Cognitive Behavioural Therapy – What is it and how does it work?
Overview
Cognitive behavioural therapy (CBT) has been found to be an effective treatment for depression and anxiety in children and adolescents. CBT is a way of helping people understand how their thinking habits cause them to feel depressed or to respond fearfully to situations. The process has been found to work well to both prevent and treat depression and anxiety, and it appears to have a long lasting effect after treatment has ended.
Some people think CBT is nothing more than learning to think positively, or that it only requires some attitude adjustment and all will be well. It is really a fairly complicated process that requires some hard work and commitment to change. The rewards are worth the effort. Learning to change behaviour AND ways of thinking can stop feelings of anxiety and depression from interfering with one’s ability to lead a full life.
How does it work?
There are many elements involved in cognitive behavioural therapy (CBT), and they can be taught in a variety of ways – one-on-one with a therapist, in groups, by reading books or via the Internet.
No single element has been shown to be successful on its own when it comes to treating anxiety or depression. They are used in combination according to which condition is being treated.
Here’s how the various elements work:
Education
Education includes learning about the symptoms and causes of anxiety or depression, the principles of CBT, the kind of homework expected during a course of treatment, and the use of popular self-help materials.
Problem solving
Both patient and clinician work together to define the problem, come up with solutions, decide on what to work on first and how, agree on how results will be monitored, and look at whether or not the problem-solving strategy is working or needs to be modified.
Exposure to anxiety-causing events
People with anxiety or depressive disorderwill try to avoid situations that trigger their symptoms or make them worse. But this strategy does little to help them overcome their anxiety. CBT encourages them to face situations they fear in a slow and gradual way. Sometimes, instead of real-life situations, imagined or virtual situations are used to expose the patient to thoughts that upset them or cause them to be afraid.
Dealing with physical symptoms
Depression and anxiety are not just emotional states. They produce real physical symptoms, such as fatigue in depression and a rapid heart rate in people who are anxious.
Extreme tiredness can make a depressed person feel like they are unable to make any effort to change a situation. A rapid heart rate can cause an anxious person to fear they may have a heart attack. That fear is enough to keep their heart rate high, creating a vicious cycle.
Cognitive behavioural therapy (CBT) teaches children and adolescents who are depressed or anxious to manage their physical symptoms and go on with their activities in spite of their fear or depression.
Improving relationships
Developing better social skills can help those who are depressed or anxious in social situations.
Cognitive strategies
Automatic thoughts like “I can’t do it” or “I’m never going to get better” help perpetuate depression and anxiety. They’re a habit that needs to be broken if progress is to be made.
Cognitive behavioural therapy (CBT) involves learning to identify those internal statements and counter them by using a new kind of hopeful self talk that encourages action and confidence and helps the person overcome bad moods or fear.
Emotion regulation
Being depressed or anxious can make a person avoid any strong emotion out of fear that they will lose control. Techniques that help with relaxation allow a person to face their fears or other emotions, like anger, in a relaxed or detached state.
Relapse prevention
Patients work with their therapist to develop a plan on how to cope with problems in the future. This gives patients a tool they can use to can stave off anxiety and depression.
Adapted from:
Swinson, et al. Principles of Diagnosis and Management of Anxiety Disorders. Canadian Journal of Psychiatry 2006; 51(Suppl 2): 1S-92S.
