Editor’s note: This article originally ran August 17, 2020, and was updated September 27, 2022.
Our country is in a persistent mental health crisis that was only worsened by the COVID-19 pandemic and its aftermath. About 1 in 5 adults experience mental illness each year, as do 17 percent of children.
“We are living through unprecedented times—we have survived a pandemic and are being told that it’s over while over 400 Americans continue to die each day. Simultaneously there has been a racial reckoning that is ongoing, stark political division, a war in Eastern Europe, and instability in global financial markets. Some of these stressors have placed enormous burden on individuals, families and communities. Any one of these stressors could contribute to anxiety and depression, but all together, it’s a lot for anyone to manage,” says UNC Health clinical psychologist Crystal Schiller, PhD.
If you’re struggling with mental health issues, a type of counseling called cognitive behavioral therapy (CBT) can help you manage uncertainty to feel better in the short run, Dr. Schiller says, and to examine what you want in life and how to navigate these barriers in the long run.
What Is CBT?
CBT is a form of psychological treatment that is effective for a range of issues, including depression, anxiety disorders, trauma, insomnia, substance abuse, marital problems and eating disorders.
It is based on the idea that psychological problems at least partly stem from unhelpful ways of thinking and learned patterns of behavior, and that people can learn better ways of coping.
CBT uses talk therapy guided by a trained therapist to help a person change thinking and behavior patterns. This can include using problem-solving skills to cope with difficult situations and identifying cognitive distortions. Cognitive distortions are ways of thinking that feel true or instinctive but often are unrealistic and detrimental. They include:
- All-or-nothing thinking: Seeing things in extremes—as either good or bad, perfection or failure
- Overgeneralization: A single negative event is viewed as a never-ending pattern of defeat
- Disqualifying the positive: Taking a good event, such as a positive work review, and saying it isn’t real or doesn’t really count
- Jumping to conclusions: Can include “mind-reading,” or assuming you know what someone is thinking, and “fortunetelling,” or believing that bad feelings about the future are established facts
Most of us have some of these types of automatic thoughts at least occasionally, but people dealing with anxiety or depression can become consumed by them.
CBT can involve keeping a daily log of your thoughts and identifying the cognitive distortions at play in your thinking so that you can adjust your perspective.
For behavior change, a CBT therapist might help you role-play a future conversation or event, so you know how you want to act in that moment. He or she can help you face something you fear in a gradual and supported way and teach you techniques that can help calm your mind and body.
Sometimes, CBT is used in conjunction with psychiatric medication, such as antidepressants, but not always. Therapists who provide CBT are often psychologists (PhDs) or licensed clinical social workers (LCSWs), who do not prescribe medication. In these cases, your doctor or a psychiatrist can work with your therapist to manage your treatment.
Challenges of CBT
To get the most benefit from CBT, a patient must commit to the process, which can be challenging. It requires time and effort to attend regular sessions with a therapist and to do additional work on your own outside of your sessions.
In addition, CBT will require you to confront your emotions and anxieties. This may make you feel uncomfortable, especially at the beginning of the process. But these feelings should lessen over time as you continue with CBT.
Importantly, this discomfort can have a major payoff in lessening your symptoms and improving your quality of life. Therapists who practice CBT can help you work gradually to minimize any discomfort and increase your chances of success.
CBT by Telemedicine
The COVID-19 pandemic has brought about a big change in how therapists provide CBT: there’s been a broad move to virtual therapy.
The connection between the therapist and the patient is very important, Dr. Schiller says, and it can still be a quality, trusting relationship over video chat. In fact, Dr. Schiller and her colleagues published a study showing that virtual therapy is just as effective as face-to-face therapy for depression.
“I see my patients in their own environment—home or work—which provides a lot of important contextual information about how they’re doing,” she says. “Some of my patients meet with me from their bed, especially when they’re feeling really depressed or fatigued. I see them in their home environment with their pets and sometimes even their family members.”
Dr. Schiller says some patients have told her that because of the telemedicine visits, they felt comfortable sharing information with her that they had never shared with anyone else. And some said the telemedicine visits enabled them to keep functioning, despite all of the pressures in their lives at home and at work.
“We have seen fewer cancellations since moving to telemedicine visits, in large part due to the convenience of meeting with therapists online. We expect telemedicine will be the new norm,” she says.
One silver lining of the pandemic, Dr. Schiller says, is that anxiety and mental health care have become less stigmatized.
“People became more comfortable talking about their experience of stress, anxiety and sadness,” she says. “We saw increases in the number of people seeking mental health care, and the numbers keep growing. People feel less afraid to reach out for help when so many of their peers are struggling, too.”
If you think therapy might be right for you, talk to your doctor. If you don’t have one, find a doctor near you.