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.
Worry is an anxious way of thinking about oneself and the world. It usually
involves thoughts about what bad things might happen in the future and/or
whether the person will be able to cope with them. Although worry can sometimes
be about events that occurred in the past, the worry is typically about
how that event could affect the future.
Nearly everyone worries at some time, and it is normal that worry increases
when problems or dangers exist, or when a person faces something new or unknown.
The most common areas of worry involve concerns with family, interpersonal
life, work or school, health, and finances. Normal worrying is usually
triggered by a reminder in the environment that is related to the area of concern,
although worry can also just pop up. Normal worry usually interferes little with
daily life, because the person is usually able to stop it. However, the frequency of
worry and the extent of anxiety it causes is different for everyone. Worry may
become distressing itself (that is, worry is the problem much more than the
feared event) and may interfere with normal functions, such as sleep or concentration,
particularly when one is faced with stressful circumstances.
When worry occurs too often or too intensely, a useful method for reducing normal worrying involves a five-step program.
1. Select a half-hour “worry period” that will take place at the same time and place each day.
2. Observe your daily worrying and learn to catch it earlier and earlier.
3. When you catch a worry beginning, postpone it to your worry period, reminding yourself that you will have time later to worry about it and that there is no use upsetting yourself now.
4. Focus your attention on the present moment (what you are doing, or the next thing on your list of things to do).
5. When you get to your worry period, you can worry about your concern as much as you like. However, it may be more useful to spend the time distinguishing
between worries over which you have little or no control, and
worries about problems that you can influence. If you can influence the
problem, do some problem solving and take some actions based on it (for
instance, if you worry that your car might break down, consider whether
it might be time to take it in for a tune-up; then do it). If the worry is
largely beyond your control, recognize that little or nothing can be done
and that you are only making yourself feel bad by worrying. This may
help you to let go of the worrying when you catch it. In some situations, it
is helpful to identify the worst thing that could happen, because often it is
something that is unlikely or something with which you can easily cope.
Generalized Anxiety Disorder
For about 3% to 4% of Americans, worry goes beyond the normal degree experienced periodically by most people.
For some people, it is excessive, uncontrollable,
and it interferes with daily functioning. People with hypochondriasis
may worry excessively about their health, people with panic disorder
may worry about panic attacks, and others may worry about a different specific
topic. In contrast, worry among people with generalized anxiety disorder
is not confined to one or two areas. Instead, people with generalized anxiety
disorder worry about a number of different things nearly every day. In fact,
excessive worry about minor things—or everything—is common in generalized
anxiety. These worries often just “pop into the mind” and usually are
about bad events in some imagined future that have little chance of actually
Although worry can lead to problem solving, some people believe that
excessive worrying will prevent what they fear from happening. They also
tend to underestimate how well they are likely to cope should the feared
events actually occur. The chronic worry and its associated feelings of anxiety
have been part of their lives for months or even years; it occurs even in the
absence of stressful circumstances. The worry is often accompanied by such
symptoms as feeling keyed-up, being on edge or restless, feeling easily fatigued,
having difficulty sleeping or concentrating, excessive muscle tension,
and irritability. Generalized anxiety is also frequently accompanied by other
anxiety problems (for instance, social phobia or panic attacks) or depression.
Generalized anxiety disorder affects women more than men and is more
common in low socio-economic groups. Most people develop the problem in
their late teens or early twenties, although many people report having been
worriers all their lives, and a few develop the problem in later adulthood.
Some people who worry excessively have survived more traumatic events in
their past, which could well contribute to a general sense that the world is a
dangerous place and that the person may not be able to cope with it.
Treatment for Generalized Anxiety Disorder
The treatments therapists use for controlling generalized anxiety usually decrease
worry and anxiety within three to six months, and the treatment benefits
may continue well past the conclusion of therapy. However, for a small
percentage of individuals, the worry persists despite professional help.
The most useful treatments are based on the recognition that the anxiety
associated with worry starts gradually and spirals into heightened anxiety. An
anxiety spiral involves a series of interactions between worrisome thinking,
fearful imagery, and physical sensations. For example, a woman may think
about driving her car, have an image of mechanical failure, and begin to
worry about how she would pay for it. These mental events cause an increase
in muscle tension and restlessness and lead to worrying about how she will
ever be able to save enough money for her son’s college education. More images
of disappointing events and failure as a mother and a provider emerge
with further increases in anxious emotion and physical arousal. Some people
might experience worry primarily in one area, such as negative worrisome
thoughts. For example, a man may begin to worry about a deadline at work,
leading to worry about the boss firing him, and then worrying about finding
another job. These fears lead to worries about bankruptcy, which leads to
fear of disapproval from his parents and wife, and eventually an image of
being alone and homeless.
Individuals with generalized anxiety usually only recognize their anxiety
when the worry has become intense. Therefore, treatment focuses on catching
the cues of the anxiety spiral earlier and earlier. The therapist helps individuals
identify early internal cues of anxiety by using environmental
reminders (e.g., phone ringing, Post-It notes) followed by coping strategies to
control them. By catching the spiral early, anxiety is weaker and easier to
control. Each time new coping responses replace the anxious responses, the
old habits are weakened and coping is strengthened until coping becomes a
habitual reaction to early anxiety cues. Coping responses include relaxation
methods to combat the physical sensations of anxiety, using anxiety-producing
images to desensitize the person to feared events and to provide an opportunity
to practice the newly learned coping responses, and cognitive therapy
to help the person see the world in a less threatening way.
In applied relaxation, the person learns how to relax, using such techniques
as progressive muscle relaxation and diaphragmatic breathing, and
learns to apply relaxation responses to early anxiety cues during daily living.
In self-control desensitization, the person becomes deeply relaxed in
the therapist’s office and then imagines scenes of the feared events or engages
in worrisome thinking. As soon as the anxious spiral is started, s/he applies
the relaxation response to reduce the physical anxiety symptoms and “let go”
of the worry while remaining in the scene with the feared events. Presentations
of imaginary scenes with coping responses are repeated until the person
is able to terminate the anxious feeling or worry. Practicing lessens the anxiety
associated with the images and increases the likelihood of using coping
responses whenever worry or other elements of anxiety are detected.
In cognitive therapy, the individual learns to identify the thoughts
that contribute to the anxious spiral (anxiety-provoking thoughts, predictions,
and interpretations about oneself, the world, and the future) and to
evaluate the evidence of the likelihood that bad things are really going to
occur. By using logic and analyzing the evidence (for instance, “My car seldom
breaks down and I have the number to AAA for towing in case the car
does break down”), the person identifies more realistic and adaptive ways of
thinking and believing. Worrisome predictions about the future come to be
seen as remote possibilities rather than fact. The person and therapist can
also conduct experiments to see if the feared predictions happen or if, in general,
things tend to turn out better than feared. In addition, even when negative
events actually do occur, the individual discovers that s/he typically
copes quite well, without the catastrophic consequences commonly expected.
Finally, all of the above treatments are sometimes combined with the suggestion
to repeatedly approach situations that are the topic of worry in order
to desensitize anxiety reactions.
For more information or to find a therapist:
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