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Social Anxiety Help is a founding regional clinic of the National Social Anxiety Center (NSAC): nationalsacenter.com


Cognitive Behavioral Therapy - Does it work?

Does it work?

Probably. Studies show that cognitive behavioral therapy (CBT) is one of the best forms of psychotherapy
or "talking treatment" for anxiety disorder. But we don't know whether cognitive behavioral therapy works better than drugs. CBT works well for children and teenagers with anxiety disorder.

What is it?

If you have psychotherapy, you'll discuss your problems with a specially trained therapist. There are many different types of psychotherapy.

Cognitive behavioral therapy is based on the idea that your anxiety happens because you have unreasonably negative thoughts about yourself and the world. During a course of cognitive behavioral therapy, you learn how to replace negative thoughts with positive ones.1 2 3

Your therapist could be a psychologist , a psychiatrist, a psychiatric nurse or a psychotherapist. In some parts of the United States, however, there may be a shortage of therapists trained in cognitive behavioral therapy.

Cognitive behavioral therapy works faster than other kinds of psychotherapy. You see a therapist every week for several months. Most people have about 16 sessions with their therapist, but you can go for longer if you need to. Cognitive behavioral therapy is not an easy option. You may find it quite upsetting to talk to someone about why you have anxiety disorder.

Your doctor may recommend that you have cognitive behavioral therapy and drug treatment at the same time. But we don't know whether this works better than having only cognitive behavioral therapy or only drugs.

How can it help?

Cognitive behavioral therapy can help improve symptoms in people with anxiety. 4 5 6 7 8 9 10 Some studies found it works well for more than half of people with anxiety disorder. 4 11 That's better than some other psychological treatments such as anxiety management training or nondirective counseling. 11

Cognitive behavioral therapy works in different ways for different people.

For you, getting better could mean feeling calmer, worrying about fewer things or simply being able to answer the telephone again. It could also mean sleeping better, getting rid of headaches or having more energy.

We know that cognitive behavioral therapy eases symptoms in the short term, but we don't know how well it works in the long term. Most of the studies we found lasted less than one year, though one small study showed that people who took part in group cognitive behavioral therapy sessions were less anxious for two years after treatment. 5

Applied relaxation may work just as well as cognitive behavioral therapy. 2 6 7 But we need larger studies to be certain.

When researchers asked people how they felt about cognitive behavioral therapy, here's what they said. 4

  • "I learned better ways of tackling difficult situations."
  • "It was reassuring to talk about my problems."
  • "I learned new ways of looking at problems."
  • "I learned that I was able to cope."
  • "I was able to talk to my therapist about anything."
Studies of children and teenagers with anxiety disorders found cognitive behaviour therapy works better than no treatment. 12 13 14 15 In one study, almost half the children who had CBT were better after treatment. 16 In another study, almost 8 in 10 children got rid of anxiety disorder during treatment. 15

Some children are treated alone, and some in groups with their family. We're not sure which works best. In one study, children who had CBT alone got better faster than children who had family CBT. But we need more research to be sure about this. 17

Why should it work?

Researchers think that anxiety disorder is linked to the way we think about ourselves and the world. If we can change the way we think, then we can control our anxiety. Doing this can also help us change the way we behave, so that we can do the things we need and want to do. 3

Cognitive behavioral therapy is supposed to be a short, practical treatment. One important goal is to teach you methods for handling anxiety. Then, if your problems come back, you should be able to use those techniques to treat yourself and keep your symptoms under control.

Can it be harmful?

We found no reports of people being harmed by cognitive behavioral therapy.

More about cognitive behavioral therapy

There are several kinds of cognitive behavioral therapy. But in all of them, you and your therapist try to change the way you think . The two of you do this together by: 1 2 3

  • Finding out the thoughts that make you worried and ill : These are sometimes called "automatic thoughts." For example, you might think, "I could crash the car" every time you want to drive. Or you might think, "Someone must have died" every time the phone rings.
  • Figuring out what therapists call your "rules for living" : These are the general assumptions you make about life. You usually form these rules when you are young, and you may not even know you have them. Examples of unhealthy rules might be, "To be happy I have to be perfect," "If I don't go out I can't get hurt" or, "I'm no good at anything."
  • Getting rid of bad rules and bad thoughts so you can replace them with better ones : The first step is to list your bad rules and bad thoughts and ask yourself if they are true. For example, "Do I really have to be perfect to be happy?" or "Am I really no good at anything?"
  • Learning and practicing ways to be more positive : For example, you might learn to change the thought, "My boss thinks I'm hopeless" to, "I must be good at my job. I've never been laid off, my colleagues like me and I always meet my deadlines."
You and your therapist may also work on techniques to change the way you behave . This might mean you enroll in school instead of dropping out, talk to people instead of avoiding them, or go for a drive instead of staying home. Therapy that includes trying to change both the way you think and the way you behave is called cognitive behavioral therapy.

