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Cognitive Behavioral Therapy (CBT)

    Cognitive Behavioral Therapy

    Cognitive behavioral therapy (CBT) is a type of psychotherapy that helps people identify and change disturbing thought and behavior patterns. It is used to treat various mental disorders like depression, anxiety, schizophrenia, etc.

    What Is Cognitive Behavioral Therapy?

    Cognitive behavioral therapy is a form of psychotherapy that aims to recognize, challenge, and change distorted beliefs, thoughts, attitudes, and improper behavior related to emotional dysfunction. As defined by American psychiatrist Judith Beck 1, CBT is a “short-term, structured present-oriented therapy” that focuses on replacing our negative thoughts and underlying beliefs with a more positive and realistic outlook.

    It helps us develop healthy coping strategies, besides improving our emotional regulation, psychological resilience, and mental health. Though initially conceived to treat depression, today, CBT is used to treat a wide array of physical and psychological health conditions.

    As the name suggests, CBT combines the twin psychotherapy approaches of cognitive therapy and behavioral therapy. The cognitive approach helps the patient build clarity about their own thoughts, expectations, and attitudes and replace the harmful cognitive distortions with realistic ones.

    The behavioral approach, on the other hand, helps a patient unlearn and relearn behaviors through careful conditioning, awareness, and mindfulness techniques.

    It is based on the belief that our thoughts, emotions, and behaviors are all connected and these should function properly altogether to ensure overall well-being. The tenure of CBT sessions depends on the type of therapy administered as well as the patient’s mental disorder and rate of recovery.

    Case Example

    Saanvi, a 25 year old resident doctor, started experiencing dejection and guilt as several of her COVID in-patients had passed away in the span of a week. The added pressure from her supervisors and the patients’ families was also beginning to affect her.

    She blamed herself for the deaths and began to question her own credibility as a doctor, even though she had tried everything in her capacity to help the patients. As she was unable to cope with these feelings, she decided to consult a therapist, who specialized in cognitive behavioral therapy.

    Saanvi was asked to keep a thought diary to note her automatic thoughts and associated feelings and behavior daily. With the help of her therapist, she eventually realized that her thoughts were linked to the faulty assumption that she was responsible for things beyond her control and that she was generalizing some isolated incidents to her entire career.

    Gradually, she was able to come to terms with the fact that the deaths were not her fault, and just because she could not save a few patients did not mean that she was a bad doctor.

    How Does Cognitive Behavioral Therapy Work?

    Cognitive behavioral therapy focuses on finding practical strategies to improve the mindset of the patient. Our thoughts, emotions, and behavior are interrelated and this relationship influences our perception of the world. With the help of CBT, we can become aware of how our thinking patterns determine our behavior and our reality.

    By encouraging self-reflection and self-acceptance, CBT helps us to develop healthier ways of thinking and behaving. This reduces the emotional distress and abnormal behavior caused by dysfunctional thinking patterns and lack of emotional regulation—thereby enabling us to function more productively and enjoy better interpersonal relationships. However, one may need several sessions, over various weeks or months, to experience the positive effects of CBT.

    History Of Cognitive Behavioral Therapy

    Cognitive therapy has its roots in ancient Greek philosophy, particularly Stoicism. At the beginning of the 20th century, with the development of behavioral therapy, CBT emerged with the works of psychologists such as –

    • John B. Watson
    • BF Skinner’s conditioning theories
    • Joseph Wolpe’s method of systematic desensitization
    • Albert Ellis’ practice of rational emotive behavioral therapy (REBT)
    • Aaron T. Beck’s free association sessions in his psychoanalytic practice

    With the “cognitive revolution” movement in the 1950s, the clinical approaches of Albert Ellis and Aaron T. Beck gained popularity—with both systems involving redressal of “present” problems, behavioral elements, and interventions.

    During the 1980s and 1990s, cognitive and behavioral techniques were merged 2 into cognitive behavioral therapy (CBT), thanks to the development of treatment methods for panic disorder by the psychiatrists David M. Clark and David H. Barlow.

