A meta-analysis of 31 controlled studies show both CBT and medications are effective in the treatment of Generalized Anxiety Disorder. This meta-analysis showed CBT was more effective at reducing symptoms of depression, and at maintaining benefits following treatment (Gould, Otto, Pollack & Yap, Massachusetts General Hospital and Harvard Medical School, 1997).
Cognitive-Behavioral Therapies (CBT) were introduced in the 1960’s, offering approaches to psychotherapy that were very different from Freudian psychotherapies, the standard approaches at the time. In Freudian psychotherapies, the therapist focuses on the client’s past, helping the client become first, aware of unconsciously stored experiences and feelings from childhood, then second, understand how they have affected them. Once the client sees how their past has determined their personality, they can often consciously choose to change how they feel and act.
CBT therapists’ primary focus is on the client’s present, daily life. CBT therapists focus on that fact that it is not what happens to someone that determines how they feel and act, but how that person interprets what happens. For example, if a car accident occurs, one bystander might worry that someone was hurt and stand by feeling upset, another might feel responsible for assisting and rush to help, another might feel grateful the accident did not involve him and happily go on his way, another might feel angry at the driver and criticize him to her colleagues when she gets to work, another might feel depressed and withdrawn the rest of the day. People’s different reactions are based on their underlying beliefs about themselves and the world, which strongly bias their automatic, moment to moment appraisals or thoughts about what is happening now. Very often, people are barely aware or unaware of their beliefs or their automatic thoughts, and operate as if their beliefs and thoughts are simply true facts. Living as if one’s thoughts and beliefs are “facts” is perhaps one of the greatest sources of suffering in the world.
In the cognitive portion of CBT, clients become more aware of the thoughts and beliefs that are daily present in their mind. Each person has their own characteristic thoughts and beliefs which formed in childhood, and these determine how one feels and reacts in response to daily events. For example, a client may become aware of the frequent thought “I have to do more than I’m doing right now.” On reflection, the client may become aware of the belief “I’m not good enough.” Once a client becomes more aware of their thoughts and beliefs, they learn how to thoroughly and objectively evaluate them. With careful examination, clients often discover their thoughts and beliefs are inaccurate or biased in patterned ways. Clients then work to develop more accurate, unbiased thoughts and beliefs. For example, a client may begin to think “I am enjoying what I’m doing right now” and believe “I’m good enough.”
In the behavioral portion of CBT, clients are challenged to intentionally act in new ways, including new actions that are different and challenging. This part of CBT can include relaxation training, skill training, exposure (facing fears) or systematic desensitization (facing fears slowly and gradually). Through this portion of CBT, one’s body relearns through new experiences it can do things that it previously avoided. Because the facing fears part of CBT can be scary or difficult, it often starts by imagining what is difficult or challenging before transitioning to real-life practice. Generally, clients start by mastering behaviors or situations that are mildly to moderately difficult, then work up gradually to more challenging situations. A critically important part is learning how to face challenging situations without any “escape” or “safety” behaviors (like keeping one’s eyes averted) that interfere with the body’s ability to learn that it’s OK. For example, someone with social phobia might practice imagining being at a grocery store over and over again, until that does not cause anxiety. Next, they may go to the grocery store with a friend over and over, until that experience no longer causes anxiety. The final step may be to go to the grocery store alone, over and over, until that no longer produces anxiety.
Clients who participate in CBT usually learn quite a lot about their own thoughts, beliefs and behaviors. With curious, compassionate exploration, clients can evaluate, often for the first time, the extent to which their thoughts, beliefs and behaviors accurately reflect all that they know about themselves and the world. Together, the cognitive and behavioral parts of CBT can quite effectively replace old patterns of thinking and behaving with new ones that are accurate, empowering, and joyful. CBT can be especially helpful in the treatment of anxiety, stress, anger and depression.