Why Homework Is Vital for Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) involves practicing new skills and strategies that have been designed to help you reduce your anxiety or anxiety-related problems. When you engage in the CBT process, you allow your brain to learn new ways of thinking and reacting. The effect can be likened to rewiring your brain.

The Value of Practice

Any time you learn a new set of skills or way of operating, you need sufficient repetition and practice before it can become second nature. Take the learning of multiplication tables. You must take the time to practice them if you wish to have the swift and automatic recall necessary to progress in math.

Similarly, athletes must practice, practice, practice to both hone their skills and to be able to perform in competition. Their brain must learn to do things automatically in a given situation. In tennis, for example, the player must practice their volley so many times that when a situation requiring a volley arises, they automatically know what to do.

You don’t have time to think it through on a conscious level every time a particular skill is required. The skill needs to be stored in your brain and body so that in the moment of need, your brain and body automatically perform that skill and you can execute what is needed.

I have ridden horses for much of my life. Horses can be unpredictable and move and behave erratically. A rider doesn’t have time to consciously think through how they will save themselves from falling off or stop a bolting horse. It must have already become automatic through practice and experience.

Source: Pixabay/geralt

Practice in CBT

Learning to manage anxiety is no different. Anxiety usually comes in abrupt spikes. If your brain were a horse—to use an analogy I like—you could say anxiety is like a horse taking off with you and galloping away out of control. It takes practice through many exposures to be able to automatically manage your horse and stay in the saddle.

I have learned after decades of helping anxious individuals of all ages that simply understanding one’s worries and fears and trying to instantly change how one responds is not realistic or effective. Like with math or sports, real-life practice is required.

Most people who see a trained CBT therapist get only 50 minutes per week with their clinician. That is not nearly enough time to practice the new ways of thinking and behaving required for significant change and symptom relief.

For this reason, I argue that good CBT always involves homework between sessions. Hearing that, you may worry it will take a lifetime of practice to reduce your anxiety enough to give you some peace. I assure you that is not the case; you won’t need to spend a lifetime honing your skills. In fact, it’s a lot easier than becoming a top-level athlete or a very accomplished musician.

Using Exposure

In simple terms, what you must do is practice exposure. This entails putting yourself in situations that trigger anxiety and refraining from engaging in your customary safety and avoidance behaviors (or rituals, if you have OCD).

Exposures, in my view, are the single most important element in overcoming anxiety problems of all kinds. Exposures allow your brain to learn something new. Doing exposure can be challenging, for sure. If exposures were a piece of cake, you wouldn’t have the anxiety problem you have.

Exposures are planned to follow a step-wise hierarchy. You always start with a step that feels tolerable. When you have become comfortable with that first step, you move on to the next step. And so on.

The following are examples of homework a person suffering from social anxiety disorder might do:

• make brief eye contact with 3 to 4 strangers daily
• make small talk with a cashier
• make 10 phone calls to random pizza parlors to see if they deliver
• use a public restroom where others can hear you using the toilet

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If you are reading this and think, “I couldn’t do any of those things,” then your first homework assignment would be something more easily tolerated. For example, it could involve making eye contact with someone who is at a distance, or you could pick a setting or people who feel less challenging than strangers. Your homework could also be an imaginal exposure, in which you use your power of imagination to put yourself in a situation that triggers anxiety, while not doing any safety or avoidance behaviors.

Making the Most of Your Homework

Note that we assign homework in CBT, rather than just suggest that you try to approach trigger situations in a different way. This is because it is challenging and often scary to make changes in how we manage problems in our lives. Moreover, anxiety itself is extremely unpleasant. If you commit to actual homework, you are much less likely to come up with ways to avoid it.

Learning and practicing any new skill will have its ups and downs. You will succeed if you are able to persevere even when a task feels painful or difficult.

So, keep your eye on the prize: to suffer less from anxiety. Don’t let your anxiety talk you out of doing the work needed to set you free. You can achieve your goal!