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Cognitive Behavioral Therapy (CBT) is a talk therapy used to treat mental health conditions and substance use disorders. CBT allows people to adjust unhealthy thought patterns, make better decisions, and live healthier lives. Due to how widely it is practiced and the numerous studies that have proven its effectiveness, CBT has been labeled the “gold standard” of psychotherapy.
What Is Cognitive Behavioral Therapy?
CBT was invented in the 1960s by psychiatrist Aaron Beck. Through his psychiatry work, Beck realized that what we think (cognition), how we feel (emotion), and our behavior are all closely connected. These three factors have a decisive influence on our physical and mental well-being.
CBT is one of the most widely-used forms of psychotherapy and can treat various conditions. It is particularly effective in treating mental health disorders with a clinically significant disturbance in cognition, emotion, and behavior.
CBT utilizes cognitive restructuring to identify an individual’s negative thought patterns and challenge and change them. In doing so, patients learn to modify their behavior and make healthier life decisions.
What Does Cognitive Behavioral Therapy Treat?
Due to its ability to adapt to any scenario, CBT treats a broad spectrum of behavioral and mental illnesses. A 2013 meta-analysis of over 100 evidence-based CBT studies found that the strongest support exists for CBT treatment of the following conditions:
- Anxiety disorders
- Somatoform disorders (experiencing physical symptoms without a physical condition) such as pain disorder and hypochondriasis
- Anger control problems
- General stress
Other conditions that can be treated with this type of therapy include:
- Substance addiction
- Depression
- Schizophrenia
- Bipolar disorder
- Obsessive-compulsive disorder (OCD)
- Personality disorders such as narcissistic personality disorder
- Eating disorders
- Behavioral addictions such as gambling addiction
- Sleep issues
- Phobias
- Sexual and relationship problems
How Does CBT Work?
CBT looks at the triggering scenarios in a person’s life and identifies the thought patterns, feelings, and behavior resulting from them. By attempting to modify these thought patterns, CBT aims to change a person’s self-destructive behavior and help them to make healthier choices.
CBT emphasizes three aspects of cognition that influence the way that a person feels and behaves:
Automatic Thoughts:
A person’s immediate interpretations of events are called automatic thoughts. Dysfunctional automatic thoughts are distorted, exaggerated, or unrealistic, leading to psychological issues and unhealthy decision-making.
An example of automatic thoughts in action is when someone feels that another person has ignored them. The person who was ignored may question internally why the other person does not like them. These thoughts can lead to negative feelings about oneself. The individual may start to feel upset, and their behavior may be modified the next time they see the person that ignored them.
CBT aims to change a person’s automatic thoughts to more positive ones. In the example above, if the automatic thoughts were that the other person was just too busy or did not see them, this would significantly change the impact of this incident. The individual would not start to think negatively about themselves, and their future behavior would not be modified.
Cognitive Distortions:
Mental health conditions, especially schizophrenia and other delusional disorders, often involve deficits in logical reasoning. When someone lacks logic, they can come to incorrect conclusions about their situation. Examples of cognitive distortions that are common in individuals with mental health concerns include:
- Dichotomous thinking: Otherwise known as black-and-white thinking, this is commonly found among people suffering from depression. Everything is viewed as either extremely positive or extremely negative.
- Overgeneralization: Broad generalizations are made based on a limited number of cases.
- Mind reading: Making assumptions about what others are thinking and feeling.
- Fortune telling: Believing that you know what will happen in the future.
- Catastrophizing: Focussing on the worst possible outcome, regardless of how unlikely it will happen.
- Selective abstraction: Concentrating only on negative aspects and ignoring anything positive.
- “Should” statements: Concentrating on what “should” or “ought to be” rather than what is happening in reality.
- Personalization or attribution: Assuming responsibility for a negative outcome.
Underlying Beliefs:
As time passes, we develop belief systems or schemas which determine how we perceive or interpret events. These are our core judgments, thoughts, and feelings on the essential aspects of our lives. CBT identifies two levels of underlying beliefs:
Core Beliefs:
Core beliefs are central ideas around oneself and the world. These are the most fundamental beliefs that a person holds. Negative core beliefs about oneself fall into four categories:
- Inferiority
- Vulnerability
- Unlovability
- Worthlessness
If someone begins to think negatively about themselves, it can affect their overall quality of life. If they feel unloved or inferior, they may sabotage themselves by making unhealthy decisions because they do not believe they deserve happiness or success.
CBT aims to address these negative core beliefs and, in doing so, can treat and potentially even prevent medical conditions from developing. Cognitive theory identifies that negative core beliefs about the self can create dysfunctional attitudes that can lead to depression.
Intermediate Beliefs:
A person’s assumptions, rules, and attitudes are intermediate beliefs and heavily influence behavior. For example, someone who feels unloved may believe that the only way to be liked is to please others. They may do things for others that could be potentially dangerous or illegal.
