Frequently Asked Questions
Do All Therapists Provide CBT/ERP? How Do I Find a Qualified Therapist?
It’s important to know who you’re entrusting as part of your health care. A credible therapist will freely discuss/advertise their training background and qualifications for providing a given treatment, hold membership in relevant professional organizations, and be free of licensing board sanctions. Open-ended services without structured goals, treatment plans or time-frame/limits are unlikely to be true CBT. Educate yourself as a consumer!
Unfortunately, locating providers properly and consistently using evidence based treatment is one of the main difficulties patients face across much of the country. National agencies including the National Institutes of Health, the Anxiety and Depression Association of America and the International OCD Foundation recognize a need for greater use of these treatments, and the proper training and supervision of more professionals. A motivated therapist with more limited training or self-learning about ERP may in some cases be the only option in a given community. Professionals can work to improve their skills and knowledge through use of readings, “tool-kit” seminars, and professional workshops (e.g., see details of upcoming Behavior Therapy Training Institute programs sponsored by the IOCDF, and offerings at Penn Center for the Treatment & Study of Anxiety). However, these activities would be viewed by most experts as limiting what services or patient severity levels that therapist would ethically and responsibly wish to offer before consulting or referring a patient elsewhere to a more experienced ERP professional or program.
Our phone screen can be useful in helping patients decide on their best available treatment options both locally and nationally, dependent on a number of factors (e.g., history and past treatments, nature and severity of symptoms, resource and support options). For more information and further considerations when choosing a therapist, please also see: http://www.ocfoundation.org/Choose_A_Therapist.aspx.
So… What Exactly is Cognitive Behavioral Therapy (CBT)? How is it Different Than Other Forms of Psychotherapy?
The basic principle of (CBT) is that what a person believes influences his or her emotions and behavior. Treatment focuses on the inter-relationships between a person’s thoughts (cognitions), actions (behaviors), and feelings (affect) and the roles they play in a person’s symptoms, functioning, and quality of life.
CBT is different from other kinds of psychotherapy or “talk therapy.” Whereas some therapies focus on helping the person to discover why they feel anxious, CBT emphasizes teaching the person how to feel less anxious and how to approach barriers to treatment. While some forms of therapy assume that the main reason people get better in therapy is because of the positive relationship between the therapist and patient, the CBT approach believes a good, trusting relationship is important but not enough.
What allows CBT to be relatively brief is its highly instructional, problem-solving approach with distinct, tangible goals. Greater treatment continuity occurs with the use of between-session homework assignments. CBT therapists believe that people change when they learn to think and behave differently. Therefore, CBT focuses on actively teaching sets of skills that patients learn to use on their own.
What is Exposure and Response Prevention Therapy?
“Exposure” consists of gradual exposure to various situations that are feared and avoided due to anxiety. At the same time, patients learn how to prevent themselves from engaging in avoidance (“safety behaviors”) or compulsions which is called “Response Prevention” (sometimes called “Ritual Prevention”).
The scientific rational behind ERP is that continuously confronting feared situations eventually leads to decreases in anxiety or habituation. (Consider an analogy of watching a scary movie 25 times in a row—your body would actually become BORED and cease responding as strongly to the frightening cues).
Patients are NEVER asked to participate in an exposure situation that would be harmful to them, and assist the therapist in planning exposures that best match their symptoms.
ERP with a properly trained therapist is very effective; depending on the study, a marked reduction in symptoms has been found to occur in 50-90% of individuals. Developed with OCD and phobias, variations have been found useful for all anxiety disorders.
How Long Will Treatment Take? Won’t It Be Expensive?
CBT is considered among the “fastest” of psychotherapies in terms of results obtained. The average number of sessions clients receive (across all types of health problems) is only 12-16. Many treatments for even significant OCD and anxiety problems can be accomplished within 25-30 sessions with appropriately structured services. And some symptom presentations may respond well in as short as 4-6 sessions! Some other forms of psychotherapy can take years. Before we conduct a thorough assessment and begin, it is impossible to determine how many sessions or what kind of sessions will be most helpful to your own situation and goals. Following the evaluation, we will discuss our team’s recommendations for the structure and estimated time frame of a treatment plan we believe to most likely be of benefit for you. Such estimates are subject to change as we gain more information about your situation and assess your treatment response. You are always an active part in the decision-making. If at any time we believe your needs are not best met at KCCAT, we will be candid about that, and refer you to another provider or type of treatment as indicated.
