Cognitive Behavioral Therapy for GAD: What to Expect

A Guide to Understanding the CBT Approach

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Cognitive behavioral therapy (CBT) is type of psychotherapy commonly used in the treatment of anxiety disorders, like generalized anxiety disorder (GAD), mood disorders, and eating disorders. Research has determined that CBT can produce reliable and significant improvement in GAD symptoms by the end of therapy, and progress can often be maintained after treatment ends. CBT has also been associated with a reduction in the need for medications in some people.

What exactly is CBT?

In contrast with some other psychotherapy approaches, CBT is a present- and problem-focused, structured talk therapy that focuses on conscious thoughts, rather than on thoughts of which we are not aware. It is generally a short term treatment, but can be longer in the case of GAD if symptoms tend to wax and wane over time. One of the overarching goals of CBT is to help you gradually become your own therapist.​​

Who provides CBT?

CBT is typically offered by clinicians who have been specifically trained in this type of psychotherapy. CBT therapists tend to be quite active during the session. Their style is likely to vary between educational, conversational, and reflective.

A CBT therapist could be a psychiatrist, psychologist, social worker, or mental health counselor. If you are interested in trying CBT, you might ask about your treatment provider’s training background with this approach or seek out an experienced CBT practitioner through referral sources such as The Association for Behavioral and Cognitive Therapies or The Anxiety and Depression Association of America.

What are the main components of CBT?

CBT interventions include education about anxiety, understanding more about your anxiety by self-monitoring, learning to relax, controlling thoughts that cause anxiety using a variety of cognitive therapy approaches, facing fears, and problem-solving issues for which anxiety might be expected and proportionate.

In general, these techniques reflect several important areas in need of change for an individual with GAD: challenging misconceptions (or distorted beliefs), testing the accuracy of assumptions, using repeated exposure, reducing avoidant behavior, and improving coping and problem-solving skills.

What happens in a CBT session?

CBT sessions are fairly structured. The agenda for the meeting will be agreed upon by you and your therapist at the start of the appointment. This collaborative style -- the "team" mentality -- extends throughout the session, as you work together with your therapist to cover as much of the agenda as feasible.

After establishing a plan for your meeting, homework is reviewed. CBT therapists often give homework. This could be reading related to an important therapeutic topic (With GAD, for example, you may be asked to learn about the purpose of anxiety or the difference between normal and excessive worry.), or it could be a written or behavioral assignment to track aspects of your anxiety and help practice new ways of thinking or acting.

Following homework review, new or ongoing topics are addressed. These may build off of the homework, relate to what has occurred in your life since your last meeting, or cover other issues deemed important by you and your clinician. At the conclusion of the session, a new assignment -- work for you to do between sessions to get the most out of your treatment -- will be agreed upon.

How frequently will I meet with my therapist?

CBT sessions typically occur once weekly. At the onset of treatment, if your symptoms are significantly impairing your day-to-day functioning or you are new to therapy, your clinician may wish to see you twice a week for a few weeks. After several months of weekly sessions, if you and your therapist agree that your symptoms are improving, you might arrange to meet less frequently – perhaps twice per month. As you approach the end of treatment, you may meet even less frequently – once a month, or once every other month – to make sure that you are adequately managing any recurrent symptoms or setbacks. Even after a “formal” treatment period has ended, you may find it helpful to return to your therapist for “booster” sessions on occasion. These meetings serve as a check-in and a refresher on particularly helpful skills for you.

References

Craske MG, Barlow, DH. Mastery of Your Anxiety and Worry Workbook (2nd Edition). In DH Barlow (Ed.) Treatments That Work. New York: Oxford University Press, 2006.

Newman MG, Crits-Christoph PF, Szkodny LE. Generalized Anxiety Disorder. In L Castonguay & T Oltmanns (Eds.), Psychopathology: From Science to Clinical Practice. New York: Guilford Press, 2013, p. 62-87.

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