Cognitive Behavioral Therapy (CBT)
Overview
Combining two therapeutic approaches, cognitive therapy and behavioral therapy, cognitive behavioral therapy (CBT) is one of the most widely recommended forms of psychotherapy today.
In 1963, Psychiatrist Aaron T. Beck published a paper in which he identified specific cognitive distortions. Such distortions included: catastrophizing (i.e., imagining something is worse than it actually is) and overgeneralization (e.g., generalizing a specific incident into a general principle – such as stating “everything goes wrong” when one thing has gone awry). The following year, Beck formulated a new therapy (CBT) which could help patients learn to recognize their automatic thoughts and cognitive distortions, to then consciously evaluate and correct them.[1]
Behavioral therapy is based on the theory of “behaviorism,” which assumes that human behavior is learned, and therefore can be unlearned, as well as learned anew. Within behavioral therapy, one seeks to find if a person’s certain behavioral patterns make their life more difficult and/or problematic.[2] As therapists came to determine behavior analysis was not enough to solely explain and account for human language and cognition, cognitive therapy was developed to help understand clients’ thoughts and feelings in a more direct and central way.[3] The term cognitive comes from the Latin word “cognoscere,” which means “to recognize,” during cognitive therapy, one would seek to recognize and clearly understand their own thoughts, attitudes and expectations.[4] By combining therapeutic modalities of understanding someone’s behavior as well as being cognizant of their thinking patterns, cognitive behavioral therapy was formed.
At its core, CBT focuses on the notion that what we think, how we feel and how we behave are closely connected and affect our well-being.[5] Essentially, “the way we think affects the way we feel.” Unfortunately, during times of acute anxiety, it is often difficult for someone to recognize the cognitive (thought-based) reason contributing to the extreme stress they are undergoing. As a person is confronted with some type of triggering situation, an anxious thought often appears, thus creating an anxious feeling; it is therefore the “thought” that leads to the “feeling.”[6] CBT seeks to both reveal and change false and distressing beliefs. This therapy helps people to become aware of inaccurate or negative thinking so that they can view challenging and difficult situations more clearly and respond to them in a more effective and healthier way.[7] Unlike other therapies, CBT focuses on current problems (and not issues from the past) as it seeks to help individuals recognize negative thought patterns and look for practical ways to improve their state of mind, and overall well-being, on a daily basis.[8]
Individuals often assume that situations and not their interpretations of the situation are responsible for one’s anxiety. However, a person’s outlook can alter how they feel about a particular situation. Consider how one’s anxiety level would be elevated if they felt ill-prepared for an exam or feared the exam would be extremely difficult, versus a lower level of anxiety if they felt as though they studied well and knew the material inside and out. Or, if a politician were giving a speech to a crowd who appeared friendly and supportive, the politician would likely have less stress than if they perceived the crowd to be non-receptive to their ideas.[9]
Cognitive behavioral therapy is used to treat a wide range of issues and is often able to quickly help someone both identify and cope with their challenges. CBT is conducted in a structured way and has been found to generally require fewer sessions than other types of therapy. This mode of therapy can be used alone or in combination with other therapies and can be an effective tool to help one learn how to better manage stressful situations.[10] While CBT is often conducted with solo clients, it can also be used during group as well as family therapy sessions.[11]
Cognitive Behavioral Therapy Treatments
Below is a non-exhaustive list of some of the uses for CBT:
Manage symptoms of mental illness
Prevent a relapse of mental illness symptoms
Treat a mental illness when medications are not a good option
Learn techniques for coping with stressful life situations
Identify ways to manage emotions
Resolve relationship conflicts and learn better ways to communicate
Cope with grief or loss
Cope with a medical illness
Manage chronic physical symptoms
Mental health disorders that may improve with CBT include:[12]
Sexual disorders
Additionally, while CBT cannot cure the following ailments, it can help people cope better with their symptoms of long-term health conditions, such as:
Irritable bowel syndrome (IBS)
Chronic fatigue syndrome (CFS)
Fibromyalgia[13]
4 Typical Steps of CBT
Identify troubling situations or conditions in your life. Together with your therapist, you will decide which issues/problems and goals to focus on. These may include anything from: medical conditions; relationship issues; grief; anger; panic attacks; anxiety or any mental health disorder.
Become aware of your thoughts, emotions and beliefs about your issues/problems. Once you have pinpointed the problems/issues you’d like to address, you will begin to share your thoughts about them with your therapist. Your thoughts should include how you interpret what is happening in regards to your problem as well as your beliefs about yourself, those involved, as well as any relevant events that may have occurred. Keeping a journal of your thoughts and feelings is often helpful.
Recognize patterns of negative or inaccurate thinking. Since people sometimes have negative or inaccurate thinking patterns, your therapist will help you identify if this is occurring and if it may be contributing to your problem at hand. One should pay special attention to their physical, emotional and behavioral responses that occur during different situations.
