CBT - FAQ
What is CBT?
CBT is an acronym that stands for “Cognitive-Behavioral Therapy.” According to CBT, our emotions, thoughts, and behaviors shape how we interpret our experiences. Over time, our perceptions have an effect on overall mental health. For example Generalized Anxiety Disorder might involve all three of the following:
feeling of anxiety (an emotion)
belief that the world is dangerous (a thought)
avoidance of the world as a result (a behavior)
Accordingly, CBT takes aim at the two of these three factors that we have any control over: our thoughts and our behaviors. Both change in behavior and change in belief are targeted. In order to change our thinking, CBT uses Socratic questioning (gentle challenging of dysfunctional thoughts though the use of logic) to arrive at a more rational belief system. We also encourage confrontation of any activity that is being avoided. Throughout my training and career as a clinical psychologist, I have developed many effective techniques to make this process feel manageable and inspiring.
What is Acceptance and Commitment therapy?
Acceptance and Commitment Therapy, or ACT, is a form of Cognitive Behavioral Therapy that points out that suffering itself is a normal part of life, and we make things worse for ourselves when we try to avoid “feeling our feelings.” Inspired by eastern philosophical approaches, ACT encourages willingness to have discomfort (even embracing it) in order to stop being at war with our internal world. According to ACT, when we are truly willing to have discomfort, that suffering no long drives our decision making, leaving one to embrace life more freely. Through willingness to have your feelings, you can bring your life in any desired, healthy direction. Techniques of ACT include mindfulness training, nonjudgmental acceptance of our thoughts and feelings, and clarification of values (what is most important to us in life). These techniques come to serve as a compass for mental health, which we can trust when choosing how to handle situations.
What is exposure and response prevention?
Exposure and Response Prevention, or E/RP, is a systematic approach for confronting avoided activities. Anxiety-provoking items are arranged on a hierarchy, listed from easiest to most challenging. Engaging in E/RP is a collaborative process that the therapist and client pursue together. Easier items are tackled first, building confidence to confront more challenging actives as therapy progresses. E/RP is the gold standard therapeutic ingredient for treating: OCD, BDD, social anxiety, and many others of the anxiety disorders.
How many sessions will I need?
The answer to this question varies, and depends on motivation for change, compliance with treatment recommendations, and overall severity of the symptoms. I have worked with plenty of individuals who recover with as few 10-12 sessions, but individuals who lack motivation, or experience more intense symptoms may require a longer-term approach. The number of sessions needed is unique to each individual situation. That said, if you are engaging in CBT and are committed to changing your habits, you will likely experience some benefit within the first few sessions.
My child is struggling; what should I do?
Parents often feel bewildered and frightened when a child suddenly struggles in a way that typical parenting strategies can’t resolve. Helping a child in these situations often requires family/parent training to break the impasse and support the child effectively. I have worked extensively with children and their parents, and understand the delicate and complex dynamics that accompany a child who is struggling.
Why might I need a personalized treatment plan?
I might recommend a deviation from the conventional 45-minute session/week format if:
your dysfunctional patterns have robbed you of normal functioning
the symptoms that you experience interfere significantly at home or at work
if distress is far-reaching and all encompassing
A treatment plan with the flexibility to offer more frequent sessions or home visits allows us to confront the problem at the source. I have found that this flexible approach allows us to reach the difficulties that my clients experience in whatever context that those difficulties emerge.
What does Evidence-based treatment mean?
“Evidence-based treatment” refers to practices that research studies have verified as effective in treating specific symptoms or disorders. You would be surprised to see how many therapists practice treatments that have not been scientifically shown to work. CBT, E/RP, ACT, and other behavioral approaches have been held up to scientific scrutiny, and have been shown to relieve troublesome symptoms associated with mood and anxiety complaints.
Will you collaborate with my child’s school psychologist or psychiatrist?
Only with your consent, of course, but yes! I favor a collaborative approach, and I am happy to advocate for my clients with regard to receiving services. I believe that a well-oiled therapeutic machine promotes a unified approach; in my clinical experience, this sometimes makes the difference!
in a nutshell, what is your typical treatment plan?
Again, this would vary widely from situation to situation, but below are a few of my favorite hits:
psychoeducation: providing information regarding the nature of anxiety and mood concerns; why we become fixated on dangers or discomfort; what is happening inside the brain; what learning has contributed to dysfunctional patterns; what we can do to improve things.
cognitive disputation: identifying errors in thinking (i.e. cognitive distortions) and disputing beliefs that are maintaining symptoms. This involves building awareness of common triggers, automatic thoughts when encountering triggers, categories of distorted thinking, and more logical conclusions.
Coping tools: This involves building a repertoire of strategies for tolerating emotional distress, and the coping toolbox is made up of strategies that aim to soothe, relax, distract, direct awareness, and create experiences that compete with the troublesome emotion. Coping tools make healthy choices easier to perform.
Building a hierarchy of fears and avoided activities, and beginning exposure and response prevention (E/RP) to confront these fears therapeutically. This process sounds intimidating, but in my experience it does not have to be painful. I always approach E/RP sensitively, careful to aim for the “window” where E/RP exercises are challenging, but not overwhelming.
Behavioral Activation: this basically means getting “back into the swing” of life, and pursuing productive activities that are rewarding. Oftentimes, people who struggle with anxiety and depression begin to withdraw from previously enjoyable activities. Behavioral activation provides a strategy for getting back to a functional, fulfilling routine.
Building Mindfulness skills: This involves focus on the present moment and immediate feelings/urges/experiences. Mindfulness training can refer to many things such as meditation, purposeful/deliberate decision-making, nonjudgmental observation, among others.
Practicing Acceptance and willingness as a means to better tolerate emotional experiences, therein providing some breathing room from where you can make mindful decisions about how to manage triggers and suffering.
Constructing Homework assignments that may be completed in between sessions so as to reinforce concepts discussed or strategies practiced in session.
Among so many other techniques!
Do you take insurance?
I do not. The reason for this is simple: insurance companies do not compensate clinicians in a way that allows private practice to be sustainable and comfortable. Psychologists who take insurance are often forced to see more clients in order to make ends meet, and this may lead to burnout and overall professional disorganization.
The good news is that many insurance plans compensate for out of network expenses, either immediately, or after some deductible is reached. Most of my clients receive something back from their insurance, which allows for therapy to be more sustainable.