Cognitive Behavioral Therapy (CBT) is a short-range, goal-oriented psychotherapy treatment focusing on a practical, hands-on approach to problem solving. The goal of this particular form of therapy is to alter patterns of behavior and the thinking that is behind an individual’s difficulties. Ideally, this also alters the way that the individual feels. The therapy is utilized to help treat a variety of issues, including relationship problems, sleeping difficulties, anxiety, depression and alcohol or drug abuse. CBT is designed to alter an individual’s behavior and attitudes by focusing on their beliefs, thoughts, attitudes and images. All of these relate to the way an individual behaves in regard to dealing with emotional issues.
A huge benefit of CBT is that it is short—generally 5-10 monthly sessions. During therapy, a patient will go to one 50-minute session per week. During each session, the therapist and patient will work with one another to determine what the problems are and develop new, effective strategies for tackling those problems. CBT works to introduce patients to a specific set of principles that they will be able to successfully apply whenever necessary. The goal is for these skills to stay with them and help them cope for the rest of their lives.
CBT can be considered a combination of behavioral therapy and psychotherapy. Behavioral therapy focuses on the relationship among your thoughts, behaviors and problems. Psychotherapy tends to focus how thinking patterns are developed in childhood and on the importance of the personal meaning placed on these things.
CBT was invented by psychiatrist Aaron Beck in the 1960s. He was performing a psychoanalysis when he observed that during his sessions, his patients often had an internal diagnosis in their minds. It was almost as if they were having a conversation with themselves, but only a fraction of this form of thinking would be vocalized to Beck.
For instance, during a session, patients may be thinking, “He (referring to the therapist) hasn’t been talking much today. Could he be annoyed with me?” These types of thoughts could potentially cause patients to feel annoyed or somewhat anxious. As a result, they could respond to that initial thought with another thought similar to the following: “He (again, referring to the therapist) is probably just tired or maybe I haven’t been talking much myself or addressing important things.” This subsequent thought could potentially alter the way patients are feeling.
Beck realized that there was an important link between a patient’s feelings and thoughts. He went on to invent the term “automatic thoughts.” This referred to the emotion-filled thoughts that simply appeared in one’s mind. He found that individuals were not always aware of these thoughts. However, he believed that they could learn to recognize and report them. If individuals are feeling upset, their thoughts are generally negative, which is neither helpful nor realistic. Beck realized that recognizing these types of thoughts were essential to understanding patients and overcoming their difficulties.
Beck named it cognitive therapy since the importance was placed on thinking. It is now referred to as cognitive behavioral therapy (CBT) because behavioral techniques are employed as well. The cognitive and behavioral elements vary from one provider’s therapy to the next, but they are all found under the one umbrella term of CBT. It has undergone various scientific trials by different teams in different places regarding a variety of issues that have been proven successful.
Importance of Negative Thoughts
CBT is based on the theory that it isn’t the events that upset a person, but it is the meaning that a person gives that event. When individuals have thoughts that tend to be too negative, it can block them from seeing or doing things based on what is believed to be true versus reality. In other words, individuals continue to hold onto those same negative thoughts without learning anything new.
For example, imagine depressed individuals thinking, “I am unable to face work today; I just can’t do it. Nothing is going to go right, and I will feel terrible.” As a direct result of those negative feelings and the belief that they are true, that individual could call out of work sick. As a result of this behavior, individuals don’t have the chance to find out that they could have been wrong about their thoughts and prediction of the day. Instead, they remained at home brooding about their failure to go to work and will likely end up thinking, “I have let everyone down, and they will be upset with me. Why can’t I simply do what other people do? I am useless and weak.” These thoughts simply make individuals feel worse and they will then likely have further difficulties going to work the following day. Thinking, feeling and behaving in this manner often result in a downward spiral. This vicious circle can apply to a variety of problems beyond depression.
Where Do Negative Thoughts Come From?
Beck suggests that negative thinking patterns come from one’s childhood and that they become automatic and somewhat fixed. Therefore, a child who got little to no open affection at home from their parents, yet was praised for schoolwork, may start thinking, “I must do well at all times, and if I don’t, I will be rejected by others.” This kind of rule for living is referred to as dysfunctional assumption and can sometimes help a person work hard.
However, when something occurs beyond that person’s control and failure is the result, that dysfunctional thought pattern is often triggered. Automatic thoughts often come to appear in that person’s mind like, “I have completely failed. No one is going to like me, and I can’t bring myself to face them.”
