CBT Therapy

In this episode, Wendy takes a look at Cognitive-Behavioral Therapy or CBT.

## Be sure to check out Wendy's novel Involuntary Hold. It's a realistic view of the psychiatric ward from the patient's perspective... with a twist! It is now available on Amazon and Audible! ##



International Info

 For those living outside the United States, I finally found some helpful information. The International Association for Suicide Prevention has a directory of crisis centers and helplines for over 50 countries! 

Just got to the internet and type in:

      findahelpline.com/i/iasp

 And it will bring you to a drop-down menu where you can input your country and region, and it will give you the information for your location. Granted, it doesn’t cover everywhere, but it’s a start!

** Remember if you, or a loved one, is in emotional crisis... Help is just a phone call away. Simply dial 9-8-8 for the Suicide and Crisis Hotline, or text "HOME" to 741741 to chat with someone via text 24/7 across the United States. **

Please contact us at bipolarforlife@myyahoo.com with any questions, suggestions, or comments.

Transcript

Bipolar for Life
Ep 5/S2-CBT Therapy

 Good evening and welcome to “Bipolar for Life.” I’m your host, Wendy Foard, and I’ve managed to live with bipolar disorder for 44 years now. It hasn’t always been pretty, but I’ve survived several suicide attempts, four psychiatric hospitalizations, and one disastrous trip to rehab. Yet, I’m still here!

Let me say up front that I am NOT a medical doctor. I am simply a seasoned manic-depressive trying to help others survive this deadly mental illness through shared information and experiences.  

As we discuss issues, please remember that I am speaking from my own experience; your bipolar experiences may be entirely different. Yet, I suspect highly that we have more in common than not. 

Tonight, I thought we’d continue our investigations into the different types of therapy, and discuss cognitive-behavioral therapy, or CBT. It’s what I think of when anyone says “therapy.”

Cognitive-behavioral therapy is a structured, goal-oriented type of talk therapy, or psychotherapy. Mental health professionals, including psychologists, therapists, and counselors, use it to manage mental health conditions and emotional concerns. It’s one of the most common and best-studied forms of psychotherapy. 

The creator of CBT was Dr. Aaron Beck, a psychiatrist at the University of Pennsylvania. In the 1960s, Dr. Beck was practicing psychoanalysis and came to realize that the approach was failing to treat his depressed patients—entrenched negative thoughts were preventing them from overcoming the disorder. So, he developed cognitive-behavioral therapy, rooted in the philosophy of Albert Ellis’s rational emotive behavioral therapy, to change harmful patterns of “emotional reasoning” and spark genuine change.  

Psycho-analytic and psycho-dynamic therapy, as well as many other approaches, center around exploring the past to gather understanding and insight. CBT is unique because it focuses on the present. What are you thinking right now? What were you thinking when you became anxious? Are there any harmful patterns that emerge?

The goal is to understand what happens in your mind and body in the present, to change how you respond.

Cognitive-behavioral therapy is based on several core principles, including:

·       Psychological issues are partly based on problematic or unhelpful patterns of thinking.

·     Psychological issues are partly based on learned patterns of unhelpful behavior.

·     Psychological issues are partly based on problematic core beliefs, including central ideas about yourself and the world.

·     People experiencing psychological issues can learn better ways of coping with them. This can help relieve their symptoms and improve their mental and emotional health.

During CBT, a mental health professional helps you take a closer look at your thoughts and emotions. You’ll come to understand how your thoughts affect your actions. Through CBT, you can unlearn negative thoughts and behaviors, and learn to adopt healthier thinking patterns and habits.

CBT usually takes place over a limited number of sessions. Using a question-and-answer format, your therapist helps you gain a different perspective. As a result, you learn to respond better to stress, pain, and difficult situations. 

CBT can be used alone or along with medication and other therapies. Your therapist will customize your treatment based on the issues you’re addressing. 

