Shoshana Shira Twersky

Your question is interesting. My doctoral and post doctoral training was excellent and it was all in cognitive behavioral therapy. That said, of course I understand that CBT is not the best course of treatment for all of my clients or for every disorder I treat. I would say that with any treatment, it needs to be the appropriate fit for both the individual as well for the disorder being treated for it to be effective and even then, the clinician needs to be flexible enough to allow for modifications as needed. I guess this is a very long way of saying that I don't think there are "weaknesses" per se to CBT, rather it's a matter of who who is delivering the CBT treatment and whether it is being done in a competent and qualified way. The timing of the CBT treatment needs to be appropriate; it would be premature if more time and focus should be taken on building the therapeutic alliance. And of course, CBT would not be appropriate if it wasn't the evidence-based treatment recommended for the issue being addressed.

Typically anxiety gets worse when it is left untreated and it can also cause other problems such as depression or sleep issues. The good news is that anxiety is very treatable! I'm not sure whether you've tried talk therapy in the past and what your experiences have been. Cognitive behavioral therapy is the best treatment for anxiety. If you search on psychology today.com you can look for a therapist and it's an excellent resource! You can search by area code and filter by insurance, type of disorder (such as "anxiety"), insurance, male/female therapist, type of treatment such as "CBT", etc. and it will show you the pictures and blurbs from each therapist.

Great question. It very much depends on what is being treated. Typically I would start with talk therapy and if it makes sense to then have a psychotropic evaluation that can be set up. Medication can compliment talk therapy and they can work well together. Sometimes medication can work as a "crutch" to get someone through a rough patch in the beginning stages of talk therapy, and at other times medication can serve to be more long term. Medication is very easy to prescribe but typically will not be "curing" anything rather it will help manage symptoms. The talk therapy is the place where you will be making actual changes which is why I would strongly encourage that for starters.

Psychotherapy very much works for depression, in particular cognitive behavioral therapy. The specific treatment for depression is called behavioral activation. The idea would be to pick something small that you would enjoy and would be doing if you were not depressed, and to do that one small thing. It's like playing "as if", the "fake it until you make it" strategy. There are also some CBT strategies for challenging negative thinking that can be very helpful with shifting your mood and consequently your behaviors. I would recommend looking for a CBT therapist if you were interested in trying psychotherapy.

I would highly recommend that you work this through with a therapist. In general, what often happens with PTSD is the person gets stuck with the traumatic part of the story and never gets past that part to the safe part. What we do in therapy is have the person talk in detail about the trauma but we don't stop at the traumatic part, we keep going... to the part that the person got away to safety, or the part when the ambulance came and got them to the hospital to take care of them, or the part when the perpetrator was arrested or found guilty in court etc. The idea is to un-taboo the story and keep talking about it repeatedly to normalize the experience, and part two, is to get past the trauma part and begin adding to the story telling the safety part that you lived to tell the story. There is of course so much more work to PTSD but this is a huge component.

Yes, stress is an appropriate reason to see a therapist. You can learn strategies for decompressing and the importance of self-care. I would imagine that the stress is coming from somewhere in your life and perhaps it would be helpful to unpack this and process. It is also important to realize that we each have 100% of time. Think of it as a pie, like a pizza pie with slices but each slice is not evenly distributed. Your slices represent the percentages of how you allocate your time and the pie has to total 100%. So if you have a slice that is being allocated to sleep for 20% and work for 50% and family for 10% and social/friends for 15% that leaves you only 5% for medical, hygiene, self-care, alone time, house hold tasks, etc. etc. so of course you're stressed! Sometimes reducing your stress is also about reshuffling your pie chart and redistributing time percentages as in the pizza pie analogy.