[IPS] Breakthrough Series 1: Cognitive Behavioural Therapy for Phobias/Anxiety

What Is Cognitive Behavioral Therapy?

Cognitive behavior therapy assumes that our thoughts, feelings, and behaviors are interconnected and involves efforts to change thinking and behavioral patterns to relieve symptoms of psychological problems. The therapy is evidence-based meaning that the therapy has been scientifically proven to produce change in many people who suffer from anxiety disorders, depression, and other severe mental illness.  

How Does the Treatment Look Like?

Below is a brief example of how the treatment would look like for David who is 10 years old and has a fear of dogs. (The following example can be specified to phobias and social anxiety.) 

STEP 1) Psycho-education: there are several topics that the child can learn and discuss to better understand the reason behind our emotions. 

  • What are emotions and what good are they?  
    • David learns the adaptive functions of our emotions as well as how our emotions can become maladaptive. 
  • How do we identify our emotions? How do we express our emotions both inside and outside? 
    • David may use the Feelings Vocabulary Chart, Feelings Thermometer, and other fun ways to identify his emotions. 
  • What is the cognitive triangle
    • David learns that our thoughts, feelings, and behaviors are interconnected. Below is an example with David’s case. 
      • Event: David sees a dog on the street. 
      • Thought: He thinks that the dog will run towards him, bite his ankle and that he will have to go to the emergency room. 
      • Feeling: He feels scared and horrified. 
      • Behavior: He crosses the street and runs away from the dog. 
      • Consequence: David feels relieved. 

*Remember that this is only a SHORT-TERM relief! 

Every part of the chain can be an intervention point for later in the treatment. Below is an example with David’s case. 

  • Thought: The child becomes a detective and detect any thinking errors that we all make and learn to check the facts. 
  • Feeling: The child can use breathing relaxation skills and other emotion regulation skills to reduce feelings of fear. 
  • Behavior: The child can practice exposure therapy to experience the reduction of anxiety even when he/she is with dogs. 

STEP 2) Cognitive Restructuring 

  • What is the anxiety cycle
    • David learns that avoiding a fearful situation/thing can decrease anxiety temporarily, but it would only increase fear in the long run and that the anxiety cycle continues to prevent him from feeling less fear. 
    • WHY? This is because David does not have the opportunity to learn that dogs are okay to be around with and believes that he has not been bitten because he stayed away from dogs. 
    • Thus, David then learns that not running away from dogs is the ONLY way he can overcome his fear of dogs. (Can you think of a way how David can overcome his fear of dogs without learning that they are okay to be around with? Probably NO!) 
  • Detect thinking errors that we all make. 
    • The following are several examples of our thinking errors: catastrophizing, feelings as facts, mind reading, blaming yourself, jumping to conclusions etc. 
    • David imagining that the dog will bite his ankle and that he will have to go to the emergency room may be an example of catastrophizing. 

STEP 3) Exposure 

  • Plan for exposure therapy! 
    • David makes a list of fearful situations with the therapist from the least fearful to the most fearful. Below is an example of David’s anxiety hierarchy. 
      • Looking at pictures of puppies 
      • Looking at pictures of dogs 
      • Looking at pictures of large dogs 
      • Watching videos of a dog 
      • Watching videos of dogs 
      • Standing two meters away from a real dog 
      • Standing one meter away from a real dog 
      • Standing right next to a real dog 
      • Touching the dog gently 
      • Hugging and playing with the dog 
  • The remaining part of the treatment is exposure therapy. It is important that David gets to experience and feel no or mild levels of anxiety at the completion of each stage! 
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