Cognitive-behavioral therapy is a valuable tool for treating and managing a wide range of mental health conditions and emotional challenges. People of all ages (including children) can receive CBT. Therapists and psychologists use CBT to treat many mental health conditions including:

·     Depression

·     Anxiety

·     Obsessive-compulsive disorder (OCD)

·     Sleep disorders

·     Post-traumatic stress disorder (PTSD)

·     Eating disorders; including bulimia, anorexia, or binge eating disorder

·     Substance use disorder and alcohol use disorder

·     Sexual disorders

·     Attention-deficit/hyperactivity disorder (ADHD)

·     Phobias

·     And personality disorders

When combined with medication, CBT is useful in treating bipolar disorder and schizophrenia. 

Studies have shown that CBT is also effective in helping manage non-psychological medical conditions, such as

·     Insomnia

·     Fibromyalgia and other causes of chronic pain

·     Chronic fatigue syndrome

·     Migraines, and

·     Irritable bowel syndrome (IBS)

CBT can help people work through everyday challenges, too. You might seek help for issues such as 

·     Relationship issues

·     Divorce

·     Problems at work

·     Grief

·     Adjusting to a new life situation or medical condition

·     Stress and coping difficulties

A therapist can be a psychologist, a psychiatrist (someone who is a medical doctor and can prescribe medications), a psychiatric nurse, a social worker, a family therapist, or other licensed professionals with mental health training.

Finding the right therapist is often a time-consuming task. Try not to become discouraged. Talk to people you trust to give you a referral for a therapist who uses cognitive-behavioral therapy, whether it’s your primary healthcare provider, a friend, or a family member. You can also search for therapists online through state and local psychological associations. IF, they are available in your area. 

Be sure that any therapist you’re interested in seeing is a state-certified and licensed mental health professional, and that they treat your area of concern (for example, depression, eating disorders, substance use disorders, etc.)

Before seeing a psychotherapist, be sure to check his or her:

·     Background and education. Trained psychotherapists can have a number of different job titles, depending on their education and role. Most have a Master’s or Doctoral degree with specific training in psychological counseling. Psychiatrists can prescribe medications as well as provide psychotherapy.

·     Certification and licensing. Make sure that the therapist you choose meets state certification and licensing requirements for his or her particular discipline.

·     Area of expertise. Ask whether the therapist has expertise and experience treating your symptoms or your area of concern, such as PTSD or eating disorders.

The key is to find a skilled therapist who can match the type and intensity of therapy with your needs.

Most therapist’s websites list the conditions and problems they treat. If you have any questions, be sure to call or email their office before you choose. 

CBT is a useful tool for addressing emotional challenges. For example, it may help you:

·     Manage symptoms of a mental illness

·     Prevent a relapse of mental illness symptoms

·     Treat mental illness when medications aren’t a good option

·     Learn techniques for coping with stressful life situations

·     Identify ways to manage emotions

·     Resolve relationship conflicts and learn better ways to communicate

·     Cope with grief or loss

·     Overcome emotional trauma related to abuse or violence

·     Cope with a medical illness, or

·     Manage chronic physical symptoms.

Cognitive-behavioral therapy may be done one-on-one or in groups, with family members or with people who have similar issues. Online resources are available that may make participating in CBT possible, especially if you live in an area with few local mental health resources like I do. 

Online therapy (or teletherapy) refers to mental health services and counseling that are provided via the internet or phone rather than in person. While some therapists conduct sessions exclusively online, many others see clients through some combination of video calls, phone calls, and in-person sessions.

Research has found that CBT delivered virtually is often equally as effective, and sometimes more effective, than CBT delivered in person. Online CBT was also effective in treating PTSD, panic disorder, and specific phobias. Given that online therapy removes certain barriers, such as travel time or childcare, it’s a strong option to consider.

