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cbt for specific difficulties

CBT for Specific Difficulties

Cognitive Behavioural Therapy (CBT) is a short-term, skills and solution-focused treatment to change difficult emotional responses by modifying a client’s thoughts and behaviours, or both. CBT is extremely helpful and effective in treating a wide range of mental health issues and specific difficulties.

Find out more about using CBT for anxiety disorders and other specific difficulties below.

Panic

According to the Diagnostic and Statistical Manual (DSM-5), panic disorder is characterised by recurrent, unexpected panic attacks accompanied by worry and behavioural changes in relation to future attacks. Panic attacks are manifested by acute, intense discomfort, with symptoms including heart palpitations, sweating, and shortness of breath. Individuals with panic disorder exhibit cognitive and behavioural symptoms, such as catastrophic misinterpretations of their symptoms as dangerous, for e.g. “my heart pounding means I will have a heart attack”, and avoidance of situations or sensations that induce panic. CBT targets these symptoms. Cognitive restructuring is used to help patients reinterpret their maladaptive thoughts surrounding panic – e.g., “if I get dizzy, I will go crazy” – to be more flexible – “if I get dizzy, it may just mean that I spun around too fast”.

Behavioural treatments for panic include exposure to the situations (in-vivo exposure, which might include driving in traffic) and bodily sensations (interoceptive exposure, which would include physical exercises to bring on physical symptoms) that trigger panic to reduce the fear and anticipatory anxiety that maintain the symptoms. The purpose of these exposures is to demonstrate that the situations and sensations are not threatening and do not suggest danger.

cbt for specific difficulties

Generalised Anxiety

Generalised anxiety disorder is characterised by excessive and uncontrollable worry about several areas of life (finances, career, the future in general). Treatment for generalised anxiety involves an approach to target excessive worry with a combination of cognitive and behavioural strategies. Although cognitive restructuring exercises are emphasised throughout the treatment to target dysfunctional thoughts, usually further cognitive treatments are included to address worry behaviour in addition to thought content. Individuals with general anxiety disorder rarely experience a decrease in anxiety after restructuring only one of their negative thoughts. The CBT conceptualisation of worry describes worry as a mental behaviour or process, characterised by repetitive negative thinking about catastrophic future outcomes.

To target worrying as a process, cognitive techniques, such as mindfulness, are emphasised. Rather than targeting the content of worry (“I think I will definitely lose my job if I make a mistake”), mindfulness exercises target the worry behaviour by promoting the opposite of repetitive negative thinking (non-judgmental and non-reactive, present moment awareness), thereby facilitating greater psychological distance from negative thoughts. Exposure therapy is often implemented as imaginal exposures for generalised anxiety, because individuals with generalised anxiety disorder rarely have an external object that is feared. Such imaginal exposures will encourage patients with general anxiety disorder to write a detailed narrative of their worst-case scenario or catastrophic outcome and then imagine themselves undergoing such an experience without avoiding their emotions. Cognitive restructuring and imaginal exposure exercises can benefit clients with generalised anxiety by targeting their tendency to give catastrophic interpretations to their worries, whereas mindfulness can be helpful in targeting worry as a mental behaviour itself.

Social Anxiety

Social anxiety involves a fear of being negatively judged in social situations. It goes together with anxiety and avoidance of interpersonal interactions and performance in front of others. The key treatment approach for social anxiety disorder consists of exposure exercises to feared social situations. Cognitive restructuring is used in conjunction with exposure exercises to reinforce the new learning and shift in perspective occurring through exposure therapy.

Typically, exposure exercises for social anxiety disorder come in two stages. The first stage of exposure often targets clients’ overestimation that something bad will happen during a social interaction. For instance, clients with this disorder may fear that they will make many verbal mistakes (saying “um” more than 30 times) during a conversation. An exposure exercise may consist of recording the client having a 2-minute conversation and listening to the recording afterward to see whether the feared outcome happened.

