From the NYU CHILD STUDY CENTER: ASK THE EXPERT:
What is Cognitive Behavioral Therapy (CBT)
By Glenn S. Hirsch, M.D.
Freud discovered the unconscious; or rather the effect of unconscious motivation in our every day lives. This important concept led to a theory of the treatment of psychiatric illness that depended on an individual’s understanding and awareness of his or her own unconscious motivation. It was hoped that this awareness would lead to more rational action and decision-making.
In the 1960s, a psychiatrist named Aaron Beck, based on his work with Freudian psychotherapy and recognition of some of its inadequacies, developed Cognitive Behavioral Therapy (CBT). CBT is based on a model that connects thoughts to feelings and that supposes that it is not the events in our lives that upset or traumatize us; it is the meaning we give to those events. As an example, a child who is depressed and has done poorly on a test may think, “See, I am such a failure, I can’t do anything right, I will never amount to anything. Why bother going to school? I can’t learn anything.”
Research has demonstrated that forms of CBT, originally utilized to treat depressed adults, can be effectively used to treat depression, anxiety, and obsessive-compulsive disorder in adults, adolescents, and children. CBT has two important components. The “C” helps patients change their automatic, negative, and often flawed thinking about a situation. The “B” helps people change their behavior and how they react to a situation.
CBT is a problem-focused treatment with a carefully structured and planned step-by-step procedure with expectations for activities and homework between sessions that help build skills. A large component of this treatment is teaching the child and family about the disorder (anxiety, depression or obsessive-compulsive disorder) and the details of the therapy. CBT therapists provide the family and patient with useful ‘tools’ and techniques to help fight the symptoms.
If the problem is one of anxiety, the next steps might involve developing a chart of the child’s symptoms that include what makes them least as well as most anxious; the child might then be taught some relaxation techniques to reduce the feeling of anxiety and tension. Following this, the child is methodically and gradually exposed to anxiety provoking situations in a way that results in the anxiety shrinking. These techniques can also be used to help a depressed child with global negative thoughts. These thoughts might include—“I’m never any good, everyone hates me, and nothing will change.” Identifying and correcting this distorted thinking is one of the essential components in treating depression with CBT.
Another essential component of CBT is working with parents and families. Parents are taught how to deal with the avoidance, negative statements, and anxiety that their children are experiencing. Children often look to their parents for reassurance. In their wish to reduce a child’s discomfort, some parents will inadvertently exacerbate the avoidance. An example of an effective way to deal with a child’s avoidance due to anxiety might be to say, “I understand that you are afraid, but I know that you can handle this, and I am here to help you. Let’s solve this problem together. What can you do first?” This and other techniques are useful for helping a child grow emotionally, become increasingly conscientious, and develop more autonomy.
This monthly column provides educators, parents and families with important information about child and adolescent mental health issues. Please submit questions for ASK THE EXPERT to Glenn S. Hirsch, M.D., Medical Director at the NYU Child Study Center at glenn.hirsch@med.nyu.edu. To subscribe to the ASK THE EXPERT Newsletter or for more information about the NYU Child Study Center, visit www.AboutOurKids.org or call 212-263-6622.#
