Lisa A. Napolitano, Ph.D.
New York, NY 10022
Cognitive Behavioral Therapy
What is CBT?
CBT, or Cognitive Behavioral Therapy, focuses on the patterns of thinking, behavior, and emotional responding that are associated with distress or life dissatisfaction. In CBT, clients learn techniques to recognize and change these patterns to improve daily functioning and life satisfaction. CBT is an empirically supported treatment for a wide variety of problems including depression, anxiety, eating disorders, addictions, compulsive behaviors, attention deficit hyperactivity disorder and test anxiety. CBT is a time-limited treatment, typically lasting from 10 to 20 sessions rather than years. Between weekly individual sessions, clients practice skills learned in session through homework exercises. Practice of the skills increases the likelihood that they will generalize to your life outside of therapy and remain part of your repertoire after treatment has ended.
Comprehensive CBT Program in NYC
Typical CBT Session
CBT therapists take an active, in-session stance to teach clients skills that can be used to improve current functioning. Usually, individual therapy sessions are 45-minutes long and take place on a once weekly basis in our Manhattan office. To help skills learned in session generalize to life outside of therapy, clients receive individualized reading, writing, or behavioral assignments to be completed during the week.
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Evidence of Effectiveness of CBT
Cognitive Behavioral Therapy has repeatedly been shown to have a lasting effect in the treatment of depression and anxiety disorders. Meta-analyses of 48 randomized controlled trials have shown that Cognitive Therapy (CT) is effective in treating mild to moderate depression (Gloaguen, Cottraux, Cucherat, & Blackburn, 1997). Research has demonstrated that CBT is superior to anti-depressant treatment and can be used as an alternative or adjunctive to pharmacological therapy. Combination therapy (medication plus CBT) is beneficial for cases of chronic and severe depression (Parker, Roy, and Eyers, 2003). For populations who cannot tolerate medicine, drug-resistant depressive disorders, or children and adolescents for whom early prescribing poses concerns, CBT is shown to be a particularly effective and preventative treatment (Parker et al., 2003).
The effects of CBT continue after treatment is ended. CBT has been shown to significantly reduce the recurrence of depression over the following 1-2 years (Gloaguen et al., 1997). In a six-year study of patients suffering from recurrent depression, those who received CBT after initial pharmacotherapy showed a significantly lower relapse rate at a six year follow-up compared to those who did not receive CBT (Fava, Ruini, Rafanelli, Fionis, Conti, & Grandi, 2004).
Evidence of Effectiveness of CBT
Cognitive Behavioral Therapy involving a combination of cognitive restructuring, relaxation training, and strategies to promote a sense of well-being has been shown to be effective in treating generalized anxiety when compared to numerous other interventions and control conditions (Hollon, Stewart, & Strunk, 2006). Studies have shown that for patients with panic disorder and agoraphobia, CBT alone or in conjunction with medication significantly reduce catastrophic thinking.
CBT is also an enduring treatment for anxiety disorders. Those treated with CBT have a higher likelihood to maintain gains after treatment termination than those treated with medication alone. Similar effects have been cited for patients with hypochondriasis and concerns about physical illness, interpersonal anxiety or social phobia, specific phobias, Obsessive-compulsive disorder (OCD), Posttraumatic stress disorder (PTSD), and generalized anxiety disorder (GAD) (Hollon et al., 2006).
Using the most stringent trial criteria, Hoffman and Smits’ (2008) meta-analysis of 27 randomized placebo-controlled trials showed that CBT is efficacious for the treatment of adult anxiety disorders. The largest effect sizes for CBT treatment in this analysis were found in patients diagnosed with Obsessive-Compulsive Disorder and Acute Stress Disorder under DSM-III-R or DSM-IV criteria (Hofmann & Smits, 2008). A randomized, controlled trial comparing CBT to short-term psychodynamic therapy in adults with generalized anxiety disorder found CBT to be superior in outcome measures of pathological worry, trait anxiety and depression, citing CBT’s specific and applied method of modifying the cognitive components of worry (Leichsenring et al., 2009).
Cognitive-Behavioral Therapy can make a crucial difference in the transition from childhood to young adulthood for youth suffering from anxiety disorders. Jansen et al. (2012) cite the increased risk of psychopathology, educational underachievement, substance abuse and suicidality in anxiety disordered youth, particularly if left untreated. CBT has been cited as the most effective treatment for childhood anxiety (Jansen et al., 2012). Multiple studies provide evidence for the short-term efficacy of CBT treatment in youth with anxiety disorders. One long-term study found that exposure-based CBT led to remission of phobic and anxiety disorders in children and adolescents 8 to 13 years post-treatment, as well as long-term remission of secondary problems like depression and substance abuse (Saavedra, Silverman, Morgan-Lopez, & Kurtines, 2010).
- Fava, G., Ruini, C., Rafanelli, C., Finos, L., Conti, S., & Grandi, S. (2004). Six-year Outcome of Cognitive Behavior Therapy for Prevention of Recurrent Depression. American Journal of Psychiatry, 161:1872-1876.
- Gloaguen, V., Cottraux, J., Cucherat, M., & Blackburn, I. (1998). A meta-analysis of the effects of cognitive therapy in depressed patients. Journal of Affective Disorders, 49:59-72.
- Hoffman, S., & Smits, J. (2008). Cognitive-Behavioral Therapy for Adult Anxiety Disorders: A Meta-analysis of Randomized Placebo-Controlled Trials. Journal of Clinical Psychiatry, 69:4.
- Hollon, S., Stewart, M., & Strunk, D. (2006). Enduring effects for cognitive behavior therapy in the treatment of depression and anxiety. Annual Review of Psychology, 57:285-315.
- Jansen, M., Van Doorn, M., Lichtwarck-Aschoff, A., Kuijpers, R., Theunissen, H., Korte, M., Van Rossum, J., Wauben, A., & Granic, I. (2012). Effectiveness of a cognitive-behavioral therapy (CBT) manualized program for clinically anxious children: study protocol of a randomized controlled trial. BMC Psychiatry, 12:16.
- Leichsenring, F., Salzer, S., Jaeger, U., Kachele, H., Kreische, R., Leweke, F., Ruger, U., Winkelbach, C., & Leibing, E. (2009). Short-term Psychodynamic Psychotherapy and Cognitive-Behavioral Therapy in Generalized Anxiety. American Journal of Psychiatry, 166:8.
- Parker, G., Roy, K., & Eyers, K. (2003). Cognitive Behavior Therapy for Depression? Choose Horses for Courses. American Journal of Psychiatry, 160:825-834.
- Patiences, D., McGuire, R., Scott, A., & Freeman, C. (1995). The Edinburgh Primary Care Depression Study: personality disorder outcome. British Journal of Psychiatry, 167:324-330.
- Saavedra, L., Silverman, W., Morgan-Lopez, A., & Kurtines, W. (2010). Cognitive behavioral treatment for childhood anxiety disorders: long-term effects on anxiety and secondary disorders in young adulthood. Journal of Child Psychology and Psychiatry, 51:8.
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