Behavior Therapy and Cognitive Behavior Therapy are types of treatment that are based firmly on research findings. These approaches aid people in achieving specific changes or goals.
Changes or goals might involve:
A way of acting: like smoking less or being more outgoing;
A way of feeling: like helping a person to be less scared, less depressed, or less anxious;
A way of thinking: like learning to problem-solve or get rid of self-defeating thoughts;
A way of dealing with physical or medical problems: like lessening back pain or helping a person stick to a doctor’s suggestions.
Behavior Therapists and Cognitive Behavior Therapists usually focus more on the current situation and its solution, rather than the past.
They concentrate on a person’s views and beliefs about their life, not on personality traits.
Behavior Therapists and Cognitive Behavior Therapists treat individuals, parents, children, couples, and families.
Replacing ways of living that do not work well with ways of living that work, and giving people more control over their lives, are common goals of behavior and cognitive behavior therapy.
HOW TO GET HELP:
If you are looking for help, either for yourself or someone else, you may be tempted to call someone who advertises in a local publication or who comes up from a search of the Internet.
You may, or may not, find a competent therapist in this manner.
It is wise to check on the credentials of a psychotherapist.
It is expected that competent therapists hold advanced academic degrees.
They should be listed as members of professional organizations, such as the Association for Behavioral and Cognitive Therapies or the American Psychological Association.
Of course, they should be licensed to practice in your state.
You can find competent specialists who are affiliated with local universities or mental health facilities or who are listed on the websites of professional organizations.
You may, of course, visit our website (www.abct.org) and click on "Find a CBT Therapist"
The Association for Behavioral and Cognitive Therapies (ABCT) is an interdisciplinary organization committed to the advancement of a scientific approach to the understanding and amelioration of problems of the human condition.
These aims are achieved through the investigation and application of behavioral, cognitive, and other evidence-based principles to assessment, prevention, and treatment.
Most people experience stressful events, but when the event is exceptionally
stressful it may be called trauma or a traumatic experience. Certain events—
such as a home lost in a fire or even a community in the midst of a flood, a
terrible injury in a car wreck, or the loss of family members in a plane
crash—are traumatic for most people. The threat of serious injury to yourself
or loved ones can also be traumatic. What usually makes an experience traumatic
is a sense of horror, utter helplessness, serious injury, or the threat of
physical injury or death. In some instances, the survivor of trauma may witness
a horrifying event rather than being directly injured or threatened with
The following experiences are commonly recognized by mental health professionals
rape or sexual assault
crime victimization, including mugging, assault, robbery, shooting
children victimized by physical, sexual, or verbal abuse
natural disasters, such as fires, floods, hurricanes, and earthquakes
war-related experiences, especially combat
serious injury situations, such as airplane or automobile crashes
Research has shown that the best predictor of whether a person will suffer
problems after the trauma is how severe the incident was—that is, how horrifying
or threatening it was. No one is immune from developing emotional or
psychological problems after a trauma. Whether or not a person begins to have
problems after a trauma partly depends upon the individual’s psychological
health prior to the event, other stressors in the survivor’s life, the age of the
survivor (the young and the elderly may be more at risk), and the support the
individual has from friends, loved ones, and the community.
What Problems Can Arise After a Trauma?
Two types of problems can result from the experience of being traumatized.
They mainly differ in the length of time before the survivor experiences problems
after the trauma. The first, called acute stress disorder, or ASD, typically
occurs in the first month following a catastrophic stressor. Fifty percent to 75%
of the population may experience symptoms of ASD after a severe community
trauma, such as a hurricane. Most people will recover from these symptoms on
their own, but the majority of people will benefit from the help of family,
friends, emergency services, or psychologists. Some of those suffering from
ASD will go on to develop the second problem cluster: posttraumatic stress
disorder or PTSD.
PTSD is virtually identical to ASD in the kinds of problems experienced by
the survivor, except that the problems persist beyond 3 months (acute
phase), for many months, or, in some people, even years. Some survivors
do not show symptoms immediately; PTSD symptoms that appear some
time after the trauma are called delayed-onset symptoms. All of the difficulties
associated with ASD or PTSD, described at greater length below, are
categorized into three main clusters: reexperiencing, avoidance, and hyperarousal.
Reexperiencing: “I Can’t Shake the Memory”
Many times the trauma is so unusual or horrible that a person cannot
let go of the memory. Even worse, vivid images, sounds, or other sensations
reminiscent of the trauma can interrupt or dominate thoughts. At
times, an individual can actually feel as if the event were happening again.
These experiences are referred to as flashbacks. Other times, the survivor
cannot shake the memories, which are intrusive but less serious and incapacitating
than flashbacks. Although these intrusions happen while one is
awake, trauma-related nightmares are also common. These experiences
are often accompanied by fear, tension, or anxiety in the form of heart palpitations
(heart racing), rapid breathing, and excessive sweating.
