This is a specific type of therapy considered best practice in the treatment of depression and anxiety. C.B.T. looks at the interplay between thoughts, behaviours, and mood (aka feelings). The premise of C.B.T. is if you can change how you think about something, you can also change how you feel and how you react. The opposite is also true. Change what you do and it can change how you think and feel. In the treatment of depression, a key piece of treatment is what is called behavioural activation (i.e. getting active). It is so key that it is the first step of C.B.T. when using it to treat depression. Once the behavior has changed, then we move on to looking at how our thoughts and our perceptions about what is happening around us can shape not only how we feel, but also how we view certain situations, ourselves, and the world.

This belief may prevent me from paying attention to all of the times that I did remember a birthday or all of the positive feedback I have gotten from friends in the past. In fact, if I continue to believe this, it may result in me withdrawing from friends (i.e. not returning phone calls or texts, not attending parties or other events). When these same friends stop inviting me to things and stop calling because I never follow through, it will only confirm my original belief which will continue to affect my behavior. In C.B.T. we would look at ways to challenge this belief by finding examples that don’t fit (i.e. like the positive feedback). Once we have challenged the belief, we ask individuals to do experiments that focus on changing behavior (i.e. if I would randomly text a friend that I hadn’t spoken to lately, what response would I get?). Both the challenging of thoughts/beliefs and the changing of behavior then impact a person’s mood.

In anxiety, C.B.T. focuses first on looking at the thoughts that contribute to anxiety. Most people who are anxious are very good at the “what ifs….”. C.B.T. identifies the “what ifs” and asks questions that challenge these thoughts, looks for patterns in thinking that contribute to anxiety, and increases confidence so that a person realizes that they can handle a difficult situation even if it did happen. Once these skills have been developed, then C.B.T. focuses on challenging the behaviours that keep the anxiety problematic (i.e. avoiding certain situations). This part of the work is called exposure therapy which essentially means slowly, in a controlled manner going into situations that cause a manageable level of anxiety. As these situations become easier, the person graduates to harder scenarios until they are able to reach their goal.

Once these thoughts have been challenged, the next step would be to design an exposure hierarchy of situations that cause anxiety listed from easy to difficult. I might start off with going to the mall before it is open. Once I am comfortable with that, I may try going to the mall on a Monday evening when there are fewer people around. I may then try going on a Sunday morning when it first opens, etc. until I am able to tolerate being in the mall on a crowded Saturday.

C.B.T. does require extensive homework and it is incredibly effective if the homework is completed. Generally, treating depression with C.B.T. requires approximately 20 sessions. To treat anxiety with C.B.T. requires approximately 12 sessions. However, the number of sessions can vary depending on the issues presented and the type of anxiety a person is feeling. Also, it is very common for people to experience anxiety and depression together requiring a more individualized approach.