Cognitive Behavioral Therapy for Anxiety
By Dr. John D. Moore
Anxiety therapy and counseling are offered by our Chicago therapists using different forms of cognitive behavioral therapy (CBT). You may have heard of CBT before in your search for anxiety treatment but do you know what the term really means? Additionally, were you aware there are different forms of CBT with some considered as “third wave” types?
If you are interested in finding out about CBT and how it can help your anxiety, this article is for you. What follows is a rundown of 9 specific kinds of CBT, including the most popular “third generation” ones as previously mention.
Figuring out which form of CBT to use is largely determined by your unique set of circumstances, previous forms of anxiety treatment, your specific strengths and life challenge areas.
Are you ready to learn more about the different types of CBT? Let’s jump right in!
1. Behavior Therapy (BT)
This form of therapy for anxiety and other mood related issues such as depression came to rise after psychoanalytic approaches reached their zenith. Many are unaware that Behavior therapy found some of its early roots in B.F. Skinner’s operant conditioning.
Historically speaking, BT is one of the first scientifically proven forms of therapy. Behavior therapy is a science driven form of therapy related to learning; such as how people react behaviorally, emotionally, cognitively and psychologically. BT remains to this day the foundation for modern cognitive behavioral therapy (CBT).
To be sure, BT is still alive and well, being practiced by many clinicians to treat anxiety issues such as: panic attacks, obsessive compulsive disorder, phobias, social anxiety and health anxiety.
BT therapy is used to help individuals with anxiety change their reactions, which is directly tied to thinking patterns and emotions. A primary example of this is exposure therapy, used as a treatment approach for specific phobias, trauma (PTSD) and other anxiety disorders.
2. Cognitive Therapy (CT)
Generally speaking, cognitive therapy is concerned with how a person thinks and exploring irrational thoughts. The goal is to identify faulty lines of thinking and reduce irrational thoughts.
CT is known for challenging toxic thinking (aka “stinking thinking) and replace unhealthy thoughts with more logical, rational ones. CT has been clinically demonstrated to effectively reduce anxiety and treat depression. It has also been shown to be an excellent treatment approach in helping people with ADHD, phobias and Generalized Anxiety Disorder (GAD).
3. Cognitive Behavioral Therapy (CBT)
This form of therapy for anxiety and other mental health issues is considered the “big kahuna” within the cognitive therapy family. At its core, CBT is the combination of both cognitive type therapies and behavioral therapies.
According to the scientific research, CBT is one of the most effective forms of psychotherapy used to treat anxiety on the planet. CBT is considered a “here and now” therapy” and is all about focusing a person’s attention on their irrational, anxiety producing thoughts. An examination of “thought distortions” is part of the CBT dynamic.
The fathers of CBT are Albert Ellis, PhD and Aaron Beck, MD. Both are considered pioneers in the field of cognitive behavioral therapy, which manifests itself in the form of modern day talk therapy.
When practiced by experienced, knowledgeable CBT clinicians, amelioration of anxiety has its best chance of happening. Lots of therapists claim to practice CBT but in truth, few have been educated or trained in delivering this form of anxiety therapy.
"Third Wave" Cognitive Behavioral Therapies
Third Generation (Third Wave of CBT)
Connected to the cognitive behavioral therapies described above are “Third Generation” forms of CBT – also referred to as “Third Wave”. The above mentioned forms of cognitive therapies are mainly concerned with behavior modification and change, particularly as it relates to anxiety, fear and depression.
The third-wave types of CBT focus more on wellness, strength based components that place emphasis on mindfulness, acceptance and alternative control. In many ways, these forms of CBT reject the “sickness model” of mental health, such as anxiety, and embrace concepts of acceptance.
4. Acceptance and Commitment Therapy (ACT)
This form of therapy still links ties much of its moorings to traditional CBT. It is still grounded in empirical research, manifested through the scientific literature. What sets Acceptance and Commitment Therapy (ACT) apart is its focus on accepting our emotions and thoughts.
