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| Tue, 03-13-2007 - 11:36am |
Cognitive-Behavioral Therapy for Anxiety
Cognitive-behavioral therapy (CBT) aims to correct ingrained patterns of negative thoughts and behaviors. As the name suggests, it has two parts. Cognitive therapy helps people change patterns of thinking that prevent them from overcoming their fears. Behavioral therapy works to change their reactions in situations that trigger anxiety. People with social phobia, for example, may assume that others will inevitably regard what they say as stupid. This is negative thinking. As a result, these people may avoid being with or talking to others. This is an example of negative behavior. The role of CBT is to break this chain of thoughts and reactions.
Because negative thoughts and behaviors tend to come to the fore when people are under stress, the first step in CBT is to help you recognize when you’re stressed. It’s important to have an inner "thermostat" that can tell you just how stressed you really are and how to dial it down.
Behavioral therapists say there are three components to a stress reaction. These are commonly called the ABCs: affect, behavior, and cognition. Affect is how you feel; it refers to your emotional response to a particular situation. Behavior is what you do; for example, it can include tensing your jaw, tapping your foot, pacing, or overeating. Cognition is the thoughts you have when you are stressed, for example, thinking, "I’m going to miss my work deadline and get fired."
Research has shown that cognitive-behavioral therapy is effective for panic disorder, generalized anxiety disorder, post-traumatic stress disorder, specific phobias, and social phobia. Cognitive-behavioral therapy can be done individually or in a group. If the anxiety is the result of a traumatic event that affected more than one person, group therapy may be most effective.
Cognitive-behavioral therapy usually takes place weekly for several weeks. The therapist begins by asking the patient to record his or her thoughts and level of anxiety in certain situations. Then, the therapist and patient discuss these thoughts, evaluate how realistic they are, and work together to substitute more productive thoughts. The therapist might also challenge the patient to consider what would happen if the fears came true, and whether that outcome would actually be so bad.
The behavioral component of cognitive-behavioral therapy incorporates two main strategies. One, called exposure or desensitization, involves having patients face their fears directly. This can be done in several ways. One is through role-playing. Another is by having an individual imagine frightening situations and describe them. Yet another strategy is to give patients "homework" in which they put themselves in real-life situations that spark anxiety. The reasoning is that avoiding anxiety-causing thoughts and situations reinforces the individual’s fears or false beliefs. In real-life situations, patients can practice recognizing negative thoughts and substituting more realistic ones. With repeated exposure, people eventually become desensitized to fear-provoking situations.
The other main strategy is teaching patients practical skills to help them feel more in control in difficult situations. For people who become extremely anxious when they have a lot to do, this may mean offering tips on time management and goal setting. Those who are uneasy in social situations can be coached on engaging in conversations and developing other social skills.
Research has found that people with generalized anxiety disorder and panic disorder who choose both cognitive-behavioral therapy and medication have fewer symptoms and a lower chance of relapse than those who use medication alone. Studies also show that in the long run these patients are able to stop taking medication or reduce their dose.
However, one recent study in the Journal of the American Medical Association found that people with panic disorder who received only cognitive-behavioral therapy maintained their improvement longer once treatment was stopped than did those who received imipramine as well as therapy. It’s possible that the medication undermined the cognitive-behavioral therapy by reducing the intensity of people’s fears. Thus, the process of facing their fears during the desensitization may have become less meaningful than it would have been otherwise. More research is needed to clarify which patients are better off with cognitive-behavioral therapy alone and which ones might benefit from medication, too.
From the Harvard Health Publications Special Health Report, Coping With Anxiety and Phobias. Copyright 2002 by the President and Fellows of Harvard College.