Techniques for changing behavior

There are many ways therapists can help you change your behavior. Your therapist will teach you the ones you need. Here are some examples.

  • Graded exposure is a technique to help you learn to deal with tasks or situations that make you feel anxious. You start small and make changes slowly, one step at a time.
  • Relaxation training helps you get through episodes of anxiety.
  • Assertiveness training helps you gain confidence to do tasks that involve dealing with other people.
  • Target setting. After setting goals you plan how you are going to reach them using small steps.
Each session with a therapist lasts about 50 minutes. At the start of each session, you and your therapist decide what you want to achieve. At the end, your therapist gives you homework. Your homework could be to practice relaxation, make a daily diary of your thoughts or do a simple task. Homework is very important. It means your treatment continues between sessions.

Treatment doesn't end when you stop going to a therapist. Cognitive behavioral therapy is designed to teach you how to help yourself. Then, if old ways of thinking and doing things come back, you can be your own therapist. This is a good approach for people who want to help themselves get better.

A course of cognitive behavioral therapy typically lasts 12 to 24 weeks, but treatment can continue for longer if you need it. It's important that you feel comfortable with your therapist. If you are unhappy with him or her for any reason, go back to your primary care doctor and ask for a referral to a different therapist.

It's also important to finish the course of treatment. Most people do. In studies, more than 9 in 10 people finished their course of cognitive behavioral therapy. 2 4

Treatments For Anxiety Disorder

Treatment Name
Treatment Rating (Do benefits outweigh harms?)
What does it do?
Possible Harms
Cognitive behavioral therapy
Very Likely
This will probably help reduce your anxiety symptoms.
Talk to a doctor or health professional
Antidepressants (imipramine (Tofranil), escitalopram (Lexapro), opipramol, paroxetine (Paxil), sertraline (Zoloft), venlafaxine (Effexor))
Likely
If you have anxiety disorder, some antidepressants can help. But they have side effects, and there are many unanswered questions about this treatment.
  • Agitation
  • Behavior changes
  • Confusion
  • Constipation
  • Depression worsened
  • Diarrhea
  • Dry mouth
  • Irritability
  • Nausea
  • Sexual problems
  • Sleepiness
  • Talking about suicide
  • Thinking about harming self (rare)
  • Thinking about suicide (rare)
  • Upset stomach
  • Weight gain
  • Weight loss
Applied relaxation
Likely
About half the people who learn appllied relaxation feel better at the end of treatment.
Talk to a doctor or health professional
Buspirone (BuSpar)
Likely
Buspirone could help you. But we don't know whether buspirone works any better than other helpful drugs.
  • Diarrhea
  • Dizziness
  • Headache
  • Indigestion
  • Nausea

Hydroxyzine (Atarax, Vistaril)

Likely
These drugs make you feel calm and may make you feel sleepy. Blocking the effect of histamine in your brain makes you feel calm.
  • Headache
  • Increased risk of accident
  • Sleepiness
Pregabalin (Lyrica)
Likely
Pregabalin can help reduce your symptoms of anxiety after about 4 weeks.
  • Dizziness
  • Dry mouth
  • Headache
  • Sleepiness
  • Thinking about harming self (rare)
  • Thinking about suicide (rare)
Antipsychotic drugs (trifluoperazine (Stelazine))
Uncertain
Antipsychotic drugs seem to lessen the effects of dopamine. Researchers don't really know why this helps reduce anxiety.
  • Blurred vision
  • Constipation
  • Dry mouth
  • Serious muscle problems (tardive dyskinesia)
  • Sleepiness
  • Twitching
Benzodiazepines (alprazolam (Xanax), bromazepam, clonazepam (Klonopin), diazepam (Valium), lorazepam (Ativan), mexazolam)
Uncertain
Benzodiazepines can make some people feel less worried and more relaxed. They can also help some patients sleep better. But they have serious side effects.
  • Addiction
  • Birth defects
  • Dizziness
  • Increased risk of accident
  • Memory problems
  • Rebound anxiety
Abecarnil
Needs Further Study
We don't know. There hasn't been enough research on this treatment.
  • Loss of balance
  • Sleepiness
Beta-blockers
Not Yet Rated
-
-
Kava
Not Yet Rated
-
-

Sources for the information in "Cognitive Behavioral Therapy - Does it work?" :

