What is Cognitive Behavioral Treatment?

Cognitive behavioral treatment (CBT) focuses on the individual’s current symptoms and is based on the premise that patterns of thoughts, feelings and actions contribute to the development and maintenance of anxiety and mood conditions. Treatment relies on an increased awareness of these patterns and a willingness to develop new ways of behaving and thinking in response to symptoms and triggers. Through this action-oriented process, the individual achieves a corrective learning experience, increases tolerance of anxiety, overcomes excessive fears and gains confidence to help them live unhindered by anxiety.

 

A thorough assessment is conducted as a first step to inform diagnostic impressions, treatment needs and recommendations. An individualized treatment plan is then developed to target the unique presentation of symptoms and challenges identified through the assessment. The length and format of CBT treatment varies for each individual but is considered a relatively short-term treatment approach (i.e., 3 to 6 months). The frequency of sessions is increasingly tapered as symptoms improve to monitor continued gains and foster relapse prevention.

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To maximize consistency and effectiveness, a collaborative approach is used, including active coordination of care with other current providers and the inclusion of the individual’s support system as indicated (e.g., parents of children, spouses).

If the assessment indicates that the presenting problems warrant treatment outside of the scope of the provider's practice, appropriate referrals will be provided.

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Under the broader umbrella term of CBT are a number of specific treatment approaches that are incorporated in treatment as indicated, including: Exposure/Response Prevention, Comprehensive Behavioral Intervention for Tics, Acceptance and Commitment Therapy, the ComB model for Body Focused Repetitive Behaviors, Acceptance-based Behavior Therapy and Behavioral Activation.

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EXPOSURE/RESPONSE PREVENTION (ERP)

ERP is a necessary component of CBT for most anxiety conditions and for Obsessive Compulsive and related disorders. The two components include exposures – facing fears in a systematic, gradual and purposeful manner to elicit anxiety – and response (or ritual) prevention – actively resisting safety behaviors and other avoidant strategies that only offer short-term reduction of symptoms but maintain the cycle of anxiety and avoidance in the long-term. Both elements are critical for effective ERP. Through the ERP process, the individual overcomes fears, gains corrective information, and retrains the brain to change how it relates to the fight or flight reaction in the face of these “false alarms.”

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COMPREHENSIVE BEHAVIORAL INTERVENTION FOR TICS (CBIT)

CBIT is a structured form of CBT for tic disorders, such as Tourette’s Disorder. It first focuses on awareness training and the development of competing responses to replace tics. This is followed by the identification of additional interventions (e.g., stress management techniques) and changes to daily activities that can further help to reduce the intensity of tics. In addition, having helpful family/social support can be an important asset in treatment, with the goal to train support people to encourage the patient’s treatment implementation in concrete ways.

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ACCEPTANCE AND COMMITMENT THERAPY (ACT)

ACT is a form of psychotherapy that incorporates mindfulness skills to develop psychological flexibility, clarify the individual’s values and take effective “act”ions guided by those values for the purposes of creating a rich and meaningful life. Mindfulness skills are taught to foster management of thoughts and feelings in ways that strengthen psychological flexibility, lower their degree of power and influence over one’s life, and enhance one’s ability to live in the present moment.

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BEHAVIORAL ACTIVATION (BA)

BA is an evidence-based approach for depression. It is based on early behavioral social learning theories (e.g., Lewinsohn, 1974) suggesting that depression is associated with low levels of positive reinforcement and high levels of aversive control, including withdrawal and avoidance behaviors. Over time, this avoidance exacerbates depressed mood, as individuals lose opportunities to be positively reinforced through experiences, social activity, or a sense of mastery. BA focuses on increasing the frequency and quality of pleasant activities, increasing one’s sense of mastery, decreasing aversive consequences and improving mood. Specific techniques include activity scheduling, monitoring of pleasant and mastery activities and gradual steps to increase enriching social engagement and contact with sources of reward.

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