CBT works to help the individual understand that this is actually what is going on in their mind. The therapy helps individuals step outside of their automatic or fixed thoughts and essentially test them against reality. CBT would encourage depressed individuals to examine some real-life experiences to see exactly what would happen to them, as well as to others, in a similar situation. As the patient gains a more realistic perspective, they may be able to see what others may think by revealing some of their difficulties to friends or family.
Without a doubt, negative things happen. However, if an individual is in a disturbed state of mind, predictions and interpretations are based on a biased view of the situation. This makes the difficulty that is being faced far worse than what is truly happening. CBT helps individuals correct those misinterpretations.
CBT is different from other types of psychotherapies because the sessions are structured as opposed to the patient speaking freely about anything that comes to mind. At the start of the session, patients will meet with a therapist to discuss specific problems and to set goals to work toward. Problems can be symptoms such as difficulty sleeping, difficulty socializing with friends, or problems concentrating on work or reading. Alternatively, the problems could be life-related, including being unhappy in a marriage, difficulty with an adolescent child, or being unhappy at work.
These problems and goals are the core of the therapy session plan. As a general rule, the start of each session will begin with the therapist and patient deciding together on the main topics to work on for the week. Time will also be allowed to discuss the conclusions from the prior session, and they will look at progress made through patients’ homework. At the end of the session, another homework assignment will be given.
The process of CBT is complex. There are multiple theories on how the process works, and patients typically have their own views. Perhaps there isn’t a single explanation, and maybe CBT works in several different ways simultaneously. Some are specific to CBT, while others it shares with other kinds of therapy.
Between sessions, working on homework assignments is a vital part of the overall therapy process. Each homework assignment will vary. For instance, at the beginning of therapy, the patient may be asked to simply keep a journal of incidents that provoke feelings of depression or anxiety so that they can examine the thoughts that surrounded that particular incident. As therapy progresses, a homework assignment may consist of specific types of exercises that help the patient cope with specific troublesome situations.
Why Is Homework Necessary?
Those who are willing to do the necessary work outside of therapy sessions will get the most benefit from CBT. For example, individuals who are diagnosed with depression tend to say that they won’t take on work or social activities until they’re feeling better. CBT could potentially introduce them to a new viewpoint such as trying even a small homework activity that can help them feel better. The assignment could be to meet a friend at a bar for a beverage or pub for a burger. This helps the patient make quicker progress than an individual who would be unwilling or feels they would be unable to take such a risk and would prefer to simply sit in on sessions and talk through their problem(s).
Importance of Structure
CBT follows a structure model because it uses session time efficiently. It also ensures that vital information is not left out, such as homework results, and that the therapist and patient are looking at new assignments that will naturally move on to the next session.
The therapist maintains an active role in structuring therapy sessions. As progress is successfully made and the patient is able to grasp principles that they have found helpful, the patient will take more responsibility for the session content. By the end of the treatment, the patient will feel empowered to work independently.
CBT is typically a one-on-one therapy. However, it can work in groups, or even families, especially during the early stages. Though it can be intimidating at first, many individuals report great benefit from sharing their troublesome experiences with others that can relate. The group sessions can also serve as a source of particularly valuable advice and support as it is coming from other individuals with personal and past experiences that have led to problems of their own. Additionally, by seeing multiple people at one time, service providers have the ability to provide assistance to more people simultaneously in an effort to provide assistance sooner to more individuals.
CBT is different from other kinds of therapy because of the relationship that therapists attempt to establish with their patients. There are some therapies that will encourage the patient to be dependent on the therapist throughout the therapy process. In this type of process, the patient views the therapist as all-powerful and all-knowing. With CBT, the relationship is very different. It focuses on an equal relationship between the therapist and patient. The relationship may be more practice, problem-focused and business-like. The therapist will often ask patients for feedback and their views on the therapy process. Beck called it “collaborative empiricism,” which highlights the importance of the therapist and patient working together to test the ideas behind CBT and how they could apply to the patient’s individual situation.
Individuals describing certain problems suitable for CBT are the ones who would benefit from its emphasis on having a particular focus and specific goals. CBT may be less suitable for individuals who feel unfulfilled and vaguely unhappy, but don’t have troubling symptoms or a certain part of their life that they would like to work on.
Overall, CBT is most effective for individuals who can relate to the overall ideas of the therapy, the problem-solving approach of CBT and the general need for self-assignment. Individuals who commonly prefer this therapy generally prefer a more practical approach to treatment, where gaining insight is not the chief goal.
CBT is often be effective for the following issues:
There is rapidly growing interest in CBT (along with the use of medication) for those who are suffering from delusions and hallucinations as well as those who have long-term issues relating to other individuals.