  1. Kaplan HI, Sadock BJ. Concise textbook of clinical psychiatry. 1st edition. Lippincott, Williams and Wilkins, Baltimore, U.S.A.; 1996.
  2. Ost L, Breitholtz E. Applied relaxation vs. cognitive therapy in the treatment of generalized anxiety disorder. Behaviour Research and Therapy. 2000; 38: 777-790.
  3. Andrews G, Creamer M, Crino R, et al. The treatment of anxiety disorders: clinician guides and patient manuals.2nd edition. Cambridge University Press, Cambridge, UK; 2002.
  4. Westen D, Morrison K. A multidimensional meta-analysis of treatments for depression, panic, and generalized anxiety disorder: an empirical examination of the status of empirically supported therapies. Journal of Consulting & Clinical Psychology. 2001; 69: 875-899.
  5. Dugas MJ, Ladouceur R, Leger E, et al. Group cognitive-behavioral therapy for generalized anxiety disorder: treatment outcome and long-term follow-up. Journal of Consulting and Clinical Psychology. 2003; 71: 821-825.
  6. Borkovec TD, Newman MG, Pincus AL, et al. A component analysis of cognitive-behavioral therapy for generalized anxiety disorder and the role of interpersonal problems. Journal of Consulting and Clinical Psychology. 2002; 70: 288-298.
  7. Arntz A.Cognitive therapy versus applied relaxation as treatment of generalized anxiety disorder. Behaviour Research and Therapy. 2003; 41: 633-646.
  8. Linden M, Baer T, Zubraegel D, et al. Effectiveness of cognitive behaviour therapy in generalised anxiety disorders: results of the Berlin CBT GAD study. Verhaltenstherapie. 2002; 12: 173-181 [in German].
  9. Linden M, Zubraegel D, Baer T, et al. Efficacy of cognitive behaviour therapy in generalized anxiety disorders: results of a controlled clinical trial (Berlin CBT-GAD Study). Psychotherapy and Psychosomatics. 2005; 74: 36-42.
  10. Covin R, Ouimet AJ, Seeds PM, et al. A meta-analysis of CBT for pathological worry among clients with GAD. Journal of Anxiety Disorders. 2008; 22: 108-16.
  11. Gould RA, Otto MW, Pollack MH, et al. Cognitive behavioural and pharmacological treatment of generalised anxiety disorder: a preliminary meta-analysis. Behaviour Research and Therapy. 1997; 28: 285-305.
  12. Cartwright-Hatton S, Roberts C, Chitsabesan P, et al. Systematic review of the efficacy of cognitive behaviour therapies for childhood and adolescent anxiety disorders. British Journal of Clinical Psychology. 2004; 43: 421-436.
  13. James A, Soler A, Weatherall R. Cognitive behavioural therapy for anxiety disorders in children and adolescents. In: The Cochrane Library. Wiley, Chichester, UK.
  14. Bernstein GA, Layne AE, Egan EA, et al. School-based interventions for anxious children. Journal of the American Academy of Child & Adolescent Psychiatry. 2005; 44: 1118-1127.
  15. Lyneham HJ, Rapee RM. Evaluation of therapist-supported parent-implemented CBT for anxiety disorders in rural children. Behaviour Research And Therapy. 2006; 44: 1287-1300.
  16. Flannery-Schroeder Ellen C, Kendall, Philip C. Group and individual cognitive-behavioral treatments for youth with anxiety disorders: a randomized clinical trial. Cognitive Therapy and Research 2000; 24: 251-278.
  17. Bodden DH, Bogels SM, Nauta MH, et al. Child versus family cognitive-behavioral therapy in clinically anxious youth: an efficacy and partial effectiveness study. Journal of the American Academy of Child and Adolescent Psychiatry. 2008; 47(12): 1384-94.

Sources for the information in "More about cognitive behavioral therapy":

  1. Kaplan HI, Sadock BJ. Concise textbook of clinical psychiatry.1st edition. Lippincott, Williams and Wilkins, Baltimore, U.S.A.; 1996.
  2. Ost L, Breitholtz E. Applied relaxation vs. cognitive therapy in the treatment of generalized anxiety disorder. Behaviour Research and Therapy. 2000; 38: 777-790.
  3. Andrews G, Creamer M, Crino R, et al. The treatment of anxiety disorders: clinician guides and patient manuals. 2nd edition. Cambridge University Press, Cambridge, UK; 2002.
  4. Durham RC, Fisher PL, Trevling LR, et al. One year follow-up of cognitive therapy, analytic psychotherapy and anxiety management training for generalised anxiety disorder: symptom change, medication usage and attitudes to treatment. Behavioural and Cognitive Psychotherapy. 1999; 27: 19-35.

 

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please email Larry Cohen, LICSW,
with offices in Washington, DC








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