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.
Everyone experiences stress in their lives, but when an event or series of events is
exceptionally stressful, it is called a trauma or traumatic experience. Those who
have been directly affected as survivors, as rescue workers, or as friends or relatives
of victims, as well as those who have witnessed tragedy and devastation,
either firsthand or on television, may be suffering from the effects of trauma.
What makes an experience traumatic are a sense of horror, utter helplessness,
serious injury, or the threat of physical injury or death. Bearing witness to others’
intense suffering can be traumatic as well. When exposed to these types of experiences,
a profound emotional reaction, both immediately and afterwards, is to be
expected. The lives of those affected by the trauma of September 11, 2001, will be
disrupted for some time. It is hard for anyone to readily return to their normal
People cope with trauma in various ways, although there are some common
coping strategies that are typically associated with better posttraumatic adjustment.
For example, it is helpful to obtain comfort from loved ones, talk with
friends and loved ones about their experience, find respite from daily demands,
and engage in forms of relaxation (e.g., naps, walks, quiet time, meditation). The
other thing to keep in mind is that the old adage about “time healing all wounds”
is mostly correct. Intense fear, anxiety, and the pain of remembering something
awful will gradually decrease over time. Surprisingly, most people are able to
return to their normal routines in about a month.
A small percentage of people suffer from intense emotional or physical distress,
called acute stress disorder (ASD), which typically occurs in the first month
following a catastrophic event. Individuals may be suffering from posttraumatic
stress disorder (PTSD) if the problems remain or become worse and if the problems
go beyond 3 months.
What Is PTSD?
PTSD is a set of significantly distressing symptoms or problems tied to exposure
to trauma that persist for many weeks or months after the event. Below are
some of the more common symptoms of PTSD. Whenever the difficulties appear,
they can disrupt lives. But help is available.
• Reexperiencing: "I can’t shake the memory."
Having survived the attacks on the World Trade Towers and the Pentagon, having
watched it from another building or on TV, people experience the tragedy as so
horrible that it feels like they cannot let go of the memory. Even worse, vivid images,
sounds, or other sensations reminiscent of the trauma can interrupt or dominate
their thoughts. At times, they actually feel as if the attack were happening
again. These experiences are referred to as flashbacks. Other times, the survivor
can’t shake the memories. Trauma-related nightmares are also common. These
experiences are often accompanied by fear, tension, or anxiety in the form of a
racing heart, rapid breathing, feelings of panic, and excessive sweating.
• Avoidance: "I can’t be around anything that reminds me of what happened," or "I feel numb."
People may feel afraid of being in, or even going near, tall buildings, feel afraid
of going on airplanes, or being around lots of people. They may feel unable to
take an elevator to a high floor. Sometimes the fear related to trauma leaves people
totally house-bound. 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. People may feel unable
to watch any news for fear of being reminded of the horrors of this attack and
the devastation that followed. When they encounter a reminder of the trauma,
they may feel extremely tense or anxious. Some people will paradoxically 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 the loss of life — a spouse, child, coworker,
or friend — or may be the loss of safety of your routine. Grief and sadness
after 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,” emotionally protect oneself for a period, 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 they are not
present when they really are. Occasionally, this is a feeling of being cut off from
their surroundings, including the people around them. It can also be similar to
“zoning out,” where the person might lose their thought or stop 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, the body systems of trauma survivors 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 involuntarily 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
These behaviors, alone or in combination, may or may not be ASD or PTSD.
It is normal, after all, to be profoundly affected by tragedy, and, therefore, is not
necessarily a sign of a larger problem. But, if a number of problems are experienced,
consultation with a mental health professional is strongly recommended
to formally diagnose its presence and, more importantly, to obtain help in relieving
Can Psychotherapy Help?
Psychotherapy 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. Also, the earlier the survivor obtains help, the more likely
serious problems can be averted or prevented. 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
Survivors are caught in a vicious cycle in which the memories and thoughts
surrounding the traumatic event keep coming back. Because the survivor reacts
to these with anxiety and, sometimes, horror, he or she pulls away from the
thoughts and memories. The survivor never really comes to understand or
process the memory, because it is always cut off before the person can make
sense of it. In 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 physiological distress.
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.
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. 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.
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.
Survivors of this horrible act, and those who experienced it from a distance,
whether in another building, on TV, or through the papers, need not suffer in
isolation. Professional therapy, behavior therapy in particular, can provide hope
and practical ways of enjoying life again after the horror of a traumatic event.
For more information or to find a therapist:
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from which you took this fact sheet