Cognitive Behavioral Therapy in San Francisco (CBT Therapy)

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What is Cognitive Behavioral Therapy (CBT)?

Cognitive behavioral therapy (CBT) is an evidence-based, structured, and time-limited psychotherapy approach that focuses on the relationship between thoughts, emotions, and behaviors. The central premise of CBT is that maladaptive thoughts (cognitions) contribute to emotional distress and unhelpful behaviors, and that unhelpful behaviors perpetuate maladaptive thoughts and emotional distress, forming a bidirectional relationship. Therefore, by identifying and restructuring these thoughts or modifying behaviors, individuals can shift their emotional states and experience meaningful change in their lives.

Conditions CBT Can Help With

CBT is an evidence-based approach which means it has been rigorously studied and shown to be effective for a wide range of psychological issues, including:

  • Anxiety & Panic Disorders: Individuals learn to identify and challenge irrational, fear-based thoughts through cognitive restructuring. Therapists can also guide clients through exposures, which is the process of gradually confronting feared situations through behavioral experiments in order to test the accuracy of their beliefs. For panic disorder specifically, interoceptive exposure is used to deliberately provoke physical sensations like rapid heartbeat or dizziness in a safe setting in order to increase resilience to discomfort and fear. Relaxation and breathing techniques are also taught to help manage the physiological symptoms of anxiety.

  • Depression: Clients are taught to recognize distorted or self-critical thoughts and replace them with more balanced perspectives that can help break the cycle of negative thinking or inertia. Through behavioral activation, clients are encouraged to re-engage in activities that bring a sense of fulfillment or pleasure, leading to improved mood. CBT also incorporates problem-solving strategies and mood tracking to help people feel more in control of their thoughts, actions, and emotional well-being.

  • OCD (Obsessive-Compulsive Disorder): Exposure and response prevention (ERP) is another form of exposure where clients gradually confront feared thoughts or situations while refraining from compulsive behaviors. Cognitive strategies are also used to challenge beliefs about responsibility, danger, or control that often underlie obsessive thoughts. In addition to reducing anxiety, clients gain insight into how compulsions reinforce obsessions and learn tools to reduce their grip, freeing them from the OCD cycle.

  • PTSD & Trauma: One CBT approach for trauma is cognitive processing therapy (CPT), which helps individuals reframe negative beliefs related to their trauma, such as guilt, shame, or self-blame. Another is prolonged exposure therapy, which involves gradually confronting trauma-related memories or avoided situations in a safe and controlled way, and remaining in them until their fear subsides. Clients also learn emotion regulation skills and grounding techniques to manage intense reactions, while developing a less distressing and more empowering narrative of the traumatic experience.

  • Phobias: This is another area where exposure is effective; by gradually facing fears starting with situations that provoke mild anxiety and moving up to more challenging ones, clients learn that their anxiety eventually subsides and that feared outcomes are unlikely to occur. Cognitive restructuring is also used to address irrational or exaggerated beliefs about situations, helping to reduce fear and build confidence.

  • Stress Management: CBT teaches clients how to identify and replace unhelpful thought patterns with more adaptive and realistic ones. Skills such as time management, assertive communication, relaxation training, and structured problem solving can also be used. These tools can empower clients to handle stress more constructively and prevent it from escalating into burnout or other mental health conditions.

  • Insomnia: CBT for insomnia (CBT-I) is a highly effective, non-medication-based approach that targets the thoughts and behaviors interfering with sleep. Clients receive education on healthy sleep habits (referred to as sleep hygiene) and are taught how to manage racing thoughts or anxiety at bedtime, as well as addressing negative beliefs about sleep. Behavioral interventions like sleep restriction and stimulus control are used to retrain the body’s circadian rhythm. 

  • Chronic Pain or Illness Adjustment: CBT helps individuals change how they perceive and respond to their symptoms and build coping strategies that increase a sense of control and resilience. Clients are encouraged to engage in meaningful activities at a manageable pace and learn relaxation or mindfulness techniques to help regulate their nervous systems. The overall focus is on improving quality of life and emotional adjustment, rather than eliminating pain entirely.

How CBT Works: What to Expect

CBT is structured and time-limited, with the usual treatment duration lasting between 6-15 sessions. However, this depends on the complexity of each case and the client’s specific treatment goals, as well as how much time they are able to commit to applying the skills in between sessions. Here is an overview of what a typical 50-minute CBT session looks like:

  1. Check-in to review mood or symptoms since the previous session and discuss progress and challenges with homework exercises

  2. Agenda setting for the current session based on client’s goals and therapist’s recommendations

  3. Exploring situations that may have triggered unhelpful patterns in the past (e.g. distorted thoughts, problematic behaviors, and heightened emotional reactions)

  4. Learning or reviewing strategies to modify undesirable patterns, such as cognitive restructuring, mindfulness, and behavioral activation

  5. Practicing coping skills and techniques using role play, exposures, thought records, etc.

  6. Collaboratively setting homework exercises to practice before the next session, such as journaling, symptom tracking, or behavioral experiments

CBT is collaborative in that the therapist is engaged in sessions and working with the client to determine goals and monitor treatment progress. CBT is present-focused and works by increasing awareness of unconscious thought and behavior patterns, learning strategies to change these patterns, and practicing these exercises and coping skills in order to reinforce healthier thoughts and behaviors. Essentially, clients are taught to become their own therapists, which empowers them to be more self-reliant and in control of their lives.

Why Choose CBT Therapy in San Francisco with Dr. Saara Muscat

Dr. Muscat has over 10 years of experience using CBT with a wide range of individuals across various settings, including community mental health, the Department of Veterans Affairs, Stanford University, UCLA, and private practice. She received her Doctorate in Psychology (PsyD) after completing graduate school at the PGSP-Stanford PsyD Consortium, where she helped develop and employ a CBT-based treatment manual for oral surgery patients at Stanford for her doctoral dissertation. Dr. Muscat provides culturally competent care to a diverse clientele in her private practice in San Francisco and offers flexible appointment scheduling and formats, including in person, walk & talk, and virtual sessions.

Frequently Asked Questions

  • The typical treatment duration for CBT is between 6-15 sessions, depending on the complexity of the case and individual’s treatment goals. This also depends on the amount of time clients are able to commit to applying their CBT skills between sessions, which is where much of the learning is solidified.

  • Dr. Muscat does not take insurance directly, but can provide you with monthly billing statements (“superbills”) that you can submit to your insurance for reimbursement.

  • CBT has shown to be effective for a range of mental health concerns, including anxiety and panic disorders, depression, PTSD, OCD, stress, insomnia, and chronic pain and illness. CBT tends to be a better fit for individuals who like structured, time-limited, and goal-oriented approaches and who are more interested in focusing on present-day situations rather than exploring the past. Feel free to schedule a complimentary phone consultation to determine whether CBT would be appropriate for you.

  • Therapy’s effectiveness depends on many factors, including the type of modality being used, the therapist’s credentials and experience, and the client’s motivation and willingness to commit to doing the work. However, the therapeutic alliance, or fit between therapist and client, is often the determining factor in how well therapy works for someone. Schedule a complimentary phone consultation with Dr. Muscat to see whether she might be a good fit for your needs.