Cognitive behavioral therapy (CBT) has been proven to be a very effective treatment for mental health concerns such as anxiety and depression. With the large variety of CBT self-help books and web-based programs available though, one may start to wonder if seeing a professional is necessary or if those self-help methods will do the trick.
The answer to this question though is not a clear-cut “yes” or “no.” Although some studies do indicate that self-directed therapy can lead to a reduction in symptoms of anxiety and depression that is sustained over time, these results may not give the full picture. Given this, there are many things that you should consider before heading down the path of self-help.
How effective is self-directed therapy?
Studies have shown that self-directed therapy tends to be moderately helpful, whereas CBT with a therapist is more effective in nature.
What are the advantages of CBT with a therapist?
- Accountability –Having someone that you need to be accountable to will increase the likelihood that you will follow through on using the strategies and techniques that you are learning. For example, if an important step in making progress is a particular behavioral challenge (e.g., facing a fear), you are much more likely to follow through with doing it if you have a therapist who is going to ask you about it.
- Added insight – One core component of CBT is identifying those thoughts and core beliefs that are causing symptoms of anxiety and depression. Although some of these thoughts and beliefs may be easy to recognize, some may be hidden a bit and in need of a therapist to bring them into your awareness. In addition, some of your thoughts and beliefs may be difficult to face and therefore easier to avoid. In these situations, it can be helpful to have the support of a therapist who will push you to confront those things that are difficult to acknowledge and recognize.
- Support – CBT strategies are not always easy to implement and at times may make you feel uncomfortable. In addition, the main reason why self-directed therapy ends up being ineffective is because it is easy to give up on. Having a therapist by your side to encourage you through the process and help you stay motivated can be an added benefit of in-person treatment. When you are ready to give up, your therapist will be there to process with you why that is and help you realize the benefits of staying committed.
How significant are my symptoms?
Individuals who benefit from self-directed therapy tend to be those with mild to moderate symptoms of anxiety or depression that do not interfere with their ability to function on a daily basis. Those individuals who have more significant symptoms (e.g., so depressed that they cannot get out of bed, so socially anxious that they avoid going places where they may need to socialize) are not good candidates for self-directed therapy and would benefit more from seeing a therapist.
How feasible is it for me to regularly meet with a therapist and can I afford it?
Various factors such as your work schedule, the area that you live in, the type of insurance that you have, and your financial means can impact your ability to find a CBT therapist that you can meet with on a regular basis and afford. If you are unable to find a provider who you can afford, that is easy to get to, and that can meet with you at a time that is convenient for you, self-directed therapy may be the next best option. If you are able though to find a provider who meets these criteria, in person therapy will likely be more effective that doing it on your own.
Are my only options self-directed or weekly individual therapy sessions with a CBT therapist?
No. Another option to consider is combining self-directed therapy with brief weekly phone calls with a CBT therapist. This way you still benefit from some of things that a therapist can provide such as added input and insight, accountability and encouragement.
I have decided that a self-directed approach would be helpful. What do I do next?
If after considering the above questions you decide that a self-directed approach would be best, the Association for Behavioral and Cognitive Therapies maintains a list of books (http://www.abct.org/SHBooks/) that they have given their “seal of approval.”
In addition, Seth J. Gillihan, PhD, a licensed psychologist and Clinical Assistant Professor of Psychology in the Psychiatry Department at the University of Pennsylvania who specializes in CBT, suggests the following guidelines in pursuing a self-directed approach:
- 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 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.
- 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 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.
I have decided that a self-directed approach will not be the most effective. What should I do next?
Since CBT has been proven to be one of the most effective treatments for depression and anxiety, you should start by searching specifically for CBT therapists. Once you have identified a few options, reach out to them to get a sense of whether they are the right fit. Even though CBT follows some basic principles and steps, each therapist might be slightly different leading to your “clicking” with one better than the other. Consider how well you feel that your therapist can relate to you, how helpful they are, and how available they are during the times that work well for you to meet.
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