CBT is the most suitable therapy for anxiety and panic – 06/19/2023 – Mental Health

CBT, cognitive-behavioral therapy, was developed throughout the 20th century by psychologists and psychiatrists as an alternative for people with depression who did not benefit from the psychoanalysis created by Sigmund Freud (1856-1939).

While psychoanalysis emphasizes the importance of delving into the analyzed subject’s unconscious, cognitive therapy focuses on the need to examine the person’s perception of their experiences.

In general, cognitive scholars rejected psychoanalysis as unscientific and based on theories that were difficult to prove, such as repressed memory.

In the 1960s, the American psychiatrist Aaron Beck (1921-2021), considered the father of cognitive-behavioral therapy, took into account that his patients with depression had automatic and negative thoughts about themselves and others. He proposed that if these thoughts were examined and confronted, the person would be able to recognize that their perception is distorted.

The cognitive therapy developed by Beck made patients feel better in a shorter treatment time than those undergoing psychoanalysis. The psychiatrist was able to demonstrate effectiveness by applying scientific methods to ensure empirical evidence.

In the 1980s, Beck’s cognitive therapy merged with the behavioral theory of the South African psychiatrist Joseph Wolpe (1915-1998), giving rise to cognitive-behavioral therapy and its different strands used today.

Because of its characteristic of examining thoughts and behavior in the face of a situation that causes discomfort, CBT is the first choice of psychotherapy for panic and anxiety disorder indicated by the WHO (World Health Organization).

“At TCC, the psychologist not only seeks to listen to the patient, his story, but also propose behavioral and cognitive changes from his day to day”, says Mariângela Gentil Savoia, psychologist and doctor in clinical psychology from USP (University of São Paulo), coordinator and professor of the specialization course in cognitive-behavioral therapy at Amban do IPq-HCFMUSP (Anxiety Outpatient Clinic of the Institute of Psychiatry of the Faculty of Medicine of USP).

Next, the psychologist explains the indications for CBT and what the patient can expect from the treatment.

What is Cognitive Behavioral Therapy?
Cognitive-behavioral therapy, as it is called, is part of a large umbrella that encompasses several approaches. But basically, what differentiates it from other methods is that CBT is an evidence-based therapy, as it has several controlled studies demonstrating clinical efficacy.

CBT has less relapse compared to pharmacotherapy, for example. It is a brief process and the application of the techniques is not complicated, they are well learned questions.

The empirical bases date back to the beginning of the 20th century. Studies with animals begin with the Russian physiologist Ivan Pavlov (1849-1936), in 1904, later developing with behaviorism, with the American psychologists John B. Watson (1878-1958) and with Burrhus Frederic Skinner (1904-1990). But psychotherapy itself began in the 1950s with the South African psychiatrist Joseph Wolpe (1915-1998), who introduced systematic desensitization and assertiveness training.

One aspect that differentiates cognitive-behavioral therapy, which comes from the behavior analysis part of the 1960s and 1970s, is the practice of a psychotherapeutic help that is based on a philosophy and a science of behavior, which are characterized by the naturalistic conception and determinism of human behavior.

This means that human beings are part of nature. He is a being of nature and, as such, his behavior is determined by the contingencies of nature. That nature can be family, friends, the environment that surrounds you.

So the TCC starts with this environmental issue, going through a cognitive issue. Then there is the contextualist question, in which the context in which people develop is what determines their behavior.

For example, if a person is born with the same genetic endowment, but is raised by different families, he develops different values, beliefs, ways of dealing with the world, according to the family and the environment in which he lives.

An important characteristic of CBT is that it is considered by the WHO (World Health Organization) as the most indicated therapy for virtually all mental disorders.

It is the first choice of psychotherapy for patients with panic and anxiety disorder by the WHO. The American Psychological Association (APA) also advocates CBT treatments for some mental disorders, CBT is considered the first choice for all anxiety disorders, depression, schizophrenia, drug abuse, among others.

CBT encompasses acceptance and commitment therapy (Act), compassion-focused therapy, dialectical behavior therapy, Beckian therapy, behavior therapy or behavior-analytic therapy, schema therapy.