In general, there is little risk in getting cognitive-behavioral therapy. But you may feel emotionally uncomfortable at times. This is because CBT can cause you to explore painful feelings, emotions, and experiences. You may cry, get upset, or feel angry during a challenging session. You may also feel physically drained. 

Some forms of CBT, such as exposure therapy, may require you to confront situations you’d rather avoid—such as airplanes, if you have a fear of flying. This can lead to temporary stress or anxiety.

However, working with a skilled therapist will minimize any risks. The coping skills you learn can help you manage and conquer negative feelings and fears. 

You might decide on your own that you want to try CBT, or a doctor or someone else may suggest therapy to you. Here’s how to get started:

·     Find a therapist. You can get a referral from a doctor, health insurance plan, friend or other trusted source. Many employers offer counseling services or referrals through employee assistance programs (EAP). Or you can find a therapist on your own, for example, over the internet.

·     Understand the costs. If you have health insurance, find out what coverage it offers for psychotherapy. Some health plans only cover a certain number of therapy sessions a year. Also, talk to your therapist about fees and payment options. Some therapists use a sliding fee scale.

·     Review your concerns. Before your first appointment, think about what issues you’d like to work on. While you can also sort this out with your therapist, having some idea of what you want to accomplish may provide a starting point.

At your first session, your therapist will typically gather information about you and ask what concerns you’d like to work on. The therapist will likely ask you about your current and past, emotional, and physical health to gain a deeper understanding of your situation. Your therapist may discuss whether you might benefit from other treatment as well, such as medications.

The first session is also an opportunity for you to interview the therapist to see if he or she will be a good match for you.

Make sure you understand:

1)          His or her approach

2)          What type of therapy is appropriate for you

3)          The goals of your treatment

4)          The length of each session, and

5)          How many therapy sessions you may need

It might take a few sessions for your therapist to fully understand your situation and concerns, and to determine the best course of action. IF, you don’t feel comfortable with the first therapist you see, try someone else. Having a good “fit” with your therapist can help you get the most benefit from CBT. 

Although, finding that “fit” can be a chore. I’ve met many a psychotherapist in my day, and I only felt comfortable enough to open up to one or two of them. Finding the perfect “fit” is not always an option, but you want to feel comfortable enough to speak openly.

Your therapist will encourage you to talk about your thoughts and feelings, and what’s bothering you.

Don’t worry if you find it hard to open up about your feelings. Your therapist can help you gain more confidence and comfort. Surprisingly, the more you do it, the easier it becomes.

CBT generally focuses on specific problems using a goal-oriented approach. As you go through the therapy process, your therapist may ask you to do homework—activities, reading or practices that build on what you learn during your regular therapy sessions, and encourage you to apply what you’ve learned in your daily life. 

Your therapist’s approach will depend on your particular situation and preferences. Your therapist may combine CBT with another therapeutic approach. For example, interpersonal therapy, which focuses on your relationships with other people. 

CBT typically includes these steps:

1)          Identify troubling situations or conditions in your life. These may include such issues as a medical condition, divorce, grief, anger, or symptoms of a mental health disorder. You and your therapist may spend some time deciding what problems and goals you want to focus on.

2)          Become aware of your thoughts, emotions, and beliefs about these problems. Once you’ve identified the problems to work on, your therapist will encourage you to share your thoughts about them. This may include observing what you tell yourself about an experience (self-talk), your interpretation of the meaning of a situation, and your beliefs about yourself, other people, and events. Your therapist may suggest that you keep a journal of your thoughts. 

3)          Identify negative or inaccurate thinking. To help you recognize patterns of thinking and behavior that may be contributing to your problem, your therapist may ask you to pay attention to your physical, emotional, and behavioral responses in different situations.

4)          Reshape negative or inaccurate thinking. Your therapist will likely encourage you to ask yourself whether your view of a situation is based on fact or an inaccurate perception of what’s going on. This step can be difficult. 

