Can you do cbt without a therapist

Deborah C. Escalante

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Source: Jim Jackson/Pexels

It’s widely recognized that a few sessions of cognitive-behavioral therapy (or CBT) can be very helpful in treating the anxiety and depression that so many people experience. However, many people don’t have access to a CBT therapist—maybe none are close by, or they’re not in the person’s insurance network, or they’re prohibitively expensive. It can also be difficult to take time off from paid work or child care every week to see a therapist.

If you’re interested in CBT for anxiety or depression and you aren’t able to see a CBT therapist, take heart—you may not need to. There are multiple options for doing CBT without a therapist, including self-help books and Internet-based treatment. Many studies have shown that self-directed CBT can be very effective.

For example, a review of 33 studies found that self-help treatment led to significant reductions in anxiety; another review of 34 studies on depression found similar benefits of self-directed therapy, particularly when the treatments used CBT techniques. Both reviews found that that, on average, the self-help treatments were moderately helpful. In other words, people who did the treatment felt substantially better—maybe not like “a new person,” but a noticeably less anxious or depressed version of themselves.

Data from these studies also suggest that people who do self-help CBT for anxiety and depression tend to hold on to their progress over time, which is very encouraging. One of the major goals of CBT is for you to “become your own therapist” by learning skills that you can continue to practice after you’ve ended treatment. These studies show that people who learn CBT skills on their own can use these skills to keep feeling well.

Does this mean the end for therapists? Certainly not. One of the other findings from the studies above is that CBT with a therapist tends to be more effective than self-help CBT, so there can be an additional advantage to working with someone directly. Self-help treatment can also be done with a limited amount of input from a professional—for example, a brief phone call each week—which can provide an extra boost compared to self-help alone. I suspect that the added benefit from working with a therapist comes not only from having the input of an expert but also from having a caring person’s consistent encouragement.

Self-help CBT is part of a movement toward stepped care, in which the goal is to match the intensity of treatment to a person’s needs. Someone who is severely depressed and barely able to get out of bed is probably not a good match for self-directed CBT, and likely will need one-on-one treatment with a professional. On the other end of the spectrum, a person with mild to moderate anxiety or depression who is generally able to function well may be a good candidate for a less intense option like a book on CBT.

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If you’re interested in self-directed CBT, the Association for Behavioral and Cognitive Therapies maintains a list of books that they’ve given their “seal of merit.” [If you’ll pardon the self-promotion, I also wrote a book on CBT for anxiety and depression.]

The cognitive techniques found in my book and others include:

  • Learning to identify your thought patterns.
  • Discovering how your thoughts affect your feelings and behaviors.
  • Determining if your thoughts are accurate.
  • Replacing biased thoughts with more realistic ones.

Common behavioral techniques include:

  • Scheduling activities for yourself that bring you enjoyment and a sense of accomplishment.
  • Recognizing how your actions influence your thoughts and emotions.
  • Planning ways to make the best use of your time.
  • Breaking down big, daunting tasks into smaller, more manageable ones.
  • Facing your fears gradually and systematically so they diminish.

As you probably noticed, these approaches are fairly simple and obvious. Indeed, much of what drew me to CBT in the beginning of my graduate training was how straightforward and intuitive it was, and these characteristics make it well-suited to self-directed therapy. As I’ve written before, what makes CBT effective isn’t so much the novelty of the interventions but the systematic approach and emphasis on practice.

You might consider the following guidelines if you decide to pursue self-help CBT:

  1. Find a book that resonates with you. Different people are drawn to different approaches, tones, level of detail, etc. If the book feels like a good fit, there’s a better chance you’ll stay engaged with it.
  2. Choose a book that is based on solid research. Self-help therapy takes considerable time and effort, so it’s worth directing your energy toward a program that has a solid grounding.
  3. Make room in your schedule to focus on the program. There are better and worse times to tackle therapy of any kind. While there’s a good chance you’ll always have competing activities, it’s better to avoid times when you’re truly overextended and the therapy is likely to get pushed to the side.
  4. Follow the program as closely as possible. It’s easy to be tempted to skip parts of a self-help program that we think won’t work, or that we think we know already. One of the dangers is that if we find a program doesn’t help, we won’t know if it’s because it wasn’t right for us or because we only did two-thirds of it. Adhering to the instructions gives us the best chance of benefiting and knowing what actually works for us.
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In a time of high anxiety, rising depression rates, soaring healthcare costs, and limited insurance coverage for mental health, self-directed psychological treatments have many advantages. Completing a program that’s right for you can lower your anxiety, improve your mood, and provide you with skills that you can use as often as you need them.

