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DigitalBlue's avatar

How does cognitive behavioral therapy work?

Asked by DigitalBlue (7072points) December 15th, 2012

I understand the basic concept of behavioral therapy, but how does the process unfold?
I have never done CBT, although it is one of the highest recommended treatments for OCD. I’m looking for a new therapist but (obviously), I’m afraid.
Does it start with talk therapy? How do the exercises increase in frequency and difficulty?

How is CBT different from forcing yourself to ignore your anxiety and push through things? In my life, I’ve always found that pushing myself through my anxiety just leaves me feeling exhausted and depressed. Is CBT more effective than just “facing your fears?”

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14 Answers

Shippy's avatar

Yes it would involve mostly talking and thinking. Thinking as in your own thinking and subsequent perception. This works well with distorted perceptions as a result of distorted thinking. I think I would also choose CBT as a therapy. Since many of my feelings which are very negative, originate in my thinking.

DigitalBlue's avatar

@Shippy my big concern is that it will move too fast, but I am assuming that a (good) therapist will be conscious of my apprehension…. right? Clearly it doesn’t work if I don’t ever relax and do it, but, I’m just nervous that there will be too much pressure to jump out of my comfort zone at a high rate of speed, haha.

Shippy's avatar

@DigitalBlue A good therapist will take as long as it needs. If you feel rushed in anyway you are still in control. So I would expect you would say so to her/him. I think perhaps you are thinking of ‘Desensitization Therapy’? Which can be used in CBT as a behavior modification technique. (Exposure Therapy). But also used in different therapies if felt as valuable. This is not for everyone. Remember you are entitled to stop any process you feel uncomfortable with. I don’t think desensitization is as popular these days. Because a lot of the issues surrounding any fear is anxiety. So anxiety would be addressed first.

I’ll give you an example. I was terrified of flying, and could not even pass the airport sign without feeling panic. I went through a therapy of type offered by SA Airlines. Which involved learning about airplanes, how they work, how they stay in the air. Understanding bumps and noises in the aircraft.

Also it addressed my anxiety about flying. I was told to rate my anxiety on a level of 10, at any given point. Then to note it, and not do anything about it. Theory being that anxiety does drop on its own eventually. But of course medication is easier. I flew about 23 hours after this. My first one hour flight being the worst. By the time I did the last few hours I felt nothing.

I’m not saying she will do this method, I am just giving you an example of exposure therapy. Which she might not use, she may be opposed to it. But certainly worked for me. It was not comfortable in the beginning at all. But it paid huge dividends in the end. I still am fearful of flying but I know I can do it. I also know my cognition of flying and perception of outcome is distorted.

DigitalBlue's avatar

@Shippy yes, that makes sense. Thank you.

harple's avatar

CBT involves you cognitively adjusting your behaviour, so it’s a process of working out what thought processes you have around [insert personal ‘issue’ here] and then actively working out how to change those thought processes so that your issue no longer has that impact on you.

It involves homework (which is the part I struggled with – the issue for me at the time was feeling like I have too much to do and that I must get it all done, and perfectly at that, so having something extra to do was a bit of a stress factor for me – worth it though).

In my brief experience with CBT, the sessions were spent identifying in what area I had my issue, discussing the thought processes that I was applying, and talking around how to change those thought processes, or more specifically what to change them to. The homework was to apply this in my day to day life, and to keep a thought-record for the process. Oh, and I was given articles to read too.

A helpful website that they directed me to, which gives you a good insight into what it might be like (depending on your therapist of course) can be found here:

poisonedantidote's avatar

(NSFW) In the interest of informing what this question looks like to some people, CBT is an already existing abbreviation for something else.

incendiary_dan's avatar

In my experience, Cognitive Behavioral Therapy (I assume this is what we’re talking about) primarily helps by examining thought processes, how they develop, and allowing the person to attempt to change those patterns of thought.

harple's avatar

@poisonedantidote thank goodness for details then!

DigitalBlue's avatar

@poisonedantidote oh, well, that’s good to know…ha.

wundayatta's avatar

Cbt for ocd is probably more effective than it is for folks with bipolar disorder. They teach you how to persuade yourself that your fears are not real. Not sensible.

Now I was unable to do this. Which made me feel like a failure, and made me more depressed. So it didn’t work for me. I had to give up fighting the depression before I could learn how to fight it. Once I gave up, I was able to take the pressure off myself, which allowed me to fight.

I think this is different from ocd. I could be wrong, but I think ocd is more treatable by cbt. Depression seems more amorphous, whereas ocd has very specific focuses. I think it might be easier to argue with yourself and find it convincing.

Its just a technique. The therapist teaches you. Think of it as a class as much as therapy. The therapists job is to teach you. You don’t have to impress the therapist. You won’t be graded. You don’t have to perform. You do this for yourself, not the teacher.

Crashsequence2012's avatar

I’ve enjoyed Cock and Ball Torture plenty in my past.

It was mild and wasn’t much more than binding my scrotum with rope until my balls were stretched tight and quite distant from my body.
It all becomes incredibly sensitive.
My GF and master would also bind the base of my penis until it was swollen, purple, veiny with an engorged head.
She would sometimes tease that it felt like the cock of another man.

Some men like hooks, needles, suction pumping and saline injection.

Not for me.

Shippy's avatar

@Crashsequence2012 Did you read the question at all?

Crashsequence2012's avatar

Did someone mention CBT?

kitszu's avatar

I don’t know if this is going to make sense but in a general way BT is replacing an undesirable behavior with a neutral or more desirable behavior. You can’t truly take a behavior away if you don’t replace it with something else. But there are different methods of BT for certain conditions.

For OCD, a good therapist would begin by encouraging an examination of your ritual(s), which should lead you to understand where they originate from.

A monster with a face is less intimidating than one without a face, and from the same stand point it’s hard to fight an opponent effectively if you know nothing about them.

From there they will encourage you to “physically” confront your monsters in baby steps or steps as big as you’re willing to take.

OCD and phobias are not the same thing, even though they are both anxiety disorders. They would be addressed in different ways. For example, confronting a phobia of flying might begin by working up the nerve to simply enter an airport. On the other hand if one was OCD about germs and constantly had to wash their hands for 2 minutes before they felt clean, the therapist might suggest them attempting to only wash their hands for one minute and fifty-five seconds.

All BTs are essentially the same though in the fact that you are going to have to “step outside your comfort zone” and continually move away from it to affect the changes you want to. It might feel scary as hell in the beginning but even the very first baby step is going to leave you feeling empowered and more in control. The further forward you move, the easier it gets (this from the voice of experience).

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