You may have long-standing ways of thinking about your life and yourself. With practice, helpful thinking and behavior patterns will become a habit and won’t take much effort.

CBT often includes learning and practicing techniques such as relaxation, coping skills, resilience, stress management, and assertiveness. 

Cognitive-behavioral therapy is considered a short-term therapy, ranging from about 5 to 20 sessions. You and your therapist can discuss how many sessions may be right for you. A typical session lasts for about 45 minutes. CBT usually lasts for 12 to 20 weeks. However, each person is unique, and mental health conditions are complex, so the length of therapy may vary.

Things to consider include:

·     Type of disorder or situation

·     Severity of your symptoms

·     How long you’ve had your symptoms or have been dealing with your situation

·     How quickly you make progress

·     How much stress you’re experiencing

·     How much support you receive from family members and other people

Except in very specific circumstances, conversations with your therapist are strictly confidential. However, a therapist may break confidentiality if there is an immediate threat to safety or when required by state or federal law to report concerns to the authorities. These situations include:

·     Threatening to immediately, or imminently, harm yourself or take your own life

·     Threatening to imminently harm or take the life of another person

·     Abusing a child or vulnerable adult—meaning someone over age 18 who is hospitalized, or made vulnerable by a disability

·     Being unable to safely take care of yourself

Cognitive-behavioral therapy may not cure your condition or make an unpleasant situation go away. But it can give you the power to cope with your situation in a healthy way and to feel better about yourself and your life. 

CBT isn’t effective for everyone. But you can take steps to get the most out of your therapy and help make it a success. For example,

·     Approach therapy as a partnership. Therapy is most effective when you’re an active participant and share in decision making. Make sure you and your therapist agree about the major issues and how to tackle them. Together, you can set goals and assess progress over time.

·     Be open and honest. Success with therapy depends on your willingness to share your thoughts, feelings, and experiences, and on being open to new insights and ways of doing things. If you’re reluctant to talk about certain things because of painful emotions, embarrassment, or fears about your therapist’s reaction, let your therapist know about your reservations

·     Stick to your treatment plan. If you feel down, or lack motivation, it may be tempting to skip therapy sessions. Doing so can disrupt your progress. Attend all sessions and give some thought to what you want to discuss.

·     Don’t expect instant results. Working on emotional issues can be painful and often requires hard work. It’s not unusual to feel worse during the initial part of therapy as you begin to confront both past and current conflicts. You may need several sessions before you begin to see improvement.

·     Do your homework between sessions. If your therapist asks you to read, keep a journal, or do other activities outside your regular therapy sessions, follow through. Doing these homework assignments will help you apply what you’ve learned in the therapy sessions.

·     If therapy isn’t helping, talk to your therapist. If you don’t feel that you’re benefiting from CBT after several sessions, talk to your therapist about it. You and your therapist may decide to make some changes or try a different approach. 

While it can be overwhelming to acknowledge and seek help for a mental health condition or emotional difficulties in your life, it’s important that you do. Your mental health is as important as your physical health. CBT can help you better understand and work through the roadblocks that are preventing you from living a full and healthy life. Mental health professionals are experts in their fields and have up-to-date knowledge on research and therapy strategies that can help you navigate life’s journey.

If you, or a loved one, find yourself in immediate need of therapy due to a crisis in your life, or a mental health condition, call 9-8-8 and talk to someone at the Suicide and Crisis Lifeline. They are available 24/7 and are ready to help. They even speak Spanish! Or, if you’d rather not get that personal, you can chat with a crisis counselor via text. Just text H-O-M-E to 741741 and find the help you need. For those of you who live outside the United States, please, look for the Suicide Prevention Line where you live. Every country has such a line, and resources are available to help. It’s worth your time and effort—Give them a call. Those who love you will be glad you did!

I want to thank you for being with me tonight. It’s always so nice when we can get together! Be safe in all your travels, and be sure to join me next time on “Bipolar for Life.” Good night.