Avoidance: “I Can’t Be Around Anything That Reminds Me of What Happened” or “I Feel Numb”
If someone was sexually assaulted in a parking garage, they may feel
frightened when approaching their garage—or any garage. The person may
feel unable to drive. Sometimes the fear related to trauma leaves people
housebound. Moreover, while many people try to avoid situations that remind
them of the trauma, some will also try to avoid thoughts and feelings
about the trauma as well as the physical reminders. Combat veterans may
feel unable to watch any news for fear of being reminded of the horrors of
wartime experiences. When a person encounters a reminder of the trauma,
she may feel extremely tense or anxious. Some people will paradoxically
find themselves in situations that are like the original trauma or actually
seek out reminders in their environment. This type of behavior does not
typically make the person feel better; often these experiences will increase
the fear, sadness, isolation, or anger.
Trauma involves loss. This may be limited to material loss (e.g., a
home), or it may mean the loss of life: a husband, wife, child, coworker, or
friend. Grief and sadness after traumatic loss can be so overwhelming and
difficult to talk about that a person can only report feeling numb. This response
is not unusual. One way of adapting to horrible events is to “shut
down,” protect oneself emotionally for a time, and seemingly have no feelings.
Trauma survivors often feel guilt for not feeling the way they believe
they should or not feeling sadness or compassion for other survivors or
those who died in the same traumatic event they escaped. For some, the
feeling of numbness causes isolation or withdrawal from social contact.
Another way that people avoid the anxiety is called “dissociation,”
where people disengage from their surroundings. It is literally feeling as if
not being present. Occasionally, this is a feeling of being cut off from surroundings,
including people. It can also be similar to “zoning out,” where
someone loses thoughts or stops listening to another. In effect, the survivor’s
body is present, but the mind has gone elsewhere.
Hyperarousal: “I Can’t Calm Down”
People who have been traumatized are usually quite anxious. Although
it may not be obvious, trauma survivors’ bodies may be working overtime.
Their heart rate, blood pressure, and sweat response may be higher. They
often have an exaggerated startle response; a sharp noise may cause them
to jump, or a horn may result in a pounding heart or an involuntary “safety
response,” such as ducking down or scrunching the head between the
shoulders. Such people may become irritable or have a quick temper. Anger
outbursts may lead to other problems, such as violence and child abuse.
Some people resort to drugs or alcohol to manage the anxiety.
Any one of the above problems in isolation may not necessarily mean
ASD or PTSD. But, if a number of problems are there, a mental health professional
may be able to diagnose its presence and, more importantly, provide
help in relieving symptoms.
Can Psychotherapy Help?
Psychotherapy for survivors of trauma with ASD or PTSD can help a
person gain relief from many of the symptoms mentioned above. Most
therapists agree that telling one’s story is central to feeling more in control.
In addition, the earlier the survivor obtains help, the more likely serious
problems can be averted or prevented. Cognitive behavior therapists have a
practical focus with two fundamental goals: to decrease the anxiety or hyperarousal
and to increase the connection the survivor has with family,
friends, or the job setting (i.e., decrease avoidance). This is usually done in
a gradual fashion.
Survivors are caught in a vicious cycle in which the memories and
thoughts surrounding the traumatic event keep returning. Because the survivor
reacts to these with anxiety and, sometimes, horror, he or she pulls
away from the thoughts and memories, thereby reinforcing the anxiety and
pain by immediately removing the thoughts and memories. The survivor
never comes to understand or process the memory, because it is always cut
off before the person can make sense of it. In cognitive behavior therapy, the
individual is assisted in processing the memory in ways that make it tolerable.
The memory will never be a happy one, but it will no longer cause intense
Cognitive behavior therapists try to make the symptoms understandable
to the survivor. In the context of a caring and trusted relationship with
the survivor, the therapist helps the survivor reduce the symptoms by using
techniques like relaxation. Therapists also try to take away the power of the
memories or flashbacks by having the survivor relive and reexperience
them. Sometimes the therapist will explore the survivor’s thoughts about
the traumatic incident and, where appropriate, help the survivor understand
when his or her beliefs about the incident are contrary to reality.
Cognitive behavior therapists often teach additional skills, such as how to
grieve, how to manage anger and rage, and how to socialize again, depending
upon client needs. The ultimate goal is to reintegrate the survivor into
his or her social structure.
Cognitive behavior therapists sometimes use techniques such as deep
relaxation or hypnosis to help clients manage the fear and anxiety. Medication can be an appropriate adjunct to therapy for survivors of trauma, especially
those for whom depression or anxiety is severe. Although most
therapy is conducted on a weekly basis over the course of months on an
outpatient basis, some people with more severe problems may choose to
see a therapist more frequently or may benefit from a brief hospital stay to
help them stabilize.
Survivors of trauma need not suffer in isolation. Professional therapy,
cognitive behavior therapy in particular, can provide hope and practical
ways of enjoying life again after the horror of a traumatic event.
For more specific information, please refer to the following Fact Sheets
in the Survivors of Trauma series: Combat-Related PTSD, PTSD and
Crime Victims, and Natural Disasters. These are all available from ABCT or
from your therapist.
For more information or to find a therapist:
Please feel free to photocopy or reproduce this fact sheet, noting that this fact sheet was writen and produced by ABCT. You may also link directly to our site and/or to the
from which you took this fact sheet