cognitive behavioral therapy


Cognitive behavioral therapy (CBT) is a highly effective, evidence-based therapy that has been found to be particularly helpful in the treatment of anxiety disorders. Starting with the premise that the ways you think (cognitions) and behave strongly affect how you feel, CBT focuses on identifying, understanding and changing self-defeating and irrational thinking and behavior patterns. CBT clients are actively involved in their own recovery. Typically, clients are asked to read about their problems, keep a journal to monitor thoughts and behaviors, and complete "homework" assignments between sessions to reinforce what has been learned.

A CBT therapist, working cognitively, will help clients notice unhelpful and automatic thoughts and teach them how to replace these with more accurate and realistic thinking. Examples of such thoughts include catastrophizing ("The hurricane will probably break all our windows and the rain will sweep in and ruin everything"), underestimating abilities ("There's no point in applying for the job because I won't get it"), and overgeneralizations ("No one likes me"). A CBT therapist will also help clients identify and change unhelpful, avoidant, or self-destructive behavior patterns. In addition, clients are taught techniques that make it easier to tolerate anxious feelings and sensations; these might include progressive muscle relaxation and diaphragmatic breathing.

supported exposure therapy


Supported exposure therapy is a form of behavior therapy that is effective in treating phobias and obsessive-compulsive disorders. As its name suggests, supported exposure therapy involves gradual exposure of clients to anxiety-provoking stimuli, situations or objects. The therapist accompanies the client into the feared situation, either physically or in imagination, in small, graded steps, while teaching the client how to manage and tolerate anxious feelings. The key to successful treatment is that the client determines the rate of exposure, so that anxiety never becomes overwhelming. In treating OCD, a variant of supported exposure therapy called exposure with response prevention can be very helpful. Here the client is exposed, in gradual steps, to the specific stimuli that cause distress and is taught how to resist engaging in the compulsive rituals that have previously been used to reduce anxiety; with practice, the strength of the compulsion is decreased and often eliminated.