What is cognitive-behavioral therapy?

Cognitive-behavioral therapy helps you change how you feel by helping you change how you think and react. Just like a negative conversation with a friend can leave you feeling down, what you say to yourself affects how you feel. When you're not aware of what you're saying to yourself, thoughts can go around and around in your head and can lead to depression or anxiety. CBT helps you:

• Change your thoughts, beliefs, ideas, attitudes, assumptions, mental imagery, and what you pay attention to. This is the cognitive, or thinking, part of CBT.
• Face the challenges in your life calmly, and then take actions that are likely to have good results. This is the behavioral, or action, part of CBT.

Cognitive-behavioral therapy is powerful. It can help you feel better without using medicine. It can also be used along with medicine. CBT can help with:

• anxiety
• depression
• eating disorders
• obsessive-compulsive disorder
• panic attacks
• phobias
• post-traumatic stress
• problems with relationships, family, work, and school
• self-esteem.

How does CBT work?

At the start of cognitive-behavioral therapy, you learn to look for patterns in your thinking. Specifically, you look for patterns of distorted thoughts. Normally, you don't spend a lot of time looking at your own thoughts. So it takes some effort to start paying closer attention to what you're thinking. For example, if you don't trust other people, you might have thoughts like:

"Everyone is out to get me." "People just want to take advantage of me whenever they can."

These thoughts are automatic because they have become habits of thinking. You don't have to make an effort to think them. They are old familiar messages that you give yourself. These thoughts are said to be "distorted" because they are not based on what's really out there. Rather, they are based on old beliefs left over from a bad experience. They can also come from negative messages that you got from other people in the past. These distorted thoughts can seem like a tape playing in your head. It is important to track down these thoughts. It is also important to notice how these thoughts make you feel.

The next part of cognitive-behavioral therapy involves learning to change these distorted thoughts. This process involves learning to argue with your own distorted thoughts. You can also learn to replace them with healthier or more accurate thoughts. The end result is a change in how you feel.

For example, you may find yourself thinking repeatedly that "Everybody hates me." You then notice that you feel sad after thinking this thought. This results in low self-esteem. During cognitive-behavioral therapy, you would learn to change or argue with "Everybody hates me." You might think to yourself, "Well, I do have at least 4 friends, so some people do like me." After thinking this new thought, you might feel hopeful. The new result is higher self-esteem.

You will also learn new skills, such as taking part in activities that you may have been avoiding, decreasing bad habits, learning new interpersonal skills, and improving stress management skills at work or at home.

What happens during a typical therapy session?

One of the first things your therapist will do is to find out how you've been feeling and what has changed since your last session.

The therapist will ask you what problem you'd like to work on during the current session.

Next, you and the therapist will discuss the problem or problems you identified. You will check the accuracy of your thoughts and beliefs and come up with ideas for problem-solving.

You and the therapist will discuss how you can make best use of what you've learned in your everyday life (between sessions). The therapist will summarize the important points of the session and ask you for feedback.

What are the benefits?

Cognitive-behavioral therapy is different from other kinds of therapy in several ways. It is:

• Results-oriented. It will help you define your goals, plan ways to accomplish those goals, and check your progress.
• Short-term. Depending on the nature of your problem and how hard you work to change your thoughts and behaviors, goals can usually be achieved in less than 20 sessions.
• Self-help oriented. CBT focuses on helping you learn ways to manage your life better.

How do I find a therapist who can do this therapy?

Therapists who do CBT usually include this information in their advertising. If a friend or co-worker recommends a therapist to you, don't hesitate to ask the therapist about the type of therapy they do. You can also check with your local associations of psychologists, social workers, or counselors for recommendations.

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