Cognitive Behavioral Therapy in Portland, Oregon

Cognitive Behavioral Therapy (CBT) is a specific type of psychotherapy that is different from traditional “talk therapy.”  A few key differences are that CBT is research-based, more structured, and and more goal-directed than other types of therapies.  If you are looking for more of a “hands on” or an active approach, CBT might be a good fit for you.  

CBT has been shown to help with depression, anxiety, worry. Are you having problems with your relationships? CBT has been shown to help with that. Are you dealing with compulsive or addictive behavior? Can’t get the sleep you need or have chronic problems with stress? We have therapists who are skilled in using CBT with all of these difficulties (and many more)…

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We have therapists who specialize in a variety of problems.  Contact us for a free consult and we can help get you matched to the best professional to help you.   Here are 2 easy ways to get started…

  1. Call us now – 503-281-4852 x2
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What We Do

At Portland Psychotherapy, we are committed to helping our clients who are struggling with anxiety, depression, and other life problems so that they can live fuller and more meaningful lives. Our commitment is not just to help our clients feel better, we help them to live better.

Who We Are

Our mission is to use science to develop and guide compassionate, effective treatment and contribute to the wider community through research and training.

More About CBT

CBT is one of the few types of psychotherapy that has been scientifically tested and found to be effective for many different issues people struggle with. In contrast to other forms of psychotherapy, CBT tends to be more focused on the present, more time-limited, and more focused on problem-solving.  Clients also learn specific psychological skills that they can use for the rest of their lives.

Studies have shown that CBT is as useful as medications for many issues and can often be better in the long term, especially for preventing relapse of symptoms. There is also lots of evidence that for many issues when a client receives CBT in addition to medication, they tend to have better outcomes than those that use medications only.

What Exactly is Insomnia? (and what you can do about it)

People can experience many difficulties with sleep throughout their lives.  Some people are often told by their parents that even as small children they were never “good sleepers.” Some people experience issues with sleep following a stressful or traumatic event in their life.  Sometimes issues with sleep just seem to come out of nowhere. 

However people with insomnia all have the same thing in common – they are not sleeping well and things don’t seem to be getting any better anytime quick.

There are three main types of insomnia

  1. Difficulty falling asleep
  2. Difficulty staying asleep
  3. Waking up too early

The criteria for an official diagnosis of insomnia are as follows:

  1. Difficulty getting to sleep, difficulty staying sleep, or waking up too early.  Also if sleep is chronically non-restorative or poor in quality.
  2. These problems with sleep happen even when all the right circumstances are present (i.e. a dark, quiet room & no need to be anywhere for a period of time).
  3. The issues with sleep cause problems for the person during the day, including at least one of the following:
  • Fatigue
  • Problems with attention, concentration or memory
  • Social problems / work-related problems / poor school performance
  • Mood disturbance or irritability
  • Daytime sleepiness
  • Reduced motivation, energy, or initiative
  • Proneness for errors
  • Accidents at work or while driving
  • Tension, headaches, or gastrointestinal symptoms in response to sleep loss
  • Concerns or worries about sleep

American Academy of Sleep Medicine. (2005). The International Classification of Sleep Disorders (2nd Edition)

What is NOT Insomnia

It’s important to also know what sleep issues are not considered insomnia.  Here is a list of other common sleep disorders:

Narcolepsy is a neurological disorder caused by the brain’s inability to regulate sleep-wake cycles normally, which causes an abnormal daytime sleep pattern and also sudden muscular weakness often brought on by strong emotions.

Sleep Terrors are characterized by a sudden arousal from sleep along with intense fear.

Sleep Walking is when people engage in activities that are normally associated with wakefulness (such as walking, eating, or dressing) while unconscious of their behaviors.

Sleep Disordered Breathing is a category of problems such as sleep apnea or snoring.

Restless Legs Syndrome is experienced as an irresistible urge to move one’s body to stop uncomfortable or odd sensations.

Circadian Rhythm Disorders are types of sleep disorders that affect the timing of sleep (often caused by shift work or jet lag). For example, a person’s body may not want to go to sleep until 5am, even though they need to get to sleep around 11pm.

REM Sleep Behavior Disorder is a sleep disorder that involves acting out violent or dramatic dreams during sleep. 

Hypersomnia is a disorder characterized primarily by severe excessive daytime sleepiness which is not better explained by a medical illness or other sleep issue.

