What is CBT (Cognitive Behavioral Therapy)

You probably have come across the term CBT or Cognitive Behavioral Therapy at least once. On the other hand, you may have heard your doctor or another health professional talk about it. You may even have been prescribed CBT as a part of treatment for a psychological issue. The possibilities are vast. Nonetheless, you are here to learn more about it. Let’s dive into the world of CBT and its clinical uses.

Cognitive Behavioral Therapy is likely the most common and popular form of therapy out there. Simply put, CBT is all about challenging and changing negative thoughts that you may have about yourself, others, or the world around you. In turn, it can change unwanted negative behaviour and help you replace them with positive ones.

We are what we think. All that we are arises with our thoughts. With our thoughts we make the world.

Gautama Buddha

History

CBT was first introduced by Dr Aaron T. Beck in the 1960s. He was a psychiatrist at the University of Pennsylvania at the time and was experimenting on psychoanalysis and depression. However, his findings did not prove a relationship between depression and psychoanalytic concepts. Instead, he found out that patients with depression experienced a lot of negative thoughts that arise automatically with the condition. The negative thoughts were usually about themselves, the world, or the future.

Beck then found out that when patients were taught to identify and access negative thoughts, it led them to think in a more realistic way. Additionally, they felt emotionally better and more functional. Just by changing negative thought patterns, patients reached a state of long-lasting change. This process is what we now know as cognitive behavioral therapy.

 

Goals of CBT

1. Changing thought patterns

The first part of CBT is the emotional component. The main focus of it is to change negative emotions and feelings that patients have about themselves, the world around them, and the future. For instance, people with addiction problems, mental disorders, and emotional issues often find themselves trapped in the same negative string of thoughts. This gives root to more self-destructive behavior or negative coping methods.

CBT helps patients cope better in stressful situations and encourages them to think differently. A therapist will teach them how to analyze and challenge their own negative thoughts. In the long run, patients will learn how to permanently change their thinking patterns which will, in turn, lead to positive behavior, coping, and emotional states.

2. Changing behavior

Behavior change is the second stage of CBT. Negative thoughts give rise to negative behavior. After successfully countering the negative thoughts, a CBT therapist will then help the patient make positive behavioral changes. Patients are encouraged to think of better ways to cope with and react to stressors.

For instance, a patient with a substance abuse disorder will be taught how not to give in to their addiction by taking a few minutes to process their thoughts positively. They are then taught to engage in a productive and positive activity to keep them busy. This process is very complex and the solution is specific to the patient.

3. Setting new goals

The final stage of cognitive-behavioral therapy is setting new goals for the patient. Goals made are realistic and always specific to the patient. For example, if a patient suffers from an anger management issue, the goal for them may be to walk away from the situation instead of reacting.

 

Uses for CBT

CBT is very useful in the treatment of depression and anxiety disorders. However, it has also been proven to be effective in treating a range of other psychological issues including:

  • Bipolar disorder
  • Borderline personality disorder
  • Eating disorders
  • Obsessive-compulsive disorder (OCD)
  • Panic disorders
  • Phobias
  • Post-traumatic stress disorder (PTSD)
  • Psychosis
  • Schizophrenia
  • Sleep problems
  • Addiction problems

That is quite a long list. So basically, CBT plays a part in the treatment of most psychological disorders. This means that it must be effective right? Let’s look at the statistics and research.

 

Effectiveness of CBT

  • CBT is very effective in the treatment of depression and anxiety. To illustrate, research suggests that CBT alone is around 50-75% effective for overcoming depression and anxiety after 5 to 15 modules. The effectiveness can be further increased by combining CBT with medication.
  • According to the National Institute on Drug Abuse U.S., CBT is very useful in the treatment of substance abuse problems. It can help increase self-control, avoid triggers, and develop coping mechanisms for daily stressors.
  • CBT is one of the most effective treatments available for eating disorders at the moment. Especially in the treatment of bulimia nervosa where patients binge eat large amounts of food and then forcefully try to get it all out through vomiting or using laxatives.
  • In a 2012 meta-analysis of 106 studies, CBT was seen to be rather effective in the treatment of psychotic disorders, general stress, anxiety disorders, chronic pain and fatigue.
  • The same study indicated that it was effective in the treatment of personality disorders as well. However, results were stronger and much better for psychodynamic therapy than CBT.

 

Benefits of CBT

The process of Cognitive Behavioral therapy is brief, highly engaging, goal-oriented, and problem-focused in comparison to other types of therapy. Therapists who use CBT concentrate on the present and the here and now, therefore they don’t need to go through your entire developmental or family history, unlike therapists who use approaches. eg: psychoanalysis. Furthermore, the total number of sessions in CBT depends on the patient and their needs. However, the average number of sessions is about five to fifteen. This is much shorter in comparison to other kinds of therapy that may take many months or even years to complete.

Here are some more benefits of CBT:

There is a benefit for everyone

CBT may not work with severe mental disorders or learning disorders. However, it can help you accept and understand that you can change a lot just by simply changing the way you think about certain things. Consequently, you don’t need to have anything wrong with you to see a CBT therapist. Even if you are looking to improve on certain qualities or negative behaviour that you may have, CBT is a good option.

CBT give patient’s hope

The central point of CBT is changing negative thoughts. For patients with severe conditions, this is useful because it can change their negative thoughts about the future and help them replace those thoughts with positive ones. In the long run, they can open their minds to new possibilities and become hopeful for the future.

