or at least I do not feel loved.

And B said, your family, your childhood, was worse than mine.

One of my talents in clinic is that I can listen to insane family stories. I can listen because my family is insane. They are cruel. At least, it feels like cruelty and horror to me. I didn't ever try to find out if a family story is true. I listen and then say, yes. I think it is appropriate for you to feel angry/sad/horrified/appalled/scared/hurt/whatever.

Somehow that listening and validation is huge. I have people come in and say, "I NEED AN ANTIDEPRESSANT." They want to supress the feelings. So I had time in my clinic: why do you need an antidepressant? Tell me the story. Fill me in. What are you feeling and why?

And more than half the time after the story, after validation, I ask, "Do you need an antidepressant?"

The person thinks. "No. I don't think so. Let me think about it. I feel better."

"Ok. Do you want to schedule a follow up?"

Half do. Half say: "No, let me wait and see. I will if I need it."

Mostly they don't need it. They have emptied out the awful feelings in the exam room and they aren't so awful after all. I say that it sounds like a pretty normal response and I would feel that way too. Because I would. Once the feelings, the monstrous feelings, are in the light of day, they relax and evaporate, dissipate like mist, fly home to the Beloved. Goodbye, dark feelings. You are appropriate and you are loved.

Blessings, Dr. Beck, and thank you.

#3: For Iron Noder XIV

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