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Cognitive behavioral therapy, or cognitive therapy, helps us recognize the distorted thoughts and beliefs that cause us pain and replace them with those that help us feel and function better. The way we perceive situations influences how we feel emotionally. Working with a therapist, we can use it to learn to deal with our emotions, relate to others in different ways and solve problems.

Working with a cognitive behavioral therapist, we can learn self-help skills that we can use for the rest of our lives. This type of psychotherapy has been found in hundreds of studies to be effective for many types of disorders. Most people notice an improvement within just a few weeks of participation.

Who can benefit from cognitive behavioral therapy?
Cognitive behavioral therapy is the most widely tested form of psychotherapy for depression and anxiety disorders and is helpful for people dealing with anger, marital conflict, loneliness, fears and substance abuse.

Those living with anxiety disorders can use cognitive therapy to learn to identify and confront their fears, modify their thinking and decrease stress.

Individuals with bipolar disorder can use it to help them understand their illness, deal with painful feelings, resolve family conflicts, gain better control over impulses and moods, and make good decisions. Individuals can learn techniques to help reduce self-criticism, withdrawal, and lack of interest in activities.

Studies have consistently shown that most people who are struggling with depression can significantly improve with cognitive therapy. Working with a cognitive behavioral therapist, they can learn to understand the distortions in thinking and behavior that can contribute to depression

How does it work?
Your therapist will begin by helping you identify the thoughts, feelings and behaviors you are having now. You will be asked to fill out forms to help determine what areas you want to work on. You will set goals about changes you'd like to make at work, at home, in your relationships with family, friends, coworkers, and others.

You will be an active participant in the process. You may complete worksheets and reading at home to help you practice new skills. Research shows that the more you practice new skills outside of the sessions, the more effective the therapy.

Your therapist will do a "check-in" with you to find out how you are feeling this week, what happened since the last session and what you'd like to focus on this week. Your therapist will help you evaluate the accuracy of your thoughts and beliefs in specific situations and work with you on problem-solving.

With your therapist, you will learn to identify distortions and biases in thinking and how to change this thinking. Cognitive-behavioral therapy is action-oriented, practical, rational, and helps the patient gain independence and effectiveness in dealing with real-life issues.

Together, Beth and Laura worked out strategies for action Beth could take. She could talk to her boss about what changes he would like to see in the way she did her job. She could track how often he criticized her and why, and notice whether he was the same with other employees. This could tell her how much of it was really about her. She could decide that she wanted to make a change and begin looking for a new job while she still had this one.

How long will I be in therapy?
Some patients remain in therapy for a short time, six to eight sessions. Other patients who have had long-standing problems may choose to stay in therapy for several months.

What about medications?
Cognitive-behavior therapy may be used with medication for anxiety disorders as you and your doctor decide best. Research indicates that people taking medication for bipolar disorder will do best with a combination of medication and cognitive behavioral therapy. Many people living with depression who participate in cognitive behavioral therapy find they do not need to take antidepressants. Depending upon the severity of your illness or problem, you might want to use medications to help you become more stable and able to participate fully in therapy.

Cognitive-behavioral therapy resources

Find a certified cognitive therapist

• Academy of Cognitive Therapy (ACT)
• Association for Behavioral and Cognitive Therapies

CBT computer-assisted educational programs
Computer-assisted CBT programs may be right for you if: you cannot locate a CBT therapist, cannot afford therapy, or are unwilling to attend. Several studies have found that computer-assisted cognitive therapy can be just as effective as traditional therapy IF the participant is willing to be an active participant.

• The MoodGYM is a free, interactive online CBT program produced by Centre for Mental Health Research (CMHR) at the Australian National University.
• Good Days Ahead: an interactive program for depression and anxiety is a DVD-ROM program written by leading CBT experts. It can be purchased through MindStreet for $99.

Related articles
Symptoms of depression
Anxiety or anxiety disorder?
Choosing a therapist

Sources
The Beck Institute
The American Institute for Cognitive Therapy

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