Three Components of CBT – NYC
Do you struggle with feeling anxious, overwhelmed, or stressed? You don’t have to struggle alone. Reaching out for support and treatment can help.
Cognitive-behavioral therapy (CBT) is a proven, evidence-based form of psychotherapy based on the theory that our thoughts affect how we feel. It is a collaborative and structured therapy that focuses on learning new skills, including problem-solving, identifying distorted thinking, changing behaviors, and improving interpersonal relationships. Besides, studies have shown that even online CBT can help people feel calmer and deal better with significant challenges.
Here are some examples of distorted thinking:
OVER-GENERALIZING: At times, we may see things as all-or-nothing. For example, if one thing goes wrong with a project, we may think that the entire project is a failure. Or if there is one thing that upsets us about a person, we may decide we do not care for that person.
MIND READING: We assume that we know what someone is thinking. We may be disappointed that a good friend or family member hasn’t contacted us during this difficult time, and we may tell ourselves, “That person just doesn’t care” or “The person must not be a good friend. She isn’t even thinking about how I’m doing”. This may or may not be true but assuming it is true is an example of a thought distortion.
CATASTROPHIZING: We exaggerate how “awful” something is or imagine the worst possible outcome. During this period of working from home, perhaps your boss wants to speak with you and worry that you will be fired. Or, you start having thoughts that this current challenging situation with COVID-19 will always make life difficult. This is an example of catastrophizing. And, this type of thinking can create increased anxiety and worry.
FORTUNE TELLING: We think we know for sure what is going to happen. For example, we may have the thought, “I will not survive this crisis” or “Things are always going to be like this from now on.”
The Research
Thousands of research studies have demonstrated the effectiveness of Cognitive Behavioral Therapy (CBT). CBT has been shown to improve depression, anxiety, panic attacks, insomnia, chronic pain, post-traumatic stress disorder, Adult ADHD, and many other disorders. As a psychiatrist and therapist, I have been practicing Cognitive Behavioral Therapy (CBT) in my New York City private practice for nearly 15 years. Many psychiatrists choose to only prescribe medications in treating patients; however, some psychiatrists are trained in both medication management and cognitive behavioral therapy, thus providing the option of both treatments in one place. I am trained and certified in both medication management and CBT. I found several CBT principles to be beneficial in the treatment and may be helpful in your treatment. Here are the principles that your psychiatrist or therapist may use to provide you with the most effective treatment.
Seven Top Strategies for Working Online with Your Therapist
1. DISCUSS GOALS OF TREATMENT
During the initial assessment phase, your psychiatrist or therapist needs to collaborate with you on treatment goals. This helps keep the treatment focused and productive. Without goals, therapy can focus on whatever problem is coming up that week and can interfere with the progress of the original presenting problems. Sometimes, the patient may not be able to specifically describe a goal except a vague “I want to be less anxious” or “I want to feel happier.” This is fine at the beginning. However, over the first couple of months, you should return to this discussion about goals to see if they can be described in more specific terms.
For example, if someone presents with depression, the goals may include finding a more fulfilling job, returning to college, exercising three times a week, making two new friends, and stopping the use of marijuana.
2. START EACH SESSION WITH AN AGENDA
Every session, your psychiatrist or therapist should start with an agenda discussed collaboratively between the therapist and the patient. Again, this helps to keep the session focused and more effective. The agenda should include following up on homework from the previous session, a check-in about the mood and week, bridging or reviewing the topics and progress from the previous session, and topics related to discuss in the current session related to a specific goal.
3. DISCUSS WHERE TO ADDRESS THE ISSUE
Most therapy goals will have several components, including distorted thoughts, beliefs, or behaviors. Thus, during the session, collaboratively decide on which level to address the goals. If you are working on distorted thoughts, it is important to elicit what thoughts or images occur that lead to distress, such as anxiety, low mood, or blocking a certain behavior. If you are working on certain behaviors such as social skills or relationship issues, it is important to discuss when to use the skills. Another useful technique for addressing behaviors is role-playing. This helps to practice the skills and address any blocks or anxieties around the behavior.
4. USE FLASHCARDS
Use flashcards to remember the session’s key points or a mantra that may help with certain thoughts or feelings. If I am working with a patient who is struggling with depression, I will title the flashcard something like “Survival Kit,” and it will include strategies to cope with the depression, such as reaching out to a friend, getting out of the house, reaching out to me, or taking care of a small chore.
5. STAY FOCUSED
At the beginning of treatment, goals for therapy are discussed. Sometimes, the therapy session may head in a direction that is unrelated to any treatment goals. This is appropriate at certain times, but if this is happening every session and for the entire duration, there can be a limit to therapy progress. The structure is important in CBT, but flexibility is also important. This would be a time to collaborate to discuss whether to continue on the current diversion or issue discussed or go back to what was discussed on the agenda.
6. ASSIGN HOMEWORK
Towards the end of each session, a collaborative discussion occurs about homework or “action tasks” to perform between sessions. An action task might be to buy a calendar if one of the issues is time management or recording thoughts and images during stressful periods in a notebook to discuss and address in the following session. Always make sure to follow-up on the homework or action task at the next session, or it creates the impression that working on problems or goals in between sessions is not a crucial part of getting better.
7. ASK FOR FEEDBACK
Towards the end of the session, ask what went well during the session, what could have gone better, and the main take-away messages. This helps to maximize the gains of therapy, improve future sessions, and improve the rate of progress.
Finding Online CBT Therapy and Treatment for Anxiety
Cognitive-behavioral therapy is an extremely effective form of therapy, either with or without medications and is an excellent way to cope and even thrive during this challenge. You can search for an online therapist or psychiatrist certified in CBT by going to the Academy of Cognitive Therapy.
If you have any questions about online therapy for anxiety, depression, or ADHD, please feel free to contact me at scott@scottshapiromd.com or 212-631-8010.