All the therapeutic processes that are within that big umbrella of CBT use techniques to help the patient to know himself, to know his limits, to change his behavior, to control anxiety, it can be through breathing techniques or distraction, meditation.

The psychologist teaches these techniques not with the aim of the patient eliminating anxiety from his life, but so that he learns to live with it and deal with crises in time, at the moment, the way they appear.

What happens during a CBT session? What can the patient expect from this approach?
What happens in the CBT session is often what happens in therapy sessions. There is a lot of verbal behavior, there is observation of the patient’s behavior by the therapist, there is the interaction between the two, the therapeutic relationship.

Depending on the CBT approach, you can expect some exercises, some training in some skills, whether it’s a social skill, whether it’s a relaxation skill, or reporting feelings. So we do training and behavioral rehearsals sometimes. The idea of ​​CBT is also to work within therapeutic insight.

In CBT, the psychologist not only seeks to listen to the patient, their story, but also propose behavioral and cognitive changes based on their daily lives. The proposal is to ensure that some issues that are bothering are evaluated and discussed and the contingencies discovered.

For example, a school difficulty that the child is facing. Is it a school issue, is it a matter of the relationship with colleagues, is it a matter of intellectual deficit? In the therapeutic process, we assess what are the causes of the problem that the patient presents.

In a patient with OCD (obsessive-compulsive disorder), we will assess which situations trigger this OCD and how the person can better deal with its effects.

Is it common for the psychologist to assign “homework”, with exercises for the patient to do during the week?
Yes, it is common to give homework to do in the week, because the idea is that behavioral and cognitive changes can only happen during the day-to-day process. If you only go to therapy for one hour a week, it’s very difficult for you to make a major change. It’s important for you to change from day to day.

Homework usually proposes that the patient observe what and how he is dealing with situations that are challenging for him. They may also include breathing exercises, mindfulness techniques, relaxation training, social skills training, exposure to fears. Sometimes, it is indicated that the patient is accompanied by a TA, who is a therapeutic companion, to help him do some things that may be more difficult, such as attending environments with many people.

Is it true that CBT is the only therapeutic approach that has scientific evidence for patients suffering from panic disorder or specific phobias?
Yes, it’s true that the only therapy that has scientific evidence for panic disorder, phobias, social anxiety, for all anxiety disorders. In addition to the WHO, CBT is recommended by the NICE (National Institute for Health and Care Excellence) guidelines, from England, and by the APA division 12, which provides an online guide on evidence-based psychological practices.

Just as scientists do drug research to see which drug is best for a given illness, CBT investigates what is the best approach for the patient to deal with certain issues.

Cognitive-behavioral therapy works a lot with specific issues, such as phobias, but also with self-knowledge. WHO indicates treatments that have proven effective to work with a specific demand. Due to investigations carried out by CBT researchers, a consensus has been reached that it is best suited for dealing with various psychiatric disorders and best suited for developing skills such as social and problem-solving skills.

How long do I need to do cognitive behavioral therapy?
It is recommended to do sessions that last about an hour, once a week. Depending on the case, you can do it twice a week. But the most common is once a week. Sometimes, we change it to every fortnight and space it out until the patient achieves full autonomy.

The objective of CBT is for the patient to have autonomy over his behavior, his life, and for him to be able to deal with his issues alone, accepting those that cannot be modified and making changes in those that can be modified.

It does not have a fixed duration. It depends a lot on the interaction, on the purpose, on the therapeutic objectives. Depending on the case, the patient can be discharged in six months, others can take a year, and others need to do it for years or throughout their lives.

Is there a moment when the patient, not having the desired evolution, should try another approach?
I think this is an important point in the therapeutic process of CBT, because the responsibility is shared. Both the therapist and the patient are responsible for the evolution of the process. So, many times, when the patient is not evolving, the therapist must evaluate how to make this change and if it is an issue that he is not dealing with. This is an important point of CBT, the therapist must always be evaluating the process.

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