The second stage of exposure exercises (social cost exposures) consists of having clients directly making their worst-case social anxiety scenario come true to determine how bad and intolerable it is. A social cost exposure might involve encouraging a client to embarrass themselves on purpose by singing “Baa Baa Black Sheep” on a crowded street. After fully confronting a social situation that the client expected would be very embarrassing, the client can then determine whether such a situation is as overwhelming and intolerable as anticipated. After repeated social cost exposures, clients with social anxiety disorder experience less anxiety in embarrassing social situations and are more willing to have less catastrophic beliefs about the meaning of making mistakes in social situations.

cbt for specific difficulties

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is characterised by obsessions (unwanted thoughts or images that are intrusive) and compulsions (actions or mental behaviours that are performed in a rule-like manner to neutralise the obsession). A CBT conceptualisation of OCD considers compulsions as a form of emotional avoidance. Although both cognitive interventions and exposure exercises are helpful for individuals with OCD, the latter are often emphasised.

The gold-standard CBT treatment for OCD is exposure and ritual prevention therapy. The primary idea underlying exposure and ritual prevention is to expose individuals with OCD to the feared circumstance associated with the obsession and prevent them from performing the compulsive ritual that gives them comfort through avoidance. For example, clients who experience frequent obsessions about whether their doors are locked, or their appliances are off (“If my door is unlocked, then my house might be robbed or something bad might happen.”) will often feel compelled to perform a compulsion (ritualistic checking) to avoid the likelihood of having their obsession come true.

Exposure and ritual prevention would be used to expose such patients to a feared situation, such as leaving their door unlocked on purpose, and resisting the compulsion to check the door or to lock it. During these exposures, the clients would be asked to embrace the uncertainty surrounding the possibility of the feared outcome coming true (someone entering the house). Repeated sessions of exposure and ritual prevention will facilitate corrective learning about the likelihood that feared outcomes will occur.

Post-traumatic Stress

The DSM-5 states that post-traumatic stress disorder (PTSD) can arise after a traumatic event in which an individual directly experiences, witnesses, or learns about the actual or threatened death, serious injury, or sexual violence toward a loved one. After the traumatic stressor event, an individual with PTSD may experience intrusion symptoms (upsetting dreams or flashbacks of the event), avoidance of reminders of the event, changes in cognitions and affect (distorted beliefs about oneself, others, and the world), and changes in physiological arousal (jumpiness, irritability). Gold-standard treatments for PTSD involve targeting the cognitive and behavioural symptoms that maintain the disorder.

PTSD treatments target negative changes in cognition by restructuring the thoughts and beliefs surrounding the traumatic event. For example, evidence-based treatments change persistent negative beliefs about the world (“I was betrayed; therefore, all people cannot be trusted”) to be more flexible (“even though I was betrayed, there are some trustworthy people”). By challenging these beliefs, the client may be better able to think flexibly, have positive affect, trust, and control in their lives. PTSD treatments are also designed to help clients confront the upsetting memories and situations associated with the traumatic event. Through in-vivo exposures (i.e., approaching situations that are reminders of the trauma) and imaginal exposures (confronting upsetting memories of the trauma), the client can begin to behaviourally approach, rather than avoid, reminders of the event to overcome their fears of the trauma and the associated symptoms.

CBT is a helpful, effective, gold-standard treatment for anxiety and stress-related disorders. CBT uses specific techniques to address unhelpful thoughts, feelings, and behaviours shown to cause and maintain anxiety. It can be used as a stand-alone treatment or may be combined with standard medications for the treatment of clients with anxiety disorders or used with innovative interventions (such as mindfulness).

How can I avail of CBT treatment?

CBT for specific difficulties can take place in both face-to-face and online therapy. Our clinicians can use this method in a clinical counselling setting, or from the comfort of your own home. Appointments can be booked in advance, and you can ask about CBT treatment upon booking. If you’re considering CBT and would like to avail of it with a therapist, you can book an appointment with Spectrum Mental Health by emailing us at [email protected] or by ringing us at 01 611 1719.

Written by: Amina Samee, Integrative Counsellor and Psychotherapist, MIAHIP

References:

  1. Kaczkurkin, A. N., and Foa, E. B. (2015). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues in clinical neuroscience17 (3), 337 – 346. https://doi.org/10.31887/DCNS.2015.17.3/akaczkurkin
  2. APA Div. 12 (Society of Clinical Psychology)
  3. Curtiss, J. E., Levine, D. S., Ander, I., & Baker, A. W. (2021). Cognitive-Behavioral Treatments for Anxiety and Stress-Related Disorders. Focus (American Psychiatric Publishing)19(2), 184–189. https://doi.org/10.1176/appi.focus.20200045
  4. Anxiety and Panic: How to reshape your anxious mind and brain. Barry. H. Orion Publishing Group Ltd: London.

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