CBT Anxiety Therapy

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Cognitive Behavioral Therapy (CBT) for the Treatment Anxiety

Cognitive Behavioral Therapy (CBT) is an anxiety treatment that is effective for many anxiety disorders. Under the orientation of Cognitive Behavioral Therapy (CBT) there are several different modalities, including Albert Ellis’s Rational Emotive Behavior Therapy (REBT) and Aaron Beck’s Cognitive Therapy (CT). While all types of Cognitive Behavioral Therapy (CBT) focus on identifying and restructuring a client’s maladaptive thoughts, thereby reducing negative emotions, there is also a strong Behavior Therapy component.

Exposure Therapy

In the treatment of anxiety disorders, a Cognitive Behavioral Therapist (CBT) will be most effective if he uses Behavior Therapy techniques including exposure therapy. Before beginning exposure therapy, it is important for a Cognitive Behavioral Therapist (CBT) to have psycho educational sessions with a client about anxiety and treatment method. Cognitive Behavioral Therapists (CBT) teach clients that anxiety is a normal human response, and evolutionarily has served human beings. It is completely normal for human being to be fearful and anticipate danger during certain events. However, anxiety or fearfulness becomes problematic when a person senses a false alarm and anticipates danger when no danger is looming. Cognitive Behavioral Therapy (CBT) teaches clients that the feared response of anxiety is paired with a neutral stimuli, and when these two things are paired together and the neutral stimuli is presented the personal experience anxiety due to the strong association between the two. The anxious client is taught through Cognitive Behavioral Therapy (CBT) psychoeducation that he must be presented with the anxiety provoking stimuli repeatedly until he recognizes that no danger is present in reality any anxiety response eventually diminishes. Presenting the anxiety provoking stimulus repeatedly to a client is called exposure therapy.

Therapeutic Alliance

It is important for a Cognitive Behavioral Therapist (CBT) to have a good rapport with his client before beginning exposure therapy. A client should have a full understanding of the rationale behind exposure therapy and feel comfortable with the therapist and trust the treatment methodology before exposure sessions begin. It may be helpful for the Cognitive Behavioral Therapist (CBT) to assign reading material to the client to help him prepare for the exposure therapy sessions.

Exposure Therapy for the treatment of anxiety may be done “in vivo” (in real life) or imaginally. In vivo exposure involves presenting the client with the feared stimulus gradually. For example, if a client has a dog phobia he will be gradually exposed to a real dog. An agile exposure is used instead of in vivo exposure when in vivo exposure is impossible. While in vivo exposure is preferable to imaginal exposure, and magical exposure has also been shown to effectively alleviate anxiety disorders. During imaginal exposure, the therapist has the client closed his eyes in the session and imagine the situation or stimulus that is feared. The therapist takes anxiety ratings from the client throughout the exposure sessions until anxiety has substantially decreased.

It is important for a Cognitive Behavioral Therapist (CBT) to first devise a fear hierarchy. A fear hierarchy is a list of feared stimulus starting from the least feared in going to the most feared item. Cognitive Behavioral Therapist (CBT) may document a client’s level of anxiety by something called a Subjective Units of Distrusts Scale (SUDS). A SUDS scale ranges from 0 to 10, with 10 being the highest level of anxiety and zero being no anxiety. It is important for a Cognitive Behavioral Therapist (CBT) to assess the clients SUDS rating at each step during exposure sessions, to ensure that anxiety is properly decreasing.

Exposure therapy should be done alone, not in conjunction with relaxation techniques. If deep breathing or relaxation is paired with exposure, these techniques may become safety behaviors for an anxious client and the client may not have the confidence to cope with the feared stimulus without the techniques. It is the goal in Cognitive Behavioral Therapy (CBT) to have the client be faced with the feared stimulus without experiencing anxiety and not engaging in a safety behavior.

During exposure therapy, a Cognitive Behavioral Therapist (CBT) may notice that the client’s SUDS rating is not decreasing. It is important for that anxiety reading to not only decrease with in an exposer session, but also between sessions. This means that it’s if a client began an exposure session at a level 8, they should begin the following exposure session at a level less than eight. If the anxiety level is not decreasing, this may be because exposure sessions are too short. Exposure sessions should last until the anxiety level is added zero, or at most a 2. It is often necessary for an exposure therapy session to last longer than one hour. Client should be informed of this beforehand, to make adjustments to their schedule. Double sessions may be used in the beginning of exposure therapy to give ample time to complete the session until anxiety levels are low.


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