It is often harder to solve issues that are significantly disabling and long-standing through short-term therapy. However, individuals often learn certain principles that can improve their overall quality of life and boost their chances of further progress. Additionally, a significant amount of self-help literature exists to offer information about treatments for certain problems as well as ideas on what individuals can do independently (or with friends and family members).
CBT has the potential to drastically reduce symptoms of a variety of emotional disorders. This has been proven by various clinical trials. Over the short-term, CBT can be just as effective as drug therapies in treating anxiety and depression disorders, and the benefits may potentially last longer. This is because relapse tends to occur after the conclusion of drug treatments and often leads to practitioners recommending patients to continue medication for a longer period of time.
Studies show a clear advantage for CBT based on check-ins with individuals up to two years following the conclusion of therapy. For instance, a mere 12 sessions of CBT can be as effective in treating depression as medication over the course of a two-year follow-up period. This type of research shows that CBT sparks real change in an individual beyond what happens in the therapy sessions.
When comparing CBT with other short-term psychological therapies, the outcome is less clear. Therapies like social skills training and interpersonal therapy can also be effective. Essentially, the goal now is to make all of these as effective as possible and to properly determine the one a specific patient will respond to best.
CBT is effective and proven, but is not a miracle cure. The therapist performing CBT must have considerable experience, and the patient must be ready to be open, brave and persistent. It is unrealistic to expect that every single individual that takes on CBT will find their way to 100 percent recovery.
Currently, experts are well-versed about individuals who have clear-cut issues. They are less familiar about how an “average individual” will perform. For instance, for a person who has several problems that aren’t as clearly defined, may need therapy to last longer in order to be effective. However, one thing is clear; CBT is quickly developing and new ideas are constantly being researched to target more complex aspects of individual’s issues.
Learning Coping Skills
CBT attempts to teach individuals skills for tackling their problems. Individuals with anxiety may learn that the best way to deal with their fears is to avoid certain situations. Confronting one’s fears in a manageable and gradual way helps give an individual faith that they can actually cope on their own.
Individuals who are depressed could potentially learn to record their thoughts in a journal and then go back to read over them so that they can look at them in a more realistic manner. This process essentially assists individuals in breaking the downward mood spiral in which they often find themselves.
Individuals with long-standing issues relating to other individuals may learn that they should not assume the worst and should instead check their assumptions about another person’s motivation first.
Changing Behaviors and Beliefs
A new technique for coping can lead to lasting changes in individuals’ basic behavior and attitude. Anxious patients could learn to simply avoid certain things or situations and may find that their anxiety isn’t quite as dangerous as they thought. Individuals that have been feeling depressed may finally see themselves as regular members of the world instead of someone who is inferior or fatally flawed. They may also come into a different attitude about their thoughts, realizing that they are just mere thoughts, nothing more.
New Form of Relationship
One-on-one CBT brings patients into a relationship that they likely have never experienced. A “collaborative relationship” style means that patients will actively be involved in changing. The therapist is constantly seeking the patient’s reactions and views, which helps to share the overall progress of therapy. Patients may reveal personal matters, but then feel relieved because no one will judge them. Patients will then arrive at decisions in an adult manner as problems are dissected and explained. Patients direct their progress freely, with or without assistance from the therapist. This is why some people value this part of CBT as the most beneficial aspect of the therapy.
Solving Life Problems
CBT helps individuals find new techniques to deal with issues that have their basis in an emotional disorder. The methods of CBT can be particularly useful because patients solve issues that may have been festering for a long time. Individuals who are anxious may have been in a boring, repetitive job with no confidence to make a change. Depressed individuals may not have felt adequate enough to get out there and meet new people to improve their social life. Individuals who have been stuck in a relationship of an unsatisfactory level may potentially find brand-new ways to resolve disputes in their relationship.
Is It Possible to Learn CBT Yourself?
CBT contains a highly educational component and there is a lot of reading material within individual therapy. As a result, you can find a significant amount of self-help literature readily available. The only problem is that researchers have not determined whether these books contain valuable material or not. One study was conducted on The Feeling Good Handbook, and it was determined that it was effective for those who have depression. Therefore, it could be helpful for other issues as well. However, keep in mind that the level of efficiency this book will have for your problem will depend on how long you have been dealing with it and the severity of the issue.
If you think CBT might be a suitable therapy treatment for you, reach out to us at Shadow Mountain Recovery. We are happy to answer any questions and address any concerns that you may have. Give us a call today to find out if CBT is the right approach for you!