Good News for Insomnia Sufferers

If you believe you suffer from insomnia and not one of the other, related disorders then there is good news for you – there is an effective, natural treatment available.  The science of sleep medicine has developed many tools over time.  One of these tools is a medication-free approach to treating insomnia called Cognitive Behavioral Therapy for Insomnia (CBTI).

If you would are interested in learning more about how CBTI can help you can read more here or contact me using the form below for a FREE telephone consult.

Psychotherapy vs. Medication for OCD – Which is More Effective?

Obsessive-Compulsive Disorder (OCD) is a serious and disabling problem for many people. Understandably, many people seek out medication to help with this problem, and research is shown that medication can be helpful some people. However, research is also very clear that particular proven forms of psychotherapy work much better than medication for OCD. A newly published review paper provides further evidence that psychotherapy outperforms medication for OCD.

Some background about the paper

Published in 2013 in World Psychiatry, Cuijpers and colleagues collected 67 studies where medication and psychotherapy were directly compared against each other for depression and anxiety-related problems. The researchers conducted what is called a meta-analysis, a way of converting the data from separate studies into a computation that allow for a direct comparison across studies.

The researchers determined that for OCD, psychotherapy is “clearly more efficacious” than medication. Specifically, psychotherapy was found to be more effective than antidepressants, the most well-research pharmacological treatment for OCD.

One caveat

One point I’d like to make clear is that we’re not talking about generic talk therapy but some form of OCD-specific cognitive-behavior therapy (CBT), typically with what is called exposure and response (or ritual) prevention (ERP). Although mild to moderate anxiety and depression may respond to generic talk therapy, OCD generally does not, and usually requires a structured approach such as CBT with ERP.

What this research adds to what we currently know

This study contributes to a body of literature suggesting that psychotherapy is the treatment of choice for OCD. Previous research has found that medication does not interfere with evidence-based psychotherapy for OCD, but neither does it enhance treatment. In sum, although some people with OCD may benefit from medication, particularly if they are also depressed, medication alone for OCD is a substandard treatment. Cognitive behavior therapy with exposure and response/ritual prevention is the gold standard. There is also newer evidence that Acceptance and Commitment Therapy (ACT), even without ERP, is an effective treatment for OCD.

Don’t take my word for it, though: you can read the Cuijpers and colleagues study yourself here.

What do people think is the best treatment for anxiety?

Here at Portland Psychotherapy, we spend a lot of time researching the most effective treatments for problems in living. Too often, though, there’s a disconnect between what the research says works and what is often used in practice. Not only is it difficult to educate the public but even mental health professionals can have difficulty keeping up.

For these reasons, I read this CureTogether post (now associated with 23andme.com) with great interest. CureTogether is a website that collects ratings of treatments. It appears to have an ongoing survey of anxiety treatments. Anyone can log in and rate what worked and didn’t work for them. May 13, 2013, the website posted the results from over 10,900 people who had participated in their survey of anxiety treatments.

What do people think works?

I’ll confess: because there’s so much misinformation out there, I was a little worried about what I’d find. I honestly expected to find evidence-practice lagging behind pop psychology. When I saw the actual rankings, however, I thought to myself, “Not bad.”

Cognitive behavior therapy (CBT)—which arguably has the most impressive research base for addressing anxiety disorders—was number 6. Given that CBT is not as “sexy” as other treatments, I was pleasantly surprised to see it in the top 10. Even Acceptance and Commitment Therapy (ACT), the specific branch of CBT offered at Portland Psychotherapy, was number 11. (This is amazing, actually, as ACT is still new to many professionals.) Even exposure therapy, which has the greatest research support but is especially unsexy, was listed at number 14.

More informal treatments such as exercise (#1), yoga (#3), and meditation (#5) also have some research support for being helpful to people. Not everyone needs to see a therapist for anxiety.

What was more concerning—although not surprising—was the prominence of a class of drugs collectively known as benzodiazepines. These include Xanax (#2), Ativan (#8), and Clonazepam (#9). I say “not surprising” because these are commonly prescribed drugs that calm you down within 20-30 minutes. I say “concerning” because, although they make people feel better in the short-term, benzodiazepines can actually maintain anxiety in the long-term: they are a short-term solution, can be addictive, and can lead to withdrawal effects with prolonged use and rebound anxiety when people stop taking it. Xanax, which is faster acting, is particularly dangerous.

What conclusions can we draw?

I should note that this isn’t an objective research study: it’s simply a summary of what people who filled out an online survey say they’ve tried and decided was helpful. That said, it’s an extremely useful snapshot of the real world treatment of anxiety.

Anxiety Treatment at Portland Psychotherapy