ROBERTO FIGUEROA MD PHD (310)963-7146
Cognitive Behavioral Therapy (CBT)
CBT and Depression
The CBT approach to treating depression can be divided into its cognitive and behavioral components.
In the cognitive component of treatment, therapist and patient learn to identify the distorted negative thinking that causes negative emotions. Then they question the veracity of these thoughts and come up with alternative balanced thoughts. They also learn about the patient's core beliefs that underlie the daily automatic negative thinking. For example, a depressed patient may have the core belief "I am a loser;" when he gets some less than ideal feedback at work he starts having rather drastic thoughts like "I won't be able to finish this task," or "the work I am doing is worthless," or "I'm going to get fired." Almost simultaneously with these negative thinking he starts feeling down, with very low motivation and energy. When he starts undergoing CBT treatment he learns to come up with more balanced thoughts, like "I'm not doing as good a job as I could, but it's not terrible either" or "If I don't improve this level of productivity I could end up getting fired, but I know I can improve it." As a result of this more realistic assessment of the situation, the patient will not feel as depressed. Furthermore, therapist and patient will have the opportunity to question the underlying core belief "I am a loser." Where did that idea come from? What evidence is there for or against it?
In the behavioral component of treatment, the therapist helps the patient assess how different daily activities or events have an impact on the patient's mood and how some of them can improve symptoms of depression. Therapists usually help patients develop an action plan, based on the behavioral activation approach. In this approach the therapist and patient create a list of activities and then they order them from less to more difficult to achieve. As the patient goes from easier to harder activity his/her feeling of mastery improves as depression lessens.
CBT and Anxiety
CBT has also been shown to effectively treat multiple types of anxiety disorders, including: panic disorder, generalized anxiety disorder (GAD), acute stress disorder, social anxiety disorder, post traumatic stress disorder (PTSD), and obsessive compulsive disorder (OCD). As with the case of CBT for the treatment of anxiety disorders, the CBT approach to treating anxiety can be divided into its cognitive and behavioral components.
The cognitive component helps people identify and question the thinking patterns that cause or trigger the feelings of anxiety. For example, people that have panic attacks often interpret their symptoms as evidence of having a heart attack or being about to pass out or lose their minds. CBT can help them question the validity of these negative and usually automatic thoughts. It can also help panic-attack sufferers to replace those thoughts by more accurate and balanced alternatives, like "I am having a panic attack, I have been told by my doctor that panic attacks are not life threatening. It will go away and I will be OK."
The behavioral component consists of exposure and desensitization. With the help of a therapist, patients build up their exposure to anxiety-provoking situations, usually right after the patient is induced into a deeply relaxed state. For example, somebody with fear of flying can create a list of activities that goes from seeing pictures of planes, to imagining themselves flying, to going to the airport just to watch planes, to actually flying. The idea behind this approach is that the patient's sensitivity drops. S/he learns from repeated experience not to fear the problematic situation.