An emphasis is placed on body awareness as a way of getting at how controlling behaviors (i.e. thought stopping) can unintentionally and paradoxically worsen anxiety.
To create positive change, ACT employs mindfulness as a way of accessing and accepting our inner thoughts and emotions. Think of ACT as a departure from other models of therapy where the goal is to try and “get rid” of a feeling or symptom.
We now know that anxiety in many ways can be worsened when a person tries to eradicate thoughts, over control behaviors or engage in strict, rigid forms of coping. The key word in ACT is acceptance. This form of cognitive therapy for anxiety and other mood related issues was developed by Stephen Hayes, PhD.
5) Dialectical Behavior Therapy (DBT)
This offshoot of CBT incorporates the empirical science of traditional CBT but became a “third generation” category with its embrace of mindfulness. The word “Dialectical” is a 25-cent term use to describe synthesis or integration of the opposites.
Generally speaking DBT is offered in a four stage process.
- Stage one focuses on the person getting ahold of their out of control behaviors.
- Stage two places emphasis on moving the person away from quiet desperation and towards experiencing emotions.
- Stage three is goal oriented with a focus on helping the person learn how to live more productively.
- Stage four examines how spirituality (not the same as religion) can act as a conduit to greater life fulfillment.
DBT targets life threatening behaviors, therapy interfering behaviors, quality of life barriers and new skills acquisition. This type of therapy has been shown effective in the treatment of personality problems, substance abuse issues plus anxiety and depression.
6. Functional Analytic Psychotherapy (FAP)
This third wave form of CBT is unique because of its interpersonal nature. The essential characteristic of Functional Analytic Psychotherapy (FAP) is the encouragement and promotion of mindfulness based living through behavior. An examination of what works and what doesn’t work is part of the FAP dynamic.
The emphasis of this form of therapy is on courage, acceptance and love. Clients are encouraged to find compassion for themselves and create positive change without personal judgement of the self.
Awareness on the here and now and love of the self – meaning all of the self- characterize FAP. Functional Analytic Psychotherapy was developed in 1991 by Dr. Robert Kohlenberg and Dr. Mavis Tsai.
7. Compassion Informed Psychotherapy (CIP)
This type of therapy is designed to help people with high degrees of self-shame, which negatively impacts self-esteem. Compassion Informed Psychotherapy helps clients who engage in self-criticism by exploring thoughts through the lens of acceptance.
In this way, CIP is similar to other third wave forms of psychotherapy in that the focus is on awareness of thoughts and acceptance of the self. Components of CIP are used in anxiety counseling to reduce stress.
8. Mindfulness Based Cognitive Therapy (MBCT)
A fairly new form of CBT riding the crest of its third wave is Mindfulness Based Cognitive Therapy (MBCT). The essential element of MBCT is mindfulness. The focus is not on changing thoughts, such as other forms of CBT but instead, changing how a person reacts to thoughts.
The scientific research suggests this is a very effective form of therapy for people who live with high degrees of stress, anxiety, chronic pain and gastrointestinal problems like IBS.
If you receive MBCT therapy, you are taught to place mindful distance from what you are thinking and avoid judgement of your thoughts. This kind of cognitive approach breaks the negative spiral of toxic thinking, which can worsen emotions such as anxiety and depression.
It can be very effective when experiencing a panic attack that includes depersonalization. The goal is to help people make healthy choices with each new day and improve life on a moment to moment basis.
9. Integrative Couples Behavior Therapy (ICBT)
This particular form of therapy is aimed at couples. It is designed to help couples with communication problems. Empathic listening is emphasized as part of the dynamic.
Couples are encouraged to better understand one another through characteristic identification. Pleasure planning is emphasized, which happens through formal homework assignments (aka self-improvement).
The clinical research suggests that the various forms of CBT discussed in this article can be used to help people living with different life challenges, such as anxiety and depression.
Cognitive Behavior Therapy is firmly grounded in evidence based science. This means empirical research studies have been conducted to demonstrate its effectiveness. If you are interested in learning more about CBT, consider picking up a copy of: The Anxiety and Worry Book by Clark and Beck.
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