How and Why Cognitive-Based Interventions Work

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Written by Teresa Bertoncin, LMFT, LPCC

Amid the fallout of the global pandemic has been an emerging epidemic of anxiety and depression. In the U.S., the national rate of anxiety tripled in 2020 (from 8.1% to 25.5%), and depression almost quadrupled (from 6.5% to 24.3%). These numbers are true for US adults in all demographic groups—especially in those with financial worries—and the rise is much higher than after previous major traumatic events.

We have been amongst a social contagion—the spread of behaviors, attitudes, and affect from one person to another—around outrage and fear. The pandemic is an emotionally taxing time and people have a tendency to express and share their emotions, especially on social media platforms. Evidence seems to suggest that it is primarily negative emotions, like fear and anxiety, that are shared in times of crisis. While fear helps us survive, when mixed with uncertainty, it can lead to anxiety. When anxiety is spread by social contagion it can lead to panic.

It is important to understand that fear is a basic human mechanism. When something scares us, we are triggered, and through fear, we learn to practice behaviors that will help us avoid that danger in the future. When we successfully avoid that danger, we then feel rewarded. We inherited this three-step mental process from our ancient ancestors: see saber-toothed tiger (trigger), run away (behavior), live to tell our offspring to avoid that part of the savanna (reward). These habit loops were formed in order to remember where food is and to avoid danger.

Fear in present times often presents as anxiety which manifests in feelings and worry. Feelings of anxiety are physical sensations that can be associated with thoughts. Worry, both a noun and a verb, is something in itself that can drive more worry. Worry can be negatively reinforced and can actually drive anxiety habit loops.

If anxiety is the trigger, worry can be a mental behavior that results in two things: it distracts us from the unpleasant feelings of fear and anxiety; and it gives us a feeling of control. This might seem counter-intuitive, but even if worrying doesn’t ‘fix’ something, it gives us the illusion that we are doing something by worrying.

In actuality, there is no evidence that worrying is more helpful in performance or outcome for others or ourselves. In fact, worrying not only causes more anxiety, but makes the thinking and planning part of our brain go off-line, fear-based learning takes over, and the anxiety habit loop often results in shut-down and/or avoidant behaviors. When we exhaust ourselves through the repetition compulsion of the anxiety feedback loop eventually realize our ineffectiveness in outcome control, the result of the habit loop spirals to and reinforces depression.

As we continue our series on What Works, this segment focuses on some of the top-down cognitive-based interventions and modalities incorporated at Clear Behavioral Health. These widely used evidence-based methods and treatments are all about changing faulty and unhelpful thoughts and negative reinforced habit loops by looking at how the mind is interpreting information. They have been shown to be very effective at helping people change behaviors and reduce uncomfortable symptoms, like depression, phobias, and other mental disorders, and have also been shown to be valuable in treating alcoholism and drug addiction. 

Some of the effective modalities that we utilize in integrative group therapy, individual therapy, case management, and skill-building workshops include Cognitive Behavioral Therapy (CBT), Mindfulness Based Cognitive Therapy (MBCT), Solution-Focused Therapy, Dialectic Behavioral Therapy (DBT) and psycho-education. Below is a brief introduction to the concepts and why they work.

Cognitive Behavioral Therapy (CBT)

CBT is widely used in treatment programs. This is especially true when it’s part of an overall program of recovery. Mental health and addiction issues are rooted in our thoughts and actions. Our beliefs about ourselves and our perception of situations can influence our experiences. CBT works on the basis that the way we think and interpret life’s events affects how we behave, and ultimately, how we feel. More specifically, CBT is a problem-specific, goal-oriented approach that focuses on present-day challenges, thoughts, and behaviors. Clear Behavioral Health’s favored recovery group therapist, Irina Jodzio, LMFT states, “I often see CBT being very effective with teens and adults in recovery.”

CBT employs two main components, 1) Functional analysis, which is a process in CBT that involves looking at the causes and consequences of a behavior; and 2) Skill building; whereby the goal of CBT is to get the person to unlearn maladaptive behaviors and learn or relearn better coping skills. Therapists at Clear Behavioral Health incorporate CBT in a broad range of practices.

Mindfulness-Based Cognitive Therapy (MBCT)   

MBCT integrates mindfulness techniques with CBT, so that a person can have a better understanding of their emotions and thoughts and learn to manage them accordingly in order to relieve himself or herself of suffering. MCBT was originally created to treat recurring depression, but its benefits have made it an important tool for mental health issues and addiction recovery – especially since the two are often related, such as with dual diagnosis (or co-occurring disorders).

MBCT teaches people to use mindfulness meditation and cognitive methods to disrupt the automatic processes that tend to trigger depression, negative thought patterns, bad moods, and bodily sensations, such as sluggishness or fatigue. Through MBCT, people can learn how to identify their sense of being and view themselves as independent from their moods and thoughts. This separation often liberates people from thought patterns that allow the same harmful messages to keep repeating.

Through MBCT, people become aware that even though emotions and the self may exist concurrently, they do not have to be in the same dimension. This understanding can foster healing by teaching people that they can disarm negative moods by interjecting them with positive thoughts. In essence, MBCT aims to give people the tools that they need to fight unwanted cognitive processes as they occur so that they are equipped to deal with distress when it occurs. Clear Behavioral Health’s therapist Rodman “Roddy” Walsh, LMFT explains, “By utilizing the principles of MBCT with a compassionate and direct approach, I encourage clients to simply be where they are. In this space, they can be the conscious observers of their own thoughts and feelings without judgment while also trying to better understand how thoughts and feelings influence behavior and patterns.”

This kind of awareness can have immediate effects on health and well-being. MBCT makes it possible to improve emotional regulation by ‘befriending’ fear, leading to improved mood and better ability to handle stress.

Dialectical Behavior Therapy (DBT) 

DBT is an expansion of MBCT & CBT in that it uses the principles of mindfulness “acceptance” and cognitive-behavioral “change” in tandem.  Focusing on validating heightened emotions supports lower resistance to changing behaviors. Dialectical Behavioral Therapy connects cognitive and behavioral therapies as a way of helping one learn and adapt healthier methods of coping with painful emotions, often through acceptance and change. 

DBT is considered a top-down approach to self-regulation, that teaches clients to manage symptoms through mindfulness and skill-based strategies. This often pairs well with the bottom-up work that is done in other therapies like Somatic Experiencing and EMDR (discussed in previous articles), by working at the level of the body to achieve similar goals to lay the foundation and build one’s capacity to work on deeper trauma processing. Clear Behavioral Health’s relatable and inspiring therapist Gracie Walker, AMFT shares her experience, “I find DBT skills to be highly effective for clients who struggle with emotional regulation. Clients learn to apply skills that will replace dysregulation and unhealthy coping skills with healthy boundaries and esteem-able communication that assists them with achieving their goals and deepening their relationships.”  

DBT is a CBT derivative for understanding coping with external triggers.  Clients explore emotionally extreme responses in their relationships.  These clients learn to attach healthier coping to these situations.

Treatments at Clear Behavioral Health may effectively blend therapy methods to cover a client’s challenges. Clear Behavioral Health Therapists are adept at providing a multitude of skills, to meet individualized treatment needs.  Stay tuned for our next and final segment of What Works in which we will discuss modalities that integrate the brain/body connection.

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