Increases self-esteem

Low self-esteem is a co-existing condition with many mental disorders. It strings together a web on negative ideas and damages the patient’s self-image and self-worth. CBT can counter this.

Helps patients relax

Aside from helping patients challenge their negative thoughts, CBT can also help them better respond to stress. This involves developing calmer responses using a range of relaxation techniques.

 

The negatives of CBT

Like every other therapeutic approach, CBT is not perfect. There are quite a few downsides of it that are important to keep in mind,

  • You need to be willing to change and commit to the process for CBT to work. It is not a magical process where everything gets better in the end. You have to put in a lot of work and learn how to look at situations differently. Therefore, it may not be the best option for people who aren’t willing to change.
  • The extra activities or “homework” that comes with CBT can sometimes take away a lot of your time.
  • CBT is structured. Subsequently, it may not be suitable for people with serious mental disorders.
  • A major part of the therapeutic process is confronting your negative emotions and thoughts. At first, this may make you emotionally uncomfortable or anxious.
  • As mentioned earlier, CBT focuses on the present. Some critics argue doing this ignores other possible causes of mental health problems such as childhood trauma or an unhappy childhood.

 

Types of CBT

CBT compromises quite a few different cognitive and behavioral techniques and approaches. These range from structured psychotherapies to self-help material. In addition, there are other therapeutic approaches that involve CBT. These include:

Cognitive therapy

A short-term form of therapy that is based on the idea that the way people think about themselves, others, or the world around them, affects how they feel emotionally. This form of therapy focuses on present thinking, behavior, and communication instead of past experiences and also on problem-solving.

Dialectical behavioral therapy (DBT)

DBT is a type of CBT that is beneficial for high-risk tough-to-treat patients. For instance, patients with suicidal thoughts or other self-destructive behavior. It addresses thoughts and behavior using techniques such as emotion regulation and mindfulness. The goal of DBT is to teach patients better coping skills and ways to change unhealthy behavior.

Multimodal therapy (MMT)

This approach was first introduced by Arnold A. Lazarus. He suggested that psychological issues must be treated by confronting seven different but interconnected components. These include behavior, emotions, sensations, imagery, cognition, interpersonal relationships, and drugs/biological issues.

Rational Emotive Behavior Therapy (REBT)

REBT is based on the idea that all people want to do well in life. For example, all of us want to be happy or become better people. However, irrational thoughts and feelings can sometimes get in the way of the process. These thoughts can then influence how you look at situations, other people, or even yourself. Often negatively. Furthermore, they can also lead to emotional and behavioral problems.

REBT helps people recognize their negative/irrational thoughts and replace them with positive rational ones.

 

CBT techniques

To help reach the goals of therapy CBT therapists use a range of techniques and strategies with their patients. To determine which ones to use, your therapist will first talk to you to find out what problems you have and what your goals are.

Here are a few techniques and approaches you may run into if you decide to go through CBT.

Cognitive reframing

This involves teaching patients to look deeply into their negative thoughts and change them to more positive and productive ones. Thus, patients can change the way they experience situations. For example, “I am totally useless and stupid because I scored low for the test” is changed to something like “I am smart. I couldn’t study well for this test. I will do better next time”.

Guided discovery

During this process, the therapist will try to put themselves in the patient’s shoes. They will then ask questions designed to challenge their beliefs and expand their thinking. The goal is to help them look at situations in a new positive way.

Exposure therapy

Exposure therapy is usually used for the treatment of phobias and fears. The therapist will gradually expose a patient to something that they are afraid of or makes them anxious while teaching them how to cope. Eventually, patients will learn how to stop or control the fear/anxiety response. For example, someone who has a fear for spiders will be gradually exposed to spiders, starting from a picture and ending with an actual spider.

Journaling

Here, your therapist will ask you to keep a journal or diary on thoughts that occur between sessions and in your normal day-to-day life. This is a great way to track your progress and your thoughts. Furthermore, it can also help you assess the situation you are in and better understand the feelings attached to that situation.

Relaxation and stress reduction techniques

The therapist will teach you a range of techniques that can help you relax and lower your stress levels. These include,

  • Mindfulness meditation
  • Deep breathing exercises
  • Muscle relaxation

Skills training

Patients are given the training to develop their skills to achieve goals. Common areas of skill training include social skills, communication skills, and assertiveness skills. Usually, the training process is done through direct instruction, modelling, and role-plays.

Behavioural experiments

This technique is mostly used for patients with anxiety disorders. They are asked to predict the outcome of tasks and events that make them anxious before finishing them or going through with them. Later the therapist asks them if the prediction came true. Often, the predicted negative outcomes do not happen and ultimately patients learn to lower their anxiety levels.

 

A word of farewell

There is no doubt that CBT is one of the best therapeutic approaches out there. However, as mentioned earlier there is quite a bit of drawback to it. Good thing is, this is the same for every approach in therapy. It is up to you and your therapist/mental health professional to determine the best approach for you.

If you are an Australian citizen who is considering going through CBT or had it recommended to you by a medical professional, we can help. Here at Epsychiatry, we have a wonderful team of trained and qualified mental health professionals including psychiatrists and psychologists, who are available full time to assist and guide you through every bit of the process. Reach out to us using the “contact us” option on the website.