Cognitive Behavior Therapy and Exposure Therapy

Cognitive Behavior Therapy

Cognitive Behavior Therapy is an evidence-based treatment designed to target individuals’ unhelpful ways of thinking and behaving with the goal of improving individuals’ relationships with emotions and increasing overall functioning. The basis of CBT is that the way a person thinks, feels, and acts are all inter-connected and each can influence one another. CBT has been proven to be effective in the treatment of depression, anxiety disorders and specific phobias, eating disorders, and substance use disorders. 

CBT theory assumes that unhelpful thought patterns, or cognitive distortions, can result in an individual feeling worse and acting in ways that are maladaptive. As a result, an individual receiving CBT would learn to notice and change cognitions from negative to neutral or positive. This in turn would ideally result in a shift in mood and behavior in a healthier, positive direction. 

Similarly, those who are working in a CBT framework may notice unhelpful patterns of behavior, and upon altering the pattern to align better with individual values and goals, they would ideally start to notice changes to thoughts and feelings. The consistent focus on cognitions and behaviors over time leads to positive change emotionally. 

My Approach

I am trained in CBT for all ages, with specific training in CBT for eating disorders (CBT-e) and depressive disorders. 

I currently use CBT to treat children, preadolescents, adolescents, young adults, and their families who may not need standard DBT or RO DBT treatment. However, I will often integrate elements of DBT, RO DBT, and exposure therapy into my CBT work. I rely on my CBT training for individuals who struggle with issues such as depression, social anxiety, generalized anxiety, phobias, disordered eating, and OCD. Treatment consists of:

• A consultation or evaluation to determine goodness of fit for the treatment

• Individual treatment, usually 45 minutes weekly where patients work towards specific goals using skills and strategies 

• Separate parent consultation as needed 

Individual therapy utilizing a CBT Framework can Include:

• Helping patients to identify and track maladaptive behaviors and thoughts, with the goal of altering them over time based on individual goals 

  • This can include learning and practicing behavioral activation and utilizing cognitive restructuring 

• Role playing/practicing of behavioral and cognitive change

• Learning/practicing relaxation strategies and coping skills to navigate negative thinking and problematic behavior

• Working on building patient confidence

• Teaching problem solving skills to navigate stressors

• Utilizing exposure techniques, which helps patients to approach and tolerate their negative emotions 

• Teaching patients and their families if necessary to reinforce/reward adaptive behavior change and efforts to restructure cognitions

Exposure Therapy:

Exposure therapy is a treatment that can be used in conjunction with CBT, DBT, or RO DBT, or may be used as a standalone treatment. It is often used in the treatment of panic disorder, specific phobias, social anxiety disorder, obsessive-compulsive disorder (OCD), generalized anxiety disorder, and post-traumatic stress disorder (PTSD).  The goal of exposure therapy is to help patients approach and tolerate the emotions that they are avoiding. Often, individuals will avoid feeling aversive emotions because they are fearful, it is uncomfortable, and/or there is a lack of confidence in the ability to handle the emotion. 

Patients who are receiving exposure therapy will gain an understanding of the behaviors and thoughts that are maintaining avoidance, along with the emotions that are being avoided. With the help of the clinician, patients over time approach previously avoided stimuli and learn to tolerate the emotions they hadn’t been allowing themselves to feel. This results in patients either habituating to/tolerating the emotion when it emerges, or the learned associations between the emotion and certain situations, behaviors, objects weakens or extinguishes the emotion. Over time, individuals who engage in consistent exposure practices become more confident, feel a sense of self-efficacy, and have an increased ability to process emotions. 

My Approach:

I am trained in exposure therapy for all ages, with specific training in exposure therapy for panic disorder, social anxiety disorder, specific phobias, OCD, and generalized anxiety disorder. I will often integrate elements of DBT, RO DBT, and CBT into my exposure work. Treatment consists of:

• A consultation or evaluation to determine goodness of fit for the treatment

• Weekly individual treatment where patients spend 45 minutes or longer per session engaging in behaviors and thought patterns that ultimately expose the avoided emotion or stimuli

• Separate parent consultation as needed 

Individual therapy utilizing an exposure-based framework can Include:

• In vivo exposure- directly facing a previously avoided situation, object, or activity in real life

• Thought exposure- exposing patients to the thoughts that might be contributing to their emotional avoidance

• Imaginal exposure- vividly imagining the avoided situation, object, or activity

• The development of a ladder or hierarchy, where patients can evaluate the intensity of their discomfort for various thoughts, situations, objects, activities

  • This serves as a road map for exposure work and helps remind patients that the therapeutic process is collaborative and that they have have control in the exposure process

• Generation of coping statements and skills to use when exposure work becomes distressing

• Interoceptive exposure- mostly used in the treatment of panic disorder or when emotional avoidance results in the manifestation of physical symptoms. Patients are exposed to physical sensations tied to avoidance that are harmless yet uncomfortable. Examples include:

  • Dizziness

  • Shortness of breath

  • Rapid heart rate

• Practicing exposures in between sessions

• Teaching patients and their families if necessary to reinforce/reward adaptive approaching

• For OCD exposure work, patients learn response prevention, which is the practice of refraining from a compulsive behavior that serves to regulate the intensity of a thought, feeling, or image. Response prevention allows for greater exposure to the uncomfortable obsession. 

  • The name of the exposure treatment for OCD is called Exposure and Response Prevention (ERP)

For more information on CBT and exposure therapy, click here or here.