The premise of cognitive behavioral therapy is that our thought patterns (cognition) and interpretations of life events greatly influence how we behave and, ultimately, how we feel.
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What is CBT?
Cognitive behavioral therapy (CBT) is a form of psychotherapy that focuses on how your thoughts, beliefs and attitudes affect your feelings and behavior. CBT aims to teach you effective coping strategies for dealing with different problems throughout life.
CBT can help you make sense of overwhelming problems by breaking them down into smaller parts.
One of the key tenets of CBT is that distorted thinking leads to distress and problematic behaviors, whereas thinking realistically with less negativity allows individuals to respond to challenging life circumstances in an effective way.1
Research shows this technique is an effective therapy for not only depression and panic disorder, but many illnesses and dysfunctional behaviors.2
Successful cognitive behavioral therapy sessions consist of a healthy collaboration between the counselor and the individual receiving therapy.
Additionally, this therapy involves clear identification of the problem, establishing attainable goals, empathic communication, frequent feedback, reality checks, homework assignments, and teaching individuals to use learned tools to promote positive behavioral change and growth.
Background of CBT
Cognitive behavioral therapy was initially modeled 40 years ago to treat depression. There are now effective cognitive-behavioral models for treating panic disorder, post-traumatic stress disorder, generalized anxiety, insomnia, social phobia, childhood depression, anger, marital conflict, substance abuse, schizophrenia, bipolar disorder, borderline personality, dental phobia, eating disorders, and many other mental and physical conditions.3
CBT aims to stop negative cycles of thought by breaking down things that make you feel bad, anxious or scared.
Recent research suggests that CBT has greater effectiveness than medications for the treatment of some cases of insomnia.4 CBT can be used for virtually any maladaptive behavior where thoughts and beliefs (cognition) play an important role.
CBT emphasizes the need to identify, challenge, and change how a situation is viewed.
According to CBT, our pattern of thinking is like wearing a pair of glasses that makes us see the world in a specific way. CBT creates an awareness of how these thought patterns create our reality and determine how we behave.
Dr. Aaron T. Beck, a pioneer in CBT, explains that the perceptions and interpretations of depressed persons are distorted.5 Depressed individuals are likely to engage in "cognitive errors," such as a negative mindset, jumping to conclusions, catastrophizing, and thinking only in black and white.
Beck noted that these errors in thinking were automatic thoughts that came spontaneously; the individual accepted them as truths instead of distortions. CBT focuses on modifying the automatic thought by challenging the validity of the thoughts against reality. When an individual stops negative, self-depreciating and catastrophic thinking, their distress decreases and they are better able to function in the desired way.
How does CBT work?
The purpose of cognitive behavioral therapy is to change thinking and behaviors that prevent positive outcomes.
CBT can help people solve various medical, social, work, and emotional problems. While other forms of psychotherapy involve delving into the past to provide insight into feelings, CBT focuses on "the here and now" thoughts and beliefs. Specific skills that involve recognizing distorted thinking, modifying beliefs, relating to others in different ways are practiced, and eventually the individual can learn to behave in the desired way.
Cognitive misperceptions can lead to unhealthy behaviors. When an individual experiences a stressful event, automatic thoughts come to mind and can lead to negative moods and emotions.
A person might overreact, fret, and feel sick. The person makes a faulty assumption or an incorrect conclusion on the meaning of the event based on no reliable truth but rather the automatic thought process that is often not even recognized.
This faulty thinking becomes a feedback loop unless interrupted and tested against reality. The cognitive-behavioral therapist helps the individual recognize how distorted thinking directly affects moods and emotions, and teaches how to change rigid thinking patterns.6
For example, a person with dental phobia fears going to the dentist because they believe they will suffer severe pain or even death from a dental procedure. The fear may have been triggered by a negative early childhood dental experience. A person with this phobia may lose sleep, experience extreme anxiety, and may neglect caring for his teeth.
A cognitive behavioral therapist can work with this individual to address the faulty thinking (because I had pain with a filling all dental visits will be painful) and develop a plan to overcome the fear.
CBT is a one on one, short-term therapy that lasts anywhere from one to twenty sessions. It is problem specific, goal oriented, and is designed to achieve remission and prevent relapse of a specific disorder. Listed below are common interventions practiced in CBT.
After working out what unhelpful thoughts and behaviors you can change, your therapist will ask you to practice these changes in your daily life.
- Identify problem areas
- Develop awareness of automatic thoughts
- Distinguish rational and irrational conclusions
- Stop negative thinking
- Challenge underlying assumptions
- See a situation from different perspectives
- Stop catastrophizing (thinking the worst)
- Identify what is realistic; is what you think really true?
- Test perceptions against reality
- Correct thinking so that it more closely resembles reality
- Examine the validity and usefulness of a particular thought
- Identify and modify distorted beliefs
- Enhance awareness of mood
- Keep a cognitive behavioral diary
- Gradually increase exposure to things that are feared
- Stop "mind reading" and "fortune telling" practices
- Avoid generalizations and all or nothing thinking
- Stop personalizing and taking blame
- Focus on how things are rather than how they should be
- Describe, accept, and understand rather than judge.
Throughout the treatment period, both the counselor and the individual discuss and agree on goals and the techniques to be used. The individual must be an active participant in the treatment plan in order to see adequate results with CBT.
Cognitive behavioral therapy is a widely practiced psychotherapy based on the theory that it is not actual events that cause our problems and various disorders, but the meanings we give to the events.
Distorted, negative thinking leads to problematic behaviors and overall dysfunction. Recognizing faulty thinking, modifying beliefs, and the practice of relating to others in more positive ways can help individuals manage and overcome many common illnesses, phobias, and disorders.
Doctors may be able to predict how people with obsessive-compulsive disorder will respond to therapy using a simple brain scan, according to the findings of a new study.
A new study has found the cognitive behavioral therapy used to reduce chronic tics in people with Tourette syndrome can also alter the functioning of their brains.
In a new study of British youth, published in the journal Addiction, researchers from the University of Montreal and CHU Sainte-Justine Children's Hospital in Canada report success in preventing, reducing or delaying cannabis use among at-risk teenagers.
Research published in the journal Sleep is the first to demonstrate an association between treatment of insomnia and reduction of suicidal thoughts in veterans.
In the past few years, CBT has been found helpful for people with chronic back pain, with some studies showing that specific online interventions using CBT techniques can lead to improvement in symptoms.
In one study of adults with chronic lower back pain, volunteers given access to an interactive online intervention to teach self-management skills (Wellness Workbook) had better scores on self-reported measures of pain, disability, disabling attitudes and beliefs, self-efficacy for pain control, and mood regulation compared to the control group who waited 3 weeks for treatment. After the control group also engaged in the CBT intervention, the scores were similar between the two groups.7
Another study found that CBT may be helpful for some people undergoing treatment for breast cancer who experience treatment-induced menopausal symptoms. This randomized, controlled, multicenter trial involved 422 women who received CBT, physical exercise or a combination of the two interventions.
After 12 weeks and 6 months, the women receiving the interventions had a significant decrease in endocrine symptoms and urinary symptoms, and an improvement in physical functioning. Those receiving CBT also reported a significant decrease in the impact of hot flashes and night sweats, as well as an increase in sexual activity.8