Reshape negative or inaccurate thinking. Once you and your therapist have determined if your view of a situation is based on fact or actually on an inaccurate perception of what's going on, steps can be taken to begin changing thinking patterns in a healthier light. This step can be difficult as people often have long-held and engrained ways of thinking about themselves and their life. However, with practice, helpful thinking and behavior patterns will become a habit and won't take as much effort.[14]
Examples of CBT in Action
Those who have developed depressive thoughts often tend to withdraw, isolate and give up their hobbies – leading to heightened unhappiness and isolation. CBT will help identify this cyclical pattern and help someone find ways to become more active, and happier, again.
Through CBT, anxious individuals will learn various methods and techniques to help calm down. Not only will CBT teach breathing exercises to help relax and focus the mind, but it will help one identify what is really occurring around them and recognize that the situation might not be as dangerous or stressful as they believe.[15]
Cognitive behavioral therapy which utilizes mindfulness is particularly useful in reducing relapses. By teaching acceptance-based strategies, one can focus on the present to reduce avoidance and increase the flow of new and corrective information.[16] One type of mindfulness-based exercise includes the use of constructive distraction techniques that facilitate healthy goal attainment. By stepping away and focusing on a distractive activity such as exercise or some other pleasurable activity, one can be present in the moment and lose focus on a disturbing rise of emotions. To increase mindfulness, one should become more aware of their bodily sensations, focus on breathing as a type of anchor for attention and concentration. Additionally, in mindfulness-based CBT, clients are taught about “non-judgment” and “acceptance.” While someone might not like what is occurring in the moment, it is helpful to accept that “it is what it is” and that situations are not necessarily “good” nor “bad” – they just “are.” Doing so helps someone to become less judgmental of themselves and those with whom they are dealing. By gaining acceptance and lessening judgment, one can often encounter decreased conflict with others as well as less shame and guilt.[17] Further, mindfulness-based CBT teaches that by distancing oneself from the intensity of their thoughts and feelings and focusing on the moment they are in, they can step back and see the situation from another angle and acknowledge that their thoughts “were just thoughts” and not necessarily “facts.”[18] Additionally, as one finds themselves becoming anxious and distressed, by identifying and acknowledging those anxious feelings they can then begin to make strides to engage in another, healthier, activity (such as exercise, creating some form of art or play). As a person turns to another distracting activity to find relief from their stress and anxiety, they will begin to learn how feelings and thoughts are “just” feelings and thoughts that were being experienced in the moment and could pass with some change in activity and thought-pattern. Without engaging in a healthier, distractive activity, a person would likely to have their thoughts spiral downward, increasing their suffering and anxiety exponentially.[19]
If you would like to explore how cognitive behavioral therapy might benefit your life, please reach out to a licensed therapist for guidance and support.
Contributed by: Jennifer (Ghahari) Smith, Ph.D.
references
1 “Commentary: Dr. Aaron T. Beck’s Enduring Impact on Mental Health,” Harvard Health Publishing: Harvard Medical School.
2 “Cognitive Behavioral Therapy,” Institute for Quality and Efficiency in Health Care (IQWiG) (2016) https://www.ncbi.nlm.nih.gov/books/NBK279297/
3 Hayes, S.C. (2004). Acceptance and commitment therapy and the new behavior therapies: Mindfulness, acceptance, and relationship. In S.C. Hayes, V.M. Follette, & M.M. Linehan (Eds.), Mindfulness and acceptance: Expanding the cognitive behavioral tradition (pp. 2). New York: Guilford Press.
4 Institute for Quality and Efficiency in Health Care
5 Ibid.
6 Clark, D. & Beck, A. (2010). Cognitive Therapy of Anxiety Disorders: Science and Practice. (pp. 30) New York: The Guilford Press.
7 “Cognitive Behavioral Therapy,” Mayo Clinic. https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610
8 “Overview: Cognitive Behavioural Therapy (CBT),” NHS. https://www.nhs.uk/conditions/cognitive-behavioural-therapy-cbt/
9 Clark, D. & Beck, A. (pp. 30)
10 Mayo Clinic
11 Friedberg, Robert. “A Cognitive-Behavioral Approach to Family Therapy.” Journal of Contemporary Psychotherapy 36(4) (December 2006):159-165. Online.
12 Mayo Clinic
13 NHS
14 Mayo Clinic
15 Institute for Quality and Efficiency in Health Care
16 Hayes, A.M., Feldman, G.C., Beevers, C.G., Laurenceau, J.P., Caradciotto, L., & Lewis-Smith, J. (2007). “Discontinuities and cognitive changes in an exposure-based cognitive therapy for depression.” Journal of Consulting & Clinical Psychology, 75, 411. Online.
17 Hathaway, W. & Tan, E. “Religiously Oriented Mindfulness-Based Cognitive Therapy” Journal of Clinical Psychology: In Session 65(2) (2009): 165. Online.
18 Ibid.166
19 Ibid.167