Dear Dr. Goldberg,
My general practitioner suggested that I consider trying “CBT” before taking medication for my anxiety. What is “CBT” and what types of symptoms does it treat? What makes CBT so different from the various therapies that I’ve tried in the past? I’m really reluctant to take medication, so any information that you can give me would be really helpful. Thank you.
This is one I hear often, so I’m glad you brought up the question. The term “CBT” stands for Cognitive Behavioral Therapy, a specific type of psychotherapy that focuses on the relationship between thoughts, feelings, and behaviors. Whereas “traditional” therapy works to understand the inner, often older and unconscious, conflicts that underlie the formation of psychiatric symptoms, CBT endeavors to challenge and modify the present thoughts and behaviors that perpetuate anxiety, depression, and other mental health conditions. As the stoic philosopher Epictetus once wrote, “men are disturbed not by things, but by the view which they take of them.” The premise of CBT is that our perceptions of ourselves, our future, and the world around us influence our emotions, and that these emotions, in turn, influence our actions. Let me provide some illustration:
A man suffering from social anxiety thinks to himself on a near-daily basis, “if people see me blushing they’ll think that I’m weak and pathetic.” This thought creates great turmoil and discomfort whenever he is called upon to speak in public or participate in groups. As a consequence, he avoids these types of activities like the plague, making excuses whenever they come around. Maybe he calls in sick to work when asked to present, or tells his friends when they invite him out that he has other plans. Really he’s sitting at home alone. This behavior leads to greater and greater anxiety because nothing has come along to invalidate these beliefs. He continues to assume that blushing is an indication of weakness and that others will judge him for it. His life becomes a series of avoidances. On the occasion that he is surprised by a chance social encounter, he gets through the moment with excruciating discomfort, waiting for the first opportunity to escape. The whole time he keeps telling himself, “just don’t blush, just don’t blush…”
As you can see from this example, our thoughts greatly dictate our level of discomfort, whether it be anxiety, depression, or various other psychiatric conditions. The man in the vignette above never stops to question whether his blushing actually indicates weakness to others; and yet, he invests a tremendous amount of emotion in this belief. But what if this is a fruitless investment? CBT helps individuals challenge the validity of their negative beliefs through direct guidance, thoughtful questioning, and helpful outside exercises. As I often frame it for my patients, CBT helps redefine the old operating system that people use to interpret their experiences and installs new software that has greater relevance in their current lives. In doing so, individuals can change the patterns of behavior that ultimately perpetuate their symptoms and limit their full experience of life.
Although cognitive behavioral therapy has been found to be as effective as psychotropic medications for the treatment of anxiety and depression, the combination of CBT and medications produces the best results. Without knowing your history, or the extent of your symptoms, I cannot advise you regarding the choice of CBT versus medication. However, I encourage you to contact a psychiatrist to discuss the pros and cons of both treatment approaches. I can tell you from my experience, and from the vast clinical data available, that CBT is a tremendously effective option and should be seriously considered whether you decide to pursue medication or not.
I wish you the best moving forward!
- Dr. Goldberg