Cognitive-Behavioral Therapy (CBT) for Anxiety Disorders
Cognitive Behavioural Therapy is a combination of two schools of psychology: one behavioral and the other cognitive. Behavioral Therapy is based on the theoretical framework suggested by John Watson. He believed that all behaviors were learned. He argued that even fear and anxiety were learned as conditioned emotional reactions.
Cognitive therapy is based on the premise that the cause of our suffering is not external stimuli or events, but rather our own thoughts. According to this school of therapy, distorted, irrational and unrealistic thoughts create a fertile ground for obsessions, self-doubt, anxiety, fears and depression, among many other problems. And so, anxiety, phobias, depression, obsessions and any bad feelings are caused by our own unhealthy thoughts. If follows then that in order to get relief from theses negative conditions, we need to correct our distorted cognitive processes.
Cognitive theory states that anxiety is the result of illogical and irrational thinking. Your exaggerated ideas about negative future events, making a mountain out of a molehill, causes you feel anxious. The therapist tries to “neutralize distorted cognition”.
Cognitive psychologists try to convince you through logic that your fear is irrational in order to stop certain thought processes that lead to a fearful or anxious reaction. Behaviorists believe that the key factor is your past, based on the duality of reward and punishment experiences that have conditioned you to be fearful or anxious. The combination of these two theories gives you the Cognitive-Behavior approach, or CBT.
To help people change their reactions to anxiety-provoking situations, cognitive behaviorist psychotherapists use techniques such as exposure, in which you confront the objects or situations that they fear and also teach you relaxation techniques. Another common technique is thought stopping to fight irrational thoughts that trigger fear or anxiety. For example you wear a rubber band on your wrist and when a negative thought appears, you snap the rubber on your wrist. The mild pain is aimed to create negative conditioning in your brain to avoid those thoughts.
Historically, behavior therapy (Skinner, Wolpe and Bandura) opposed psychoanalytical theories. Their belief was that fears and anxiety are the result of dysfunctional learning. They focused on the environmental factors and the behavioural characteristics of the individual as the cause of disorders. They based their theories on the work of Pavlov (classical conditioning) and that of Skinner (operant conditioning). And so, the goal of therapy is to de-condition the person to free him from his fear and anxiety reaction.
Among the methods used to help people are biofeedback, autogenic training and progressive relaxation. Another technique involves gradual exposure to the fear while one practices relaxation or deep breathing. The goal is that eventually you get exposed to the real situation or the actual object that causes you anxiety or fear. On the average such an approach might take between 20 to 30 sessions.
The focus of the Cognitive-behavior therapy is threefold:
- Exposure, whether it is imaginary or the actual object or situation.
- Teaching you specific relaxation techniques and deep breathing to make feel that you have control over the symptoms and that upon the arrival of anxiety you can calm yourself and feel reassured.
- A “stress inoculation training” to help you cope with anxiety and fear producing triggers. Some of the techniques may include relaxation training and attention diversion procedures.
However the method of exposure, so popular among cognitive behavior therapists, can create a vicious circle. If you suffer from fear and anxiety, you tend to avoid the fear inducing situation. If you are exposed to it, even gradually, your resistance increases since you tend to react and cannot help it.
The cognitive model requires you to recognize you own automatic and spontaneous thoughts related to fearful or anxiety producing situations. Once you manage to perceive your own spontaneous thoughts, that usually are rapid occurring, you must modify your own pattern towards a more realistic one and less of a catastrophic one. Thus, it is an extreme rationalization of the situation and an attempt to understand the anxiety and the fear logically.
It may serve to reassure and calm you to realize that you are “normal” by becoming conscious and understanding how exactly your fear and anxiety functions. However attempting to be conscious of you problem, inevitably generates resistance to change. Neurologists have demonstrated that the fear response triggers before and more rapidly than any cognitive processes. Trying to stop this trigger with your conscious thoughts is a near impossible task because it goes against human neuro-physiology and how the brain and nervous system function.
What Cognitive-Behavior Therapy fails to recognize is that your feelings are not simply a direct reaction to your thoughts. Feelings and sensations related to fear and anxiety are influenced greatly by other factors such as how others respond to you, or whether or not they help you.
So they claim that you must modify your thinking. But since your fears and anxiety are because of your faulty and irrational assumptions, you must learn how to correct them. According to their jargon “negative cognition” or “distorted cognition” lead to fear and anxiety. You must realize that your thoughts are irrational and have a more realistic interpretation of events. First of all most people suffering from fear and anxiety know that their condition is not rational. Secondly, brain research has shown that anxiety response is an automatic reaction. Will power and rationalization is an arduous way to go about tackling it.
In a popular book about anxiety, the writer, a cognitive psychologist, gives the following advice to cope with fear of flying: “Don’t get scared of getting scared or feeling anxiety related to your flight, especially when you enter it and when it takes off.” This sounds like an advice from someone that doesn’t know well how fear functions. You just can’t ask a person with phobia not to get scared! A person has a phobia exactly because they cannot stop reacting fearfully to something.
In the first chapter of another popular self-help book on anxiety and depression, the author, a famed cognitive psychologist, states the following:
In my experience the most crucial predictor of recovery is a persistent willingness to exert some effort to help yourself.
Usually a person suffering from anxiety, phobias or depression, have exerted much effort. They are willing to persistently “exert some effort”. However, the very nature of a severe depression, phobia, anxiety or obsession dictates that the person, despite of his effort, has been unable to “feel good”.
Throughout, readers are constantly reminded that they are responsible for their own thoughts. This approach could work with some people who can follow this line of reasoning and are able to make some improvements. However for the majority, being told they are sort of “wrong” or “mistaken” to feel anxiety, fear or depression doesn’t help.
This line of books and therapies based on rationalization could have some negative consequences for depressed individuals. When they cannot follow the logic of cognitive therapy or fail to complete the exercises outlined in these books, they get the impression that they are a very difficult case or a “lost cause” and can not be helped.