Welcome to my office

Welcome to my office

An Explanation of CBT

I was recently asked to explain a bit more about Cognitive Behavioral Therapy. A therapist specializing in CBT trains clients on how to learn new ways of thinking and behaving. I mainly treat folks with depression and anxiety. CBT is an effective treatment for these kinds of problems.

As an example, for OCD sufferers, CBT is used to challenge the belief that a compulsion is the only way to reduce the anxiety from an obsession. An obsession is an unwanted, intrusive thought.

When a frightening thought enters the mind of an OCD sufferer, that person will try almost anything to rid themselves of that anxiety.

Any behavior, whether overt (observable to others) such as washing, cleaning, going back to check, or covert (unseen by others because it is only in the sufferer's mind) such as counting, replacing bad thoughts with "good" thoughts, praying, etc. is considered to be a compulsion.

One of the biggest compulsions is avoidance. Well, that bothers me so I will never do that again!

Another is seeking reassurance either from others (everything is going to be okay, right? You don't think I'm really going to get sick if I do this, right?) or reassuring yourself by searching the web for information or telling yourself: No, I would never act that way......I am sure nothing bad will happen....., etc.
The trouble begins when the compulsions start to grow as they almost always will. If 6 months ago, you could wash your hands twice and feel clean and okay to move on, well then 3 months ago, you had to up it to four times, and today, you are washing eight times to get the same relief you had before.

The treatment for an OCD sufferer is to make a hierarchy (list) of fears and rate them as to how much anxiety each creates. We then start with a lower one, and challenge the idea that only a compulsion will reduce anxiety. This is called ERP, exposure/response prevention. The sufferer will deliberately do the activity that he or she has been avoiding or performing rituals to get through, without doing the compulsion.

Yes, anxiety will rise, as this person has trained his or her brain to believe that the only way to reduce anxiety is through performing compulsions.

But God has not designed our bodies to experience high anxiety for long periods of time; it isn't biologically possible. So while there will be a spike, anxiety will go down without doing the compulsion. It's like a science experiment in grade school, testing the hypothesis.

Based on the success of the lower anxiety producing behaviors, the OCD sufferer will then progress to higher ones. This method is the only evidence based treatment proven to work to manage OCD. Often medications, usually SSRI's, are prescribed and added to help with therapy, but this is not necessary.

So that is the basis for ERP, a type of CBT for your OCD. (smile) all those letters..........
Please email me if you have further questions or if you would like to come in for an evaluation. Other folks have had great success in managing depression, anxiety and other issues that come up in life. There's no reason for you not to try if you are also suffering. God bless you.

And this is the single best article I have ever read on OCD. It's by Dr. Fred Penzel: