# Cognitive therapy, and behavioural therapy - do you know the difference?



## Lachlan (Jul 3, 2008)

?? I have just realised the difference, and similarities


----------



## nonethemore (Oct 18, 2010)

Usually both therapies are combined and work together for anxiety. Behaviour can affect cognition (thinking) and thinking can affect behaviour. Cognitive therapy aims to challenge any distorted thinking or threatening cognitions. Behavioural therapy typically involves the patient actually exposing themselves to feared situations. Repeated exposure allows the patient to perceive feared situations differently and make more reasonable assessments.


----------



## Lachlan (Jul 3, 2008)

^I think there is a little more to the concept of Behavioural therapy than than. This is one of the things that resently I becaome aware of. Behavioural therapy was actually developed _before_ cognitive therapy. From what I interpreted, the idea behind the behavioural therapy is that by focussing on the behaviour of the patient only, he can be changed. The example used to illustrate this point was someone being treated for bulimia. There was no cognitive therapy involved in this. The person was first told to record what they ate, and how many times they threw up etc, for a month. After looking at the records, the therapist then devised a routine that the patient was told to follow. this included steps like, eating food two spoonfulls at a time, and then waiting one minute. These instructions focussed on changing the _behavior_ of the patient. Over time, the modified behaivor began to affect the patient. The theory explained that by seeing the advantage in the new behaivor after being exposed to it, the patient will naturally adopt this, and forget the old behaivor of binge eating, an throwing up. Over time the patients throwing up decreased and eating habits became more regular.

To me, this really highlighted the power of the _behavioural_ side of CBT, becasue I learn from behavior a lot, personally. I think this is an important part of CBT, perhaps referred to as 'Reinforcement' by some specialists. Not only is it interacting to confirm the cognitive part of the therapy, like you said, but it is actually a powerfull method of therapy, and change, in itself in the right situations.


----------



## wxolue (Nov 26, 2008)

Behavioral therapy works like this. When someone experiences a situation that produces anxiety, they get a rush of adrenaline. This was from back in the stone age with mountain lions blah blah blah... After about 20 minutes of sustained anxiety (adrenaline), your body kicks in to say thats enough, we can't stay in this heightened state anymore, and the adrenaline is turned off (you don't feel anxious anymore).

Someone with an anxiety disorder does something funny. Someone with SA, when in a situation that produces anxiety, will use avoidance techniques to avoid feeling the anxiety. These can be as obvious as leaving right before giving a presentation, or as subtle as speaking quickly, so as not to leave gaps in your speech that may produce anxiety. Avoiding eye contact, hands in pockets, using big words, smiling in excess. All of these can be avoidance techniques. Some are so natural, we don't even realize them.

When we utilize these avoidance techniques successfully, (we avoid experiencing anxiety), we shut off the adrenaline before the body has a chance to do it itself. After a while, the body becomes dependent on being taken out of an anxiety provoking situation in order to turn off adrenaline, instead of naturally doing it after 20 min. Behavioral therapy attempts to reverse this process by forcing the body to experience anxiety without avoidance techniques, which subsequently forces the body to naturally turn off the adrenaline. Behavioral therapy seeks to make the natural adrenaline turnoff become more automatic.

The result is in a shorter length of anxiety before the adrenaline is turned off, and a lower peak of anxiety.

Cognitive therapy reverses the root of a patients anxiety by reversing the inaccurate negative thoughts they have. Behavioral therapy also serves as a sort of test to see if the cognitive thoughts. "Noone wants to talk with me." By exposing yourself to anxiety (in this case, initiating a conversation with someone), you not only gain the behavioral benefits, but your assumption that noone wants to talk to you is disproved.


----------



## nonethemore (Oct 18, 2010)

wxolue said:


> Behavioral therapy works like this. When someone experiences a situation that produces anxiety, they get a rush of adrenaline. This was from back in the stone age with mountain lions blah blah blah... After about 20 minutes of sustained anxiety (adrenaline), your body kicks in to say thats enough, we can't stay in this heightened state anymore, and the adrenaline is turned off (you don't feel anxious anymore).
> 
> Someone with an anxiety disorder does something funny. Someone with SA, when in a situation that produces anxiety, will use avoidance techniques to avoid feeling the anxiety. These can be as obvious as leaving right before giving a presentation, or as subtle as speaking quickly, so as not to leave gaps in your speech that may produce anxiety. Avoiding eye contact, hands in pockets, using big words, smiling in excess. All of these can be avoidance techniques. Some are so natural, we don't even realize them.
> 
> ...


Interesting. I've haven't really heard much about the biological (adrenaline) aspect of behavioural therapy before.

I agree that exposure/behavioural component is a really significant aspect of CBT. You have to expose yourself to situations you usually find threatening in order to condition yourself with different responses and develop more rational thoughts.


----------



## Lachlan (Jul 3, 2008)

wxolue said:


> Behavioral therapy attempts to reverse this process by forcing the body to experience anxiety without avoidance techniques, which subsequently forces the body to naturally turn off the adrenaline. Behavioral therapy seeks to make the natural adrenaline turnoff become more automatic.
> 
> The result is in a shorter length of anxiety before the adrenaline is turned off, and a lower peak of anxiety.


right. So this is whats going on in the brain/body, biologically. How did you see the actual therapy working? ie, the practical application of the therapy. If you were trying to treat someone with SA by behaivoral therapy alone, how would that work? do you think it would work? I'm guessing from your explaination it would be something along the lines of repeated 'exposure' to currently anxiety creating situations, possibly starting with less anxious situations. From what I understood, a main idea behind the behaivoral therapy was that the new behaivor that the patient is intructed to follow provides its own reward, so that in time, the patient forgets the old behaivor (in a situation like you've explained, 'avoidance') and continues with the new behaivor naturally because it's the most rewarding. Where are you suggesting that reward comes from if soley trying to treat SA with behaivoral therapy? I'm guessing maybe the period of time after the adrenaline has stopped could become a 'reward' for 'getting over' the first anxious period, if what you said is true. I could see this working. My interpretation of behaivoral therapy and SA, was that there wasnt really a big enough 'natural reward' from therapy prescribing 'exposue', partly to do with the supposed cognitive element of SA, which is why CBT is common.


----------



## wxolue (Nov 26, 2008)

I've never heard of the reward idea. It would have to be a dam big award to get someone with anxiety to face their fears. I told you the physical part (adrenaline). There's also a bit of overlapping in the behavioral and cognitive parts.

When you face a fear, feel anxious without avoidance techniques, feel the natural coming down from anxiety, and then exist in the situation that had caused you anxiety a few minutes ago without anxiety, it sort of proves that x situation isn't so bad. The "It actually doesn't make me feel anxious" thought appears naturally and in a subtle way (the only change that you will notice with behavioral therapy is that you don't feel as bad after the third or fourth exposure). In that sense, you are changing your cognitive thoughts through behavioral therapy.

If you attempt exposure therapy without cognitive therapy, you probably won't get anywhere. You may feel better in the few hours after the exposure, but its only a matter of time before you review the exposure with "I should have done X" or "I looked like such an X" or "I'm such an X." Without the cognitive therapy to catch these thoughts, the exposures wont get you anywhere.

To answer some questions I missed:

In my therapy, there were two parts to the exposure:

A) Weekly: This is stuff we did in the session. Public speaking was it for a long time. The first one was talking about our anxiety to two therapists and the three other group members. The fifth time was speaking to 12 people (7 of which we didn't know) about something personal. We didn't know what the topic was until we got up there (speech on the fly). Each therapy session the tasks got harder because we were improving, but because the tasks got harder, the anxiety we felt week to week was constant. Difficulty up, anxiety the same.

B) Homework: This is stuff we did every day in between therapy sessions. We were instructed to do the same exposure every day. In this instance, difficulty the same, anxiety down (the same exposure was easier to do the 5th, 6th, 7th time)

As I said, I've never heard of any reward. Is this like giving myself a present after doing something anxiety provoking? CBT (as I learned it) is about realizing through thought changing and actual personal experience that our anxieties are irrational. It's never presented that bluntly, but thats how I see it a month into therapy in a nut shell.


----------



## Lachlan (Jul 3, 2008)

Yeah, I think how you interpret CBT it is prety much the same as me. I agree with what you said about why just behaivoral therapy wouldnt work. I think the 'reward' is sort of what you expalined, just being in the situation without the anxiety.


----------

