Does CBT work?
Cognitive Behavioural Therapy (CBT) is considered by most accademics and clinicians to be the best long-term solution for people with severe social anxiety. So what is CBT and does it really work? Academic reasearch says that, yes, for most people CBT does lead to significant improvements, but there is a lot more to the phrase ‘does CBT work?’ than first meets the eye.
Firstly, CBT is an evolving therapy. This means that CBT today is not what CBT was 15 years ago. CBT for social anxiety used to mostly be about learning relaxation through controlled breathing, visualisation techniques, simple exposure, and replacing negative self-talk with cognitive coping strategies. These may still be used today, but through research CBT has moved on. Today, if you visit a well trained CBT practitioner your therapy might well be more focused on using behavioural experiments to gather evidence to counter negative beliefs, eliminating the use of safety behaviours, focusing outwardly to reduce self-focused attention, video feedback, and even exposure through virtual-reality.
The basic premises of CBT have continued to be the same; we can change our feelings and increase our quality of life through changing our thoughts and behaviour, but how we do that has changed over time. This is an important point to make for those who may have tried CBT a good few years ago or have been unlucky enough to visit a therapist who has not updated their training. If CBT has not helped you much in the past then it is quite possible that it could be more beneficial if you tried it again with more up-to-date techniques.
Much of the help I offer people resembles CBT and I may even use CBT terminology from time to time. In many respects it is CBT because I focus on helping people change the way they think and behave to overcome their social anxiety, but some of the theory and techniques I employ are unique and would not commonly be found in a typical course of CBT (although I hope that they will be in the future). So when answering the question, ‘does CBT work?’, the answer is not so straight forward. It really depends on what that CBT consists of. Not all CBT is the same.
A second point to make regards the relationship between therapist and client. In CBT this is commonly called the therapeutic alliance. It is important that you get on well with your therapist and feel like they are someone who can understand and help you. If you do not gel well together then it could be a significant barrier to progress. The idea of the therapeutic alliance is not so much that the therapist is there to help you, but rather that together, as a team, you can work through your difficulties. If you wanted to visualise this then you might like to see you and the therapist sitting together facing the problem as opposed to you sitting opposite each other with the therapist looking at you with the problem. If your therapist is not someone you can feel understood by, trust and cooperate with then sooner or later it will get in the way of the therapeutic process, so another answer to the question, ‘does CBT work?’ is that it depends on your relationship with your therapist.
Some personalities fit together better than others and it is not necessarily a failing of your therapist or yourself if you do not connect. If you do not get on well with your therapist then be brave and bring up the matter with them, it could lead to a major break-through in your progress. If things still are not working out, ask to see someone else. It is possible that they can refer you to a colleague who will be a better match. I understand that this can be difficult to do when you have social anxiety, but it might be a key step towards you making significant progress.
Finally, CBT never works for anyone. What I mean by this is that CBT is just a set of theories and techniques. It has to be you who puts in the time and effort to turn those theories and techniques into changes in your life. Although most people understand this, and it can seem patronising to state the obvious, the unfortunate truth is that a lot of people still stand back and take a passive approach to therapy in the hope that change will happen to them. Fear of failure is a big reason for this, but it is important to remember that if we do nothing, then nothing will change, and worse, our situation could even deteriorate.
As you can see, when someone asks the question, ‘does CBT work?’, the answer is not as straight forward as a simple yes and no. CBT does help many people overcome their social anxiety, but your success will depend greatly on what exactly your CBT consists of, how good your relationship is with your therapist and whether or not you are ready to make the commitment of time and effort that is required by it.
What have your experiences of CBT been?
Tags: CBT, CBT for Social Anxiety Disorder, CBT for Social Phobia, CBT Techniques, Cognitive Behavioural Therapy, Cognitive Therapy, Social Anxiety Therapy, Therapeutic Alliance, Therapeutic Relationship
December 21st, 2008 at 9:40 pm
I think it can work but due to the nature of my anxiety I never complete the therapy b/c I’m to anxious to even go to the sessions. So I wind up always starting from the beginning with a new therapist and going over the same mundane start that I already know like the back of my hand.
http://diaryofashyblackwoman.blogspot.com/
January 14th, 2009 at 4:02 pm
You bring up something that I am sure affects a lot of people with social anxiety when they are in therapy. It is hard starting again with someone new and expensive if you have to pay for it. It takes time to build up trust and tell someone your story and I think this is another reason why it is so important to choose a therapist well from the start. If you start with someone new it would probably be helpful to tell them from the start that you can end up getting too anxious to go to sessions and are prone to moving on to another therapist. You can then work together to put something in place to prevent or resolve this when it happens.
August 1st, 2009 at 7:07 am
Hi Nick. I think it’s great CBT has helped you so much. I was just wondering how long it took for CBT to begin reducing your symptoms, as I am beginning a course of CBT myself?
August 1st, 2009 at 12:36 pm
Hi John, Everyone starts from a different place and is unique, so it’s almost impossible to say how long it will take for different people. CBT is very much a thing where you get out as much as you put in, so if you really give it your all then you’ll have a good chance of making progress quickly. I worked through a program of CBT when I was starting out. I’d already done some self-taught exposure therapy at quite a basic level, but it was the first thing I tried that had any structure to it. I really worked hard at it and did my best to follow it to the letter, putting in the time and effort every day. If I remember rightly, much of my social anxiety had gone within 3 months and by 6 months things were much better and I got a temping job and did that for a month with hardly any anxiety at all. It wasn’t all the CBT though, within that time I also work really hard on some other self-help/personal development programs. I’d say the CBT really took the edge off my SA, and then working on other things and developing my own understanding of social anxiety really helped me leave it behind. I think CBT can be really helpful and I would recommend it to people as the best option that’s currently available, but what I’m putting together now I hope will be a big step forward and really help people achieve above average levels of confidence in a shortest time possible. People will still have to work hard at it to achieve the results, but that’s always going to be the case.
August 26th, 2009 at 2:22 pm
Try computerised CBT? Could this be an option for shy black woman? Good luck. Josh
August 26th, 2009 at 9:38 pm
People can access a free computerised CBT course for people with Social Anxiety through this Australian site, http://ecouch.anu.edu.au I’d be interested to know how people get on with it…