Discovering New Options: Self-Help Cognitive Behavioral Therapy

By Seth J. Gillihan | Nov. 01, 2016

 

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 close by or they're not in-network or they're prohibitively 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 CBT for 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 bed is probably not a good match, and will likely need one-on-one treatment with a professional.)

Studies also show that people tend to maintain their progress over time, which is very encouraging. One of the goals of CBT is to "become your own therapist" by learning skills you can use on your own after treatment to keep feeling well. 

If you're interested in self-directed CBT, the Association for Behavioral and Cognitive Therapies maintains a list of books they've given their "seal of merit." I also recently wrote a book on CBT for anxiety and depression called Retrain Your Brain: Cognitive Behavioral Therapy in 7 Weeks.  The workbook is meant to present the 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.

The cognitive techniques found in my book and others include:

  • Identifying your thought patterns.
  • Discovering how your thoughts affect your feelings and behaviors.
  • Determining if your thoughts are accurate.
  • Replacing biased thoughts with more realistic ones.

Common behavioral techniques 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:

  1. 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.
  2. Choose a book that is based on solid research. Self-help therapy takes considerable time and effort, so it's worth directing your energy toward a program that has a solid grounding.
  3. 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.
  4. 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 we find 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 psychological treatments have many advantages. Completing a program that's right for you can lower your anxiety, improve your mood and provide you with skills 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

Comments
Bob Reuter
Seth, many of your commenters seem to feel you will respond to them or are simply unable to be clear in writing. Do you follow up with them or do a follow-on blog to reduce this confusion. I was a Stanford doctoral student; but, after Vietnam service got an MBA from Wharton instead. I did undergraduate research in the role of language in concept development and got very interested in cognitive studies (Festinger, Cognitive Dissonance) and Psycholinguistics. I am planning a blog and looked up what is happening in CBT blogs to see where the need is. I worked out a lot of my issues related to geographic relocation, relationships, and just feeling bad at times ending up seeing the relationships between the dynamic duo, "thoughts and feelings."
9/13/2018 12:19:43 PM

Sophia Lara
Such a great description about Cognitive Therapy. Thanks for sharing this useful blog with us. Cognitive therapy is based on the theory that much of how we feel is determined by what we think.
Before reading this blog I checked another website which is too useful. I would like to share with you ( http://www.5degreespsychotherapy.com )

Keep sharing man !!
4/12/2018 2:45:32 AM

Sara
I have started : Cognitive Behavioral Therapy I have only had one session and had to deal with a true heart break from just a few mnths ago. it feels like a flood gate has opened and Im going crazy. I had large traumas from teens. And I know they effect me but my mind had forgotten them i didnt have night mares just didnt like being grabbed from behind is all..My husband went through a mental break if thats what I can call it the things that he did durring this put me in a mental jail.. I see things over and over b4 my session i HAD ALOT of anger still but now I am back to my feelings as it was happening.
7/25/2017 8:59:57 PM

Kim Moore
I think this blog may be helpful I have no contact with anyone really. I am looking for a day support group either online or here in town. Gainesville GA
12/7/2016 10:52:37 AM

Carmen Celis
Is great this services
12/6/2016 12:45:17 AM

Carmen Celis
This is the first time I hear of this programs and I want to learn. Thank You.
12/6/2016 12:44:10 AM

j
but geez...ANOTHER self-help book? They are everywhere and all promise help with purchase. Have they worked yet? No. Ripping desperate people off time and again. Meh.
12/3/2016 2:43:54 AM

Esther Fidler
Recovery International provides self-help cognitive behavioral training in support groups, online meetings, phone meetings, chat rooms, and has many books by Dr. Abraham Low. Find info on recoveryinternational.org. This program has changed my life/thinking. I have become a happy person and left behind the harshness in my relationships. Anxiety is now better controlled.
12/1/2016 9:11:34 PM

Carol
How about for a caregiver with few resources, who is struggling with so many issues? And has health challenges of their own?
12/1/2016 12:13:13 PM

Gerri
I want to learn more about trauma based cognitive behavior therapy for people who have experienced abuse as a child. Do you have any books to recommend?
12/1/2016 10:35:41 AM

Margie
Thank you. I will certainly research this. My current "self" project is moving to thriving instead of just surviving. I also am struggling with as a newer insurance agent. The only competition I have is the person looking at me in the mirror every day. - from our regional business meeting.

It seems just as difficult and just as painful inside to maintain, let alone improve self confidence. I have a great support system when I use it. CBT might be the link from awareness to overcoming. Have a great day.
12/1/2016 9:07:07 AM

Fran kumpula
A source for reliable reading for self help would be helpful.
12/1/2016 8:29:46 AM

Jane Huber
Help!
12/1/2016 8:00:27 AM

Jane Huber
Most interested for help for me and my son.
12/1/2016 7:59:42 AM

nancy a krell
We are so fortunate to have NAMI pass information like this on to us.
12/1/2016 7:14:44 AM

Christina Cline
Need assistance
12/1/2016 1:08:52 AM

Tavius
I have been using CBT since first introduced years ago. I find the idea that thoughts make feelings very powerful. Recognizing distorted thinking is a key to happiness.
11/30/2016 8:03:32 PM

Brittany
http://www.abct.org/SHBooks/
11/16/2016 6:00:21 PM

Patricia McLaughlin
Thank you, Seth. NAMI members may also want to explore the online self help app programs found at workithealth.com. This self help digital series is for individuals dealing with dual diagnosis of substance abuse and mental health conditions. The program is available to individuals, employers and health insurance providers. You can also follow them on twitter @workithealth.
11/3/2016 11:18:11 AM

Fawn
It would be really helpful to have a suggested list of reliable reading!
11/2/2016 1:29:31 PM

Cynthia
This is great! Perhaps NAMI could follow suit by offering the information in the Family to Family course for those who cannot access a face to face class or simply do not want to.
11/1/2016 6:11:41 PM