Clinic Psychology Services Cognitive Behavioural Therapy Cognitive-Behavioural Therapy is a form of treatment that has repeatedly been shown to be among the most effective in reducing or eliminating anxiety and depressive disorders. The Cognitive-Behavioural Therapy provided at the Anxiety and Depression Clinic involves three components that are critical to overcoming anxiety/depression: Education, Thought Challenging, Emotional Engagement. Education “You can’t fix what you don’t understand.” This adage is completely true when it comes to anxiety and depressive disorders. This is why it is essential for treatment to have a good educational component that explains what the disorders are all about and how they are treated. Education itself won’t get rid of anxiety or depression - it’s not quite that powerful - but it makes the other techniques work. Education can help reduce stigma, provide hope, helps you understand what the treatment will involve and why. Thought Challenging Our minds are wonderful things. They take in massive amounts of information about the world, try to make sense of the information based on our past experiences, beliefs, and biases, and then create an appropriate emotional state based on the information. Usually our minds are accurate in interpreting the information and selecting the appropriate emotional response, but not always. Consider a scary movie. We are not in any real danger while watching the movie, but emotionally we respond as if we were in danger. With anxiety and depression, this type of mismatch is happening. The mind interprets something as negative, hopeless, or dangerous or threatening when in fact it is either not as negative, hopeless, or dangerous as the person feels. Thought challenging is a process of systematically identifying and challenging these thoughts, helping the client learn to re-evaluate the actual amount of danger, threat, negativity, or hope. Emotional Exposure and Response Prevention Emotional engagement is the most powerful component of treatment, a critical element. Unfortunately, it is by definition the most difficult part of treatment. Emotional engagement involves exposing yourself to things that cause negative emotions or anxiety to rise. Depending on the specific emotional difficulties, this may involve social interactions, activity schedules, confronting certain animals or objects such as heights or germs, situations such as talking to authority figures, body sensations such as racing heart or shortness of breath, or thoughts such as worries or memories. Emotional engagement works by helping clients learn new, correct information to contradict what they expected to happen. Whether this is learning that “I expected [dangerous outcome] to happen, but it didn’t” or “I expected this to [be overwhelming, be a failure] but it wasn’t that bad”. The more we learn this, the more our minds shift from expecting the worst to having more realistic expectations. Our therapists understand that this usually is difficult, which is why we don’t expect (or want) our clients to tackle the harder things first. Instead we start with something that will be only mildly to moderately difficult. Once our client has success in overcoming that emotional exposure, we move to something slightly harder and so forth. Very often, a therapist and client will sit down before undertaking exposure to create a “Hierarchy of Emotional Engagements”, which is an ordered list of things that cause different amounts of negative emotions, as well as the different variations that make them more or less emotionally difficult. This hierarchy then serves as a roadmap for treatment.