Center for Integrated Behavioral Health proudly offers Cognitive Behavioral Therapy in the Lehigh Valley. Cognitive Behavioral Therapy (CBT) is a comprehensive system of psychotherapy, including 3rd wave behavioral approaches Acceptance and Commitment Therapy (ACT) and Dialectical Behavior Therapy (DBT), which are active, goal focused, and target skill development to alter problematic behavior patterns. Clients are taught a range of strategies and provided with between session assignments and coaching to help generalize skills to daily life. CBT can be administered in a variety of formats including individual therapy, group therapy, family therapy, and parent training.
CBT is based on a theoretical model, which argues that thoughts, feelings, and behaviors influence each other, and contribute to the development and maintenance of psychological disorders. Accordingly, cognitive behavioral approaches treat psychological problems by intervening in all three areas: 1) assisting clients with increasing their awareness of thoughts and, when necessary, correcting errors in thinking, 2) identifying and labeling emotions and learning strategies to improve emotion regulation, and 3) examining and changing behavioral patterns that cause and maintain problematic thoughts and emotions. The CBT model has been applied with success in the treatment of a wide range of disorders and problems, including depression, anxiety (e.g., social anxiety, specific phobias, OCD, generalized anxiety disorder), anger, habit disorders (e.g., trichotillomania, skin picking), impulsive behaviors, thought disorders, ADHD, behavioral problems, social skills deficits, and family/relational problems. Importantly, this therapy approach has demonstrated success both alone, and in combination with medication. Furthermore, research has demonstrated maintenance of treatment gains over time.
A. Assessment (1-2 sessions)
At the outset of treatment, clients will have an 80-minute consultation with a psychologist. Depending on the age of the individual presenting for treatment as well as the presenting problem, this consultation may involve parents, spouses, or other caregivers. The purpose of this initial meeting is to assess the client’s presenting problem, the history of the client’s difficulties, current and prior treatments, and family history of psychological disorders. In addition, the therapist gathers information about other aspects of the client’s life, including relationships, medical history, academic and work history, as well as recent and long-term stressors that may be affecting the client’s life and mood. Finally, the psychologist works with the client to set goals to lessen symptoms of distress, resolve problems, and improve functioning. The psychologist also assesses the client’s expectations for therapy. At the conclusion of the consultation, the therapist provides the client(s) with his or her initial impressions, as well as recommendations for treatment.
B. Psychoeducation (1-2 sessions)
Prior to starting treatment, the therapist provides the client with education regarding his or her presenting problem, diagnosis, and treatment. The therapist may provide the client with recommendations for articles, books, and other readings that will provide additional information regarding symptoms, prognosis, and treatment options. This is a period of both orienting the client to the components of the treatment plan, and using strategies to build commitment for the treatment plan. Given the collaborative nature of cognitive behavioral treatment, the therapist emphasizes the need for the client’s participation and feedback, as well as the completion of homework assignments between sessions to assist with skills generalization. Depending on the client’s presenting problem, the therapist may be orienting the client to one or more therapeutic modalities, including individual therapy, family therapy, couples counseling, group therapy, and parent training.
C. Treatment (varied length)
Depending on the specific presenting problem, therapists choose from a menu of cognitive behavioral techniques to help the client address his or her difficulties and improve his or her quality of life:
- Cognitive Strategies: Clients learn to notice thoughts, be present in the moment, understand the impact of thoughts on the way they feel and behave, accept thoughts even when they are painful, and change thoughts that are inaccurate, unhelpful or are causing emotional pain.
- Behavioral Strategies: Clients learn strategies to solve problems, make effective decisions, manage time effectively, complete tasks and overcome procrastination, confront situations that are feared or avoided, identify and work toward valued life goals, and learn new skills, such as social skills, negotiating skills and assertiveness training.
- Physical Strategies: Clients learn to counteract unpleasant physical symptoms associated with different feelings by tensing and relaxing various muscle groups, performing breathing exercises, and learning other meditative techniques to reduce tension and improve well-being.
The skills described above are applied within a range of therapeutic modalities, including individual, group, family, couples, and parent training. By adopting a comprehensive understanding of the client’s problems and including group and family therapy as needed, therapists help clients to generalize skills learned in treatment, address systemic factors that may be contributing to or maintaining problems, and conduct interventions in the environment to increase reinforcement of skillful behaviors.
Maintenance/Relapse Prevention Phase (as needed)
Once the active treatment is completed, mutually agreed upon goals have been met, and the client has demonstrated that he or she can adequately apply strategies to daily life, the maintenance/relapse prevention phase is initiated. During this phase, sessions are gradually tapered, as needed from weekly to biweekly, to monthly, and so on. The therapist reviews the client’s progress in treatment, skills learned, and tools the client will continue to utilize to maintain treatment gains. The therapist and client collaboratively work on relapse prevention by discussing potential symptom recurrence, identifying stressors that trigger symptoms, and developing plans for coping with these stressors. During this phase, the therapist and client will also discuss conditions under which the client may consider ‘booster sessions’ to review and reinforce skills.