Discovering New Options: Self-Help Cognitive Behavioral Therapy

As a therapist, I’ve repeatedly seen the same research conclusions: a few sessions of cognitive-behavioral therapy (or CBT) can be very helpful in treating anxiety and depression. CBT’s simple yet powerful changes to the way we think and act can have profound impacts on our health and well-being.

However, many people don't have access to a CBT therapist—maybe they’re not close by or they're not in-network or they're prohibitively expensive. It’s also tough to take time off work or child care every week to see a therapist. 

If you’ve wanted to try CBT for anxiety or depression but aren't able to see a CBT therapist, you may not need to. Many studies have found that self-directed CBT can be very effective. Two reviews that each included over 30 studies (see references below) found that self-help treatment significantly reduced both anxiety and depression, especially when the treatments used CBT techniques. The average amount of benefit was in the “moderate” range, meaning people didn’t feel 100% better, but were noticeably less anxious and depressed.

(Note: Self-help CBT is probably most appropriate for someone with mild to moderate symptoms who is generally able to function well. A person who is severely depressed and barely able to get out of bed is probably not a good match, and will likely need one-on-one treatment with a professional.)

Studies also show that people tend to maintain their progress over time, which is very encouraging. One of the goals of CBT is to "become your own therapist" by learning skills you can use on your own after treatment to keep feeling well. 

If you're interested in self-directed CBT, the Association for Behavioral and Cognitive Therapies maintains a list of books they've given their "seal of merit." I also recently wrote a book on CBT for anxiety and depression called Retrain Your Brain: Cognitive Behavioral Therapy in 7 Weeks.  The workbook is meant to present the best-tested tools of CBT in a user-friendly way over the course of several weeks. The exercises included are similar to what I do when I'm working with someone in-person.

The cognitive techniques found in my book and others include:

• Identifying your thought patterns.
• Discovering how your thoughts affect your feelings and behaviors.
• Determining if your thoughts are accurate.
• Replacing biased thoughts with more realistic ones.

Common behavioral techniques include:

• Scheduling activities that bring you enjoyment and a sense of accomplishment.
• Recognizing how your actions influence your thoughts and emotions.
• Making the best use of your time.
• Breaking down daunting tasks into more manageable ones.
• Facing your fears gradually so they diminish.

These approaches are fairly simple and obvious. What drew me to CBT was how straightforward and intuitive it was, which also makes it well-suited for self-directed therapy. The following guidelines might be helpful if you decide to pursue self-directed CBT:

1. 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.
2. 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.
3. 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.
4. 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. 

In a time of high anxiety, rising depression rates, soaring health care costs and limited insurance coverage for mental health, self-directed psychological treatments have many advantages. Completing a program that's right for you can lower your anxiety, improve your mood and provide you with skills you can use as often as you need them. 

Seth J. Gillihan, PhD, is a licensed psychologist and Clinical Assistant Professor of Psychology in the Psychiatry Department at the University of Pennsylvania. He has a clinical practice in Haverford, PA, where he specializes in CBT and mindfulness-based interventions for the treatment of anxiety, depression, OCD, and insomnia. Dr. Gillihan writes the ThinkActBe blog on PsychologyToday.com, and can be found at sethgillihan.com