As a therapist, I’ve repeatedly seen the same research conclusions: a few sessions of cognitive-behavioral therapy (or CBT) can be very helpful in treating anxiety and depression. CBT’s simple yet powerful changes to the way we think and act can have profound impacts on our health and well-being.
However, many people don't have access to a CBT therapist—maybe they’re not closeby or they're not in-network or they'reprohibitively expensive. It’s also tough to take time off work or child care every week to see a therapist.
If you’ve wanted to try CBTfor anxiety or depression but aren't able to see a CBT therapist, you may not need to. Many studies have found that self-directed CBT can be very effective. Two reviews that each included over 30 studies (see references below) found that self-help treatment significantly reduced both anxiety and depression, especially when the treatments used CBT techniques. The average amount of benefit was in the “moderate” range, meaning people didn’t feel 100% better, but were noticeably less anxious and depressed.
(Note: Self-help CBT is probably most appropriate for someone with mild to moderate symptoms who is generally able to function well.A person who is severely depressed and barely able to get out of bedis probably not a good match, and will likely need one-on-one treatment with a professional.)
Studiesalso show that people tend to maintain their progress over time, which is very encouraging.One of the goalsof CBT is to"become your own therapist" by learning skills you can use on your own after treatmentto keep feeling well.
If you're interested in self-directed CBT, the Association for Behavioral and Cognitive Therapies maintains alistof books they've given their "seal of merit." I also recentlywrotea book on CBT for anxiety and depression called Retrain Your Brain: Cognitive Behavioral Therapy in 7 Weeks. The workbook is meant to presentthe best-tested tools of CBT in a user-friendly way over the course of several weeks. The exercises included are similar to what I do when I'm working with someone in-person.
Thecognitivetechniques found in my book and others include:
- Identifying your thoughtpatterns.
- Discovering how your thoughts affect your feelings and behaviors.
- Determining if your thoughts are accurate.
- Replacing biased thoughts withmore realisticones.
Commonbehavioraltechniques include:
- Scheduling activities that bring you enjoyment and a sense of accomplishment.
- Recognizing how your actions influence your thoughts and emotions.
- Making the best use of your time.
- Breaking down daunting tasks into more manageable ones.
- Facing your fears gradually so they diminish.
These approaches are fairly simple and obvious. What drew me to CBT was how straightforward and intuitive it was, which also makes it well-suited for self-directed therapy. The following guidelines might be helpful if you decide to pursue self-directed CBT:
- Find a book that resonates with you.People are drawn to different approaches, tones, level of detail, etc. If a book feels like a good fit, there's a better chance you'll stay engaged with it.
- Choose abookthat is based on solid research.Self-help therapy takes considerabletime and effort, so it's worth directing your energy toward a program that has a solid grounding.
- Make room in your schedule to focus on the program.While there's a good chance you'll always have competing activities, it's better to avoid periods in your life when you're truly overextended and the therapy is likely to get pushed to the side.
- Follow the program as closely as possible.It's easy to want to skip parts of a program we’re already familiar with or we think won't work. One of the dangers with that is if wefind a program doesn't help,we won't know if it's because it wasn't right for us or because we only did part of it. Sticking to the instructions gives us the best chance of benefiting.
In a time of high anxiety, rising depression rates, soaring health care costs and limited insurance coverage for mental health, self-directed psychologicaltreatments have many advantages.Completing aprogram that's right for you can lower your anxiety,improve your mood and provide you withskills you can use as often as you need them.
Seth J. Gillihan, PhD, is a licensed psychologist and Clinical Assistant Professor of Psychology in the Psychiatry Department at the University of Pennsylvania. He has a clinical practice in Haverford, PA, where he specializes in CBT and mindfulness-based interventions for the treatment of anxiety, depression, OCD, and insomnia. Dr. Gillihan writes the ThinkActBe blog on PsychologyToday.com, and can be found at sethgillihan.com
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