Examples of Different Types of CBT
Cognitive Behavioral therapy is an umbrella term for many therapies stemming from the link between cognition, emotion, and behavior. Examples of types of CBT include:
Dialectical Behavior Therapy (DBT)
DBT focuses on people who experience deep emotions and are prone to making decisions based on feelings rather than rationally. DBT is used to treat many conditions and as a suicide prevention tool, as it reduces self-directed violence.
Rational Emotive Behavior Therapy (REBT)
One of the core pillars of CBT, REBT, is a sound psychological intervention. REBT helps patients identify and deal with irrational beliefs and manage their emotions. Its action-orientated approach assists people in reframing their thinking patterns.
Acceptance and Commitment Therapy (ACT)
ACT is a more recent version of CBT, developed in the 1980s. Through positive reinforcement and counter-conditioning, patients are encouraged to accept their feelings as a justifiable response to their circumstances before making behavioral changes. ACT has been shown to be efficacious for conditions including anxiety, depression, and chronic pain.
What To Expect From CBT Sessions
CBT sessions are usually for individuals, but CBT principles can also be incorporated into family or group sessions. Led by a licensed CBT health professional, the sessions are tailored to the individual needs and goals of the patient but generally follow a similar structure:
The First CBT Session
During the first session, the Cognitive Behavioral Therapist will spend time getting to know the client. They will ask questions to understand their thinking and behavioral patterns. The client will identify personal goals concerning their life and the outcome of CBT treatment. These goals can include stopping a particular behavior, such as drug abuse, or lessening the symptoms of their mental health condition.
The CBT Treatment Plan
Once the therapist understands the patient better, they will identify a suitable treatment plan. The American Psychological Association (APA) recognizes that sessions tend to use a combination of CBT techniques, examples of which include:
Methods To Change Thinking Patterns
- Recognize distortions in thinking: Recognizing and reevaluating distortions in light of reality.
- Understand others: Gaining an understanding of the motivation of others and their behavior.
- Problem-solve: Developing and practicing coping mechanisms for stressful or problematic scenarios.
- Increase self-confidence: Having greater confidence in one’s abilities.
Methods To Change Behavior Patterns
- Face fears: Dealing with fearful situations to reduce their impact.
- Make different decisions: Choosing different, more positive actions when faced with a challenging situation.
- Role-play: Developing coping mechanisms for dealing with others by acting out potentially problematic scenarios.
- Calm the mind and body: Learning relaxation techniques to help quieten inner thoughts.
At the End of Each CBT Session
At the end of each therapy session, the CBT therapist will summarize the issues that have been addressed. They will also allocate homework, which has been identified as one of the critical factors in securing a better long-term outcome from CBT treatment. An example of a commonly assigned homework is to keep a “thought log.” Clients log their automatic thoughts and gain a greater understanding of them. Clients are encouraged to feel empowered to continue the CBT practices they have learned outside their sessions.
What Are the Benefits of CBT?
All therapeutic approaches are different, and not one therapy works for everyone. CBT has some particular benefits, though, as follows:
- Highly adaptable: CBT treatment plans can be adapted to any circumstances and the individual needs of patients.
- Treatment for co-occurring disorders: CBT effectively treats co-occurring disorders as it can address and identify the underlying causes of both conditions. A systematic review of patients with Post Traumatic Stress Disorder (PTSD) and substance addiction found that CBT treatment had a favorable outcome in all areas.
- Constantly evolving: CBT is continually developing as a widely used and studied therapy, with newer approaches such as ACT introduced to address specific needs.
- Relatively quick: An average course of CBT therapy is short-term and lasts between 15 and 20 sessions. CBT concentrates on the present and the changes that can be made now rather than dealing with past trauma.
- Engaging approach: CBT patients exercise self-help and make immediate changes to see immediate benefits.
- Easily accessible: CBT is readily available across the U.S. and is often covered by healthcare insurance policies.
Are There Any Drawbacks to CBT?
Some of the potential disadvantages of CBT include the following:
- Total commitment is required: Patients must be wholly committed to the program to see benefits from it.
- Time-consuming: Patients must be able to attend sessions regularly and complete their homework.
- Present-only focus: Critics of CBT state that it is not a comprehensive treatment method as it does not address the underlying issues behind someone’s mental illness, such as past trauma.
- Individual-only focus: CBT only focuses on the patient and does not address broader issues such as society, peer, and family influence.
- May not be effective for all conditions: Studies have found that CBT is more effective in treating some conditions than others. A 2018 meta-analysis of CBT trials concluded that although CBT is a moderately efficacious treatment for anxiety disorders, more effective treatments are needed for PTSD, panic disorder (PD), and social anxiety disorder (SAD).
Cognitive Behavioral Therapy is a well-used and adaptable form of therapy that has proven effective in many studies. It is also a personal journey that requires an open relationship between the therapist and the client. Finding the right therapist for you is essential, and rehab.com can help you to discover qualified CBT practitioners in your area.
The benefits to patients of CBT treatment are well recognized. Changing your thoughts, feelings, and behavior can positively impact your life and those around you.
