What is cognitive therapy

Cognitive-behavioral therapy is a relatively short-term, focused psychotherapy for a wide range of psychological problems including depressionanxiety, anger, marital conflict, loneliness, panicfearseating disorderssubstance abuse, alcohol abuse and dependence and personality problems. The focus of this therapy is on how you are thinking, behaving, and communicating today rather than on your early childhood experiences. The therapist assists the patient in identifying specific distortions (using cognitive assessment) and biases in thinking and provides guidance on how to change this thinking.

Cognitive therapy helps the patient learn effective self-help skills that are used in homework assignments that help you change the way you think, feel and behave now. Cognitive-behavioral therapy is action-oriented, practical, rational, and helps the patient gain independence and effectiveness in dealing with real-life issues.

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Many people wonder what to expect when they begin therapy. Although your individual experience will vary depending on the problems and goals that you have, many patients can expect the following:

Initial Assessment: You will be asked to complete a number of self-report forms. These forms assess your presenting problem and your history of problems. These standardized questionnaires assess depression, anxiety, emotions, decision making, personality, relationship issues, substance abuse, and other problems. After your therapist has reviewed these forms you can work together to determine what areas need work and what your “symptom level” is prior to treatment. In this way, you can also assess whether you are making progress.

Periodic Assessments: Periodically your therapist may have you fill out additional forms in the course of treatment to see what is changing and what still needs to change. This allows you and your therapist the opportunity to see what is really going on. You can learn if your depression, anxiety or emotional responses are changing. You may also want to set some goals for your behavior—for example, projects that you want to get done or things that you are procrastinating on.

Self-Help: A great deal of research shows that patients who actively do self-help homework are more likely to improve and maintain their improvement. You and your therapist can develop techniques and interventions that you can practice outside of therapy sessions to help you feel more effective in handling your emotions, negative thoughts, relationships and behavioral problems. Self-help builds a sense of self-effectiveness.

Aren’t my emotions important? Our group uses the latest research on emotional processing to enhance the humane nature of your experience. We emphasize the importance of compassion and validation in therapy and encourage you to direct compassion and validation toward yourself when you are feeling down. In addition, our approach emphasizes how you think about and deal with your emotions. For example, we will examine if you feel ashamed or confused about the way you feel. We will also examine your beliefs that your emotions are out of control or dangerous. In fact, our view is that your emotions are the central part of your experience and they often contain information about what you need. Your therapist can help tailor your therapy to help you understand and respect your emotional experiences–without feeling overwhelmed by that experience.

Reading Material: You and your therapist can decide together what additional reading material can help you understand your problem. This website is an excellent source of information on a great number of issues—so you should take some time and examine the content of the extensive readings on this website. We also have books available for purchase and other reading material on a number of problems. We will try to suggest readings that reflect scientifically based approaches to depression, anxiety, relationship issues and other problems.

Plan of Treatment: You and your therapist can work together to set up a problem list or goals that you want to work on. These problems might include procrastination, self-esteem, sadness, inactivity, anxiety, relationship conflicts, or any problems that you think you need help with. Over the course of treatment you and your therapist can devise plans and techniques to address these problems.

Agenda-setting: Although you and your therapist will want to be open to dealing with your immediate concerns as they arise in the session, we recommend that you come to each session with one or two issues that you want to address for that meeting. In addition to your topics, you and your therapist will want to review your feelings about the last session, any self-help you used, and your plans for the coming week, including additional self-help.

Isn’t Medication Important? Medication can often help you get a better handle on your problems. Therefore, you will want to consider medication as part of your treatment. Not all patients need to take medication—in fact, for depression and anxiety, many people get better without medication. However, it may be a valuable additional tool that you can use. We can provide you with referrals to leading psychopharmacologists in the area for a medication consultation. Some patients — for example, those with bipolar disorder or schizophrenia — should consider medication as an essential part of their overall treatment program. 

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Why Cognitive Therapy?

As you know, there are many kinds of therapy that are available. Our group focuses on a wide range of different kinds of cognitive and behavioral therapies—in order to find the treatment best suited for you. The exciting thing about cognitive- behavioral therapy is that it actually works. This conclusion is based on a great deal of scientific research. Numerous outcome studies show that cognitive therapy is as or more effective than medication in the treatment of depression, anxiety, obsessions, and other fears and does not have the negative side-effects of medications. Furthermore, it is often superior to other treatments in preventing relapse because patients learn self-help in therapy.

Many patients choose to combine cognitive-behavioral therapy with medication. Cognitive therapy is the most widely tested form of psychotherapy for depression and the anxiety disorders. Recent research shows that cognitive therapy can also be used with medication for patients with bipolar disorder (manic depression) and schizophrenia.

How can I learn more about cognitive- behavioral therapy?

Depending on the problems that you want to solve, your therapist can recommend a number of books or readings for you. We believe that the more you know about yourself, the better off you will be. We hope that you can learn to become your own therapist. To read more about how to identify your negative thinking, you can read the chapter, “Eliciting Thoughts and Assumptions,” in Robert Leahy’s book, Cognitive Therapy Techniques. You can also read his blog post on Cognitive-Behavioral Therapy: Proven Effectiveness

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Cognitive Therapy
Substance Abuse Miniseries by
Dr. Graham Reynolds