Anxiety Disorder and Anxiety Attack: Beware of CBT

Anxiety Disorder and Anxiety Attack: Beware of CBT

If you have a problem with anxiety, anxiety disorder, or anxiety attack, beware of CBT.

Millions of people worldwide have difficulty with anxiety, anxiety disorder, or anxiety attacks.  In their seeking help for it, they often come across information that suggests that cognitive-behavioral therapy (CBT) could be helpful.  They then seek out treatment from a practitioner promoting themselves as practicing “CBT”.

However, cognitive-behavioral therapy (CBT) does not exist as a distinct psychotherapeutic technique.  It is a category or classification of therapies with some similarities that, together, make them distinct from other therapeutic approaches.  There are several approaches to cognitive-behavioral therapy, including Rational Emotive Behavior Therapy, Rational Behavior Therapy, Rational Living Therapy, and Cognitive Therapy.

When seeking the services of a mental health professional who promotes him- or herself as practicing “CBT,” ask them, “What approach to CBT do you utilize.”  If they do not know how to answer the question, you might consider moving on to the next therapist on your list.

When seeking the services of a cognitive-behavioral therapist, make certain that the approach that they perform is consistent with the following:

1. CBT is based on the Cognitive Model of Emotional Response.
Cognitive-behavioral therapy is based on the idea that our thoughts cause our feelings and behaviors, not external things, like people, situations, and events.  The benefit of this fact is that we can change the way we think to feel / act better even if the situation does not change.

2. CBT is Briefer and Time-Limited.
Cognitive-behavioral therapy is considered among the most rapid in terms of results obtained.  The average number of sessions clients receive (across all types of problems and approaches to CBT) is only 16.  Other forms of therapy,  like psychoanalysis, can take years.  What enables CBT to be briefer is its highly instructive nature and the fact that it makes use of homework assignments.  CBT is time-limited in that we help clients understand at the very beginning of the therapy process that there will be a point when the formal therapy will end.  The ending of the formal therapy is a decision made by the therapist and client.  Therefore, CBT is not an open-ended, never-ending process.

3. A sound therapeutic relationship is necessary for effective therapy, but not the focus.
Some forms of therapy assume that the main reason people get better in therapy is because of the positive relationship between the therapist and client.  Cognitive-behavioral therapists believe it is important to have a good, trusting relationship, but that is not enough.  CBT therapists believe that the clients change because they learn how to think differently and they act on that learning.  Therefore, CBT therapists focus on teaching rational self-counseling skills.

4. CBT is a collaborative effort between the therapist and the client.
Cognitive-behavioral therapists seek to learn what their clients want out of life (their goals) and then help their clients achieve those goals.  The therapist’s role is to listen, teach, and encourage, while the client’s roles is to express concerns, learn, and implement that learning.

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5. CBT is based on aspects of stoic philosophy.
 Not all approaches to CBT emphasize stoicism.  Rational Emotive Behavior Therapy, Rational Behavior Therapy, and Rational Living Therapy emphasize aspects of stoicism.  Beck’s Cognitive Therapy is not based on stoicism.

Cognitive-behavioral therapy does not tell people how they should feel.  However, most people seeking therapy do not want to feel they way they have been feeling. The approaches that emphasize stoicism teach the benefits of feeling, at worst, calm when confronted with undesirable situations.  They also emphasize the fact that we have our undesirable situations whether we are upset about them or not.  If we are upset about our problems, we have two problems — the problem, and our upset about it.  Most people want to have the fewest number of problems possible.  So when we learn how to more calmly accept a personal problem, not only do we feel better, but we usually put ourselves in a better position to make use of our intelligence, knowledge, energy, and resources to resolve the problem.

6. CBT uses the Socratic Method.
Cognitive-behavioral therapists want to gain a very good understanding of their clients’ concerns.  That’s why they often ask questions.  They also encourage their clients to ask questions of themselves, like, “How do I really know that those people are laughing at me?”  “Could they be laughing about something else?”

7. CBT is structured and directive.
Cognitive-behavioral therapists have a specific agenda for each session.  Specific techniques / concepts are taught during each session.  CBT focuses on the client’s goals.  We do not tell our clients what their goals “should” be, or what they “should” tolerate.  We are directive in the sense that we show our clients how to think and behave in ways  to obtain what they want. Therefore, CBT therapists do not tell their clients what to do — rather, they teach their clients how to do.

8. CBT is based on an educational model.
CBT is based on the scientifically supported assumption that most emotional and behavioral reactions are learned.  Therefore, the goal of therapy is to  help clients unlearn their unwanted reactions and to learn a new way of reacting.

Therefore, CBT has nothing to do with “just talking”.  People can “just talk” with anyone.

The educational emphasis of CBT has an additional benefit — it leads to long term results.  When people understand how and why they are doing well, they know what to do to continue doing well.

9. CBT theory and techniques rely on the Inductive Method.
A central aspect of Rational thinking is that it is based on fact. Often, we upset ourselves about things when, in fact, the situation isn’t like we think it is.  If we knew that, we would not waste our time upsetting ourselves.

Therefore, the inductive method encourages us to look at our thoughts as being hypotheses or guesses that can be questioned and tested.  If we find that our hypotheses are incorrect (because we have new information), then we  can change our thinking to be in line with how the situation really is.

10. CBT emphasizes the important role of homework.
If when you attempted to learn your multiplication tables you spent only one hour per week studying them, you might still be wondering what 5 X 5 equals.  You very likely spent a great deal of time at home studying your  multiplication tables, maybe with flashcards.

The same is the case with psychotherapy.  Goal achievement (if obtained) could take a very long time if all a person were only to think about the techniques and topics taught was for one hour per week.  That’s why CBT therapists assign reading assignments and encourage their clients to practice the techniques learned.

There is a plethora of evidence to show that defined cognitive-behavioral approaches are effective for helping people to overcome anxiety, an anxiety disorder, and anxiety attacks.