NOV.

01,

2016

By Seth J. Gillihan

 

As a therapist, I’ve repeatedly seen the same research conclusions: a few sessions of cognitive-behavioral therapy (or CBT) can be very helpful in treating anxiety and depression. CBT’s simple yet powerful changes to the way we think and act can have profound impacts on our health and well-being.

However, many people don’t have access to a CBT therapist—maybe they’re not close by or they’re not in-network or they’re prohibitively expensive. It’s also tough to take time off work or child care every week to see a therapist. 

If you’ve wanted to try CBT for anxiety or depression but aren’t able to see a CBT therapist, you may not need to. Many studies have found that self-directed CBT can be very effective. Two reviews that each included over 30 studies (see references below) found that self-help treatment significantly reduced both anxiety and depression, especially when the treatments used CBT techniques. The average amount of benefit was in the “moderate” range, meaning people didn’t feel 100% better, but were noticeably less anxious and depressed.

(Note: Self-help CBT is probably most appropriate for someone with mild to moderate symptoms who is generally able to function well. A person who is severely depressed and barely able to get out of bed is probably not a good match, and will likely need one-on-one treatment with a professional.)

Studies also show that people tend to maintain their progress over time, which is very encouraging. One of the goals of CBT is to ”become your own therapist” by learning skills you can use on your own after treatment to keep feeling well. 

If you’re interested in self-directed CBT, the Association for Behavioral and Cognitive Therapies maintains a list of books they’ve given their “seal of merit.” I also recently wrote a book on CBT for anxiety and depression called Retrain Your Brain: Cognitive Behavioral Therapy in 7 Weeks.  The workbook is meant to present the best-tested tools of CBT in a user-friendly way over the course of several weeks. The exercises included are similar to what I do when I’m working with someone in-person.

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The cognitive techniques found in my book and others include:

  • Identifying your thought patterns.
  • Discovering how your thoughts affect your feelings and behaviors.
  • Determining if your thoughts are accurate.
  • Replacing biased thoughts with more realistic ones.

Common behavioral techniques include:

  • Scheduling activities that bring you enjoyment and a sense of accomplishment.
  • Recognizing how your actions influence your thoughts and emotions.
  • Making the best use of your time.
  • Breaking down daunting tasks into more manageable ones.
  • Facing your fears gradually so they diminish.

These approaches are fairly simple and obvious. What drew me to CBT was how straightforward and intuitive it was, which also makes it well-suited for self-directed therapy. The following guidelines might be helpful if you decide to pursue self-directed CBT:

  1. Find a book that resonates with you. People are drawn to different approaches, tones, level of detail, etc. If a book feels like a good fit, there’s a better chance you’ll stay engaged with it.
  2. Choose a book that is based on solid research. Self-help therapy takes considerable time and effort, so it’s worth directing your energy toward a program that has a solid grounding.
  3. Make room in your schedule to focus on the program. While there’s a good chance you’ll always have competing activities, it’s better to avoid periods in your life when you’re truly overextended and the therapy is likely to get pushed to the side.
  4. Follow the program as closely as possible. It’s easy to want to skip parts of a program we’re already familiar with or we think won’t work. One of the dangers with that is if we find a program doesn’t help, we won’t know if it’s because it wasn’t right for us or because we only did part of it. Sticking to the instructions gives us the best chance of benefiting. 

In a time of high anxiety, rising depression rates, soaring health care costs and limited insurance coverage for mental health, self-directed psychological treatments have many advantages. Completing a program that’s right for you can lower your anxiety, improve your mood and provide you with skills you can use as often as you need them. 

 

Seth J. Gillihan, PhD, is a licensed psychologist and Clinical Assistant Professor of Psychology in the Psychiatry Department at the University of Pennsylvania. He has a clinical practice in Haverford, PA, where he specializes in CBT and mindfulness-based interventions for the treatment of anxiety, depression, OCD, and insomnia. Dr. Gillihan writes the ThinkActBe blog on PsychologyToday.com, and can be found at sethgillihan.com

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