We recognize that the cost of treatment is an investment. At times, a patient’s level of symptoms and needs can make these costs appear daunting. Families must carefully weigh this along with current and potential costs of living with an untreated (or under-treated) disorder, which may also be quite significant over time. The reality is that providing high quality specialty care is not a free or low-cost service, but please know we are committed to managing healthcare costs, including helping to explore available options or alternatives if they may be appropriate to your presentation.
While many people obtain lasting relief with appropriate treatment, it is important to know that most experts consider anxiety disorders to be chronic conditions. Therefore, the effective management and reduction of symptoms, the recognition of how to handle future symptoms that may occur, and the long-term adaptation of life skills towards happy, healthy, and productive functioning are more realistic goals than the notion of a “cure.” The true cost effectiveness of CBT/ERP is often best viewed both in terms of more immediate improvements in symptom interference, as well as longer term gains in future functioning.
I’m Not Sure We Need a Specialist Yet… is KCCAT Only for More Severe or Homebound Patients?
Absolutely not! Treatments are completely individualized to level of need. In fact, we encourage families and other providers to consider KCCAT services as an aid to early intervention and even prevention. Our thorough assessment procedures and consultation services may serve to detect and redirect potentially maladaptive approaches to general coping styles, parenting a child with an anxious temperament, resolving school or behavioral difficulties that stem from anxiety reactions, and other proactive strategies that may help to significantly reduce the probability of developing more impairing symptoms — before the time commitment and costs of full treatment is needed. Our free phone screen and initial consultation appointment option could be a great way to decide if a tailored, early intervention approach might be a good fit for your situation. We are always happy to provide educational and reading suggestions, too!
Can I Receive Services Even If I Live Far Away?
Individuals coming to the clinic may live outside the greater Kansas City area. Following an evaluation, some patients may have portions or all of their treatment elsewhere: they live too far away to come on a regular basis, or they may already have follow-up care arranged with another provider for after our intensive outpatient program. We regularly work very closely with other therapists, physicians, and schools to ensure that your care is comprehensive.
Patients who lack available CBT resources in their area may also consider the option of an Intensive Treatment Program, if warranted for their particular problem. An intensive consists of daily or several times a week therapy (which, depending on their symptoms usually ranges from 1-4 weeks). Patients do not spend the entire day in session; rather, each session lasts several hours. Patients stay at a local hotel (we have arrangements with several nearby) and spend additional time between sessions working on goals. We are also able to supplement our treatment protocols with phone or televideo sessions when appropriate, reducing travel needs and assisting with generalization to the home environment even when home visits are impractical due to distance.
What Exactly is “Intensive” Treatment? Is it More Difficult?
The word “intensive” only means that treatment is delivered on a more frequent schedule (sometimes called “accelerated” treatment). As ERP is a learning-based therapy, there is some evidence that this format may be equally or more effective than spaced treatment for some patients, so even those who have not responded to past therapy may be successful with an intensive. Working more closely with your therapist allows you to receive immediate feedback and support. As we recommend mastery of increasingly difficult exposures for all patients, regardless of their session frequency, intensive therapy should be thought of as more focused and possibly more effective, but not necessarily more difficult to do than weekly treatment. The good news is that many people finish these intensive treatments noticing dramatic improvements in symptoms and armed with new skills for continued improvement.
Even for those patients less severely impaired, some may find it more convenient to come for treatment for a briefer period of time, rather than stretch out their treatment. Besides those who come in from out of town, this may also be a good option for “jump starting” treatment for patients who have difficulty adjusting work or school schedules.
Our no-interest payment plans are available for intensive treatments, please speak with our staff about your treatment needs. An evaluation can help determine if an intensive program may be a good option for you.