    Benefits Of Cognitive Behavioral Therapy

    Research and clinical practice testify to the various benefits of cognitive behavioral therapy, including:

    1. Challenging and changing faulty beliefs, also known as cognitive distortions
    2. Rectifying improper behavior related to emotional dysfunction
    3. Improving emotional regulation
    4. Developing healthy coping strategies
    5. Developing useful social and life skills
    6. Developing greater psychological resilience
    7. Developing a value system
    8. Enhancing self-empathy
    9. Solving current problems and improving present circumstances
    10. Enhancing treatment outcomes in mental health conditions like substance addiction, eating disorders, depression, etc.
    11. Enhancing the sufferer’s quality of life

    Types Of Cognitive Behavioral Therapy

    CBT includes several cognitive or behavioral psychotherapies that aim to change our negative and maladaptive thoughts, behaviors, and actions. Chronic or acute mental health symptoms are treated using evidence-based techniques and structured strategies. These approaches may also include non-medical interventions like self-help strategies.

    Some of the most common types of CBT approaches include the following:

    1. Cognitive therapy (CT)

    This form of therapy is based on the cognitive model of psychopathology and focuses on recognizing and improving distorted, unhelpful thoughts, behaviors, and emotional responses.

    2. Dialectical behavior therapy (DBT)

    DBT primarily focuses on changing thought and behavior patterns related to emotional dysfunction. It also helps the patient develop positive strategies to promote emotional regulation as well as mindfulness. It is considered quite effective for borderline personality disorder and depression.

    3. Multimodal therapy

    In multimodal therapy, the core concept suggests that mental health problems can be treated when certain interconnected yet separate modalities are addressed. These include affect, behavior, cognition, drug/biological considerations, interpersonal factors, imagery, and sensation.

    4. Rational emotive behavior therapy (REBT)

    REBT mainly focuses on enabling patients to recognize irrational and unjustifiable beliefs, challenge such beliefs actively, and replace these negative thought patterns with more positive ones.

    5. Acceptance and commitment therapy (ACT)

    ACT uses strategies associated with acceptance, mindfulness, commitment, and behavioral changes to increase a person’s psychological resilience and flexibility.

    6. Metacognitive therapy (MCT)

    MCT is a form of psychotherapy that strives to modify metacognitive beliefs that cause cognitive and behavioral dysfunctions like anxiety, rumination, obsession, attention-fixation, etc.

    7. Reality therapy (RT)

    RT involves counseling and problem-solving strategies that focus on the here-and-now actions of the client and his/her ability to create a better life. It maintains that the individual is suffering from unfulfilled basic needs and focuses less on mental illness. Its three tenets include realism, responsibility, and right-and-wrong.

    8. Eye movement desensitization and reprocessing (EMDR)

    Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy used extensively to treat post-traumatic stress disorder (PTSD). In EMDR, the patient is asked to recall personal distressing experiences whilst doing bilateral stimulation, such as side-to-side eye movement, tapping either side of the body, etc.

    9. Other types of CBT

    Apart from these, other common types of CBT are used to treat psychiatric disorders—including:

    • Metacognitive training
    • Exposure therapy
    • Cognitive processing therapy (CPT)
    • Self-instructional training
    • Stress inoculation training
    • Schema focused therapy
    • Cognitive behavioral family therapy

    Cognitive Behavioral Therapy Techniques

    Cognitive behavioral therapy techniques help a person identify disturbing thoughts and behavioral patterns that lead to psychiatric disorders and psychological distress.

    1. Identifying negative thoughts

    CBT helps a person identify certain negative and harmful thought patterns that lead to maladaptive conduct. It encourages people to introspect and use this self-reflection and self-discovery to trace the source of their emotional dysfunction, difficult behavior, etc.

    2. Practicing new skills (Behavioral experiments)

    Self-reflection helps a person gain new insights into one’s own life. The person may apply this knowledge to real-world situations and develop healthy coping strategies. These may include self-help techniques and better social skills that a person uses to rectify his/her emotional distress and abnormal behavior.

    3. Goal-setting

    In CBT, a therapist helps the client (suffering from mental illness) in setting short-term and long-term goals. These goals not only aid the person’s recovery from mental illness but also enhance his/her happiness and life satisfaction in the long run. Objectives set in CBT verge on the SMART (specific, measurable, attainable, relevant, time-based) principle of goal-setting and focus on the process as much as the outcome.

    4. Problem-solving

    CBT helps a person suffering from mental illness develop major problem-solving skills that help him/her deal better with daily stressors and cope better with the symptoms of psychological or physical illness. Problem-solving, as advocated by CBT, involves:

    • Identifying the problem
    • Generating possible solutions to the problem
    • Evaluating the application and success of each solution
    • Choosing a solution to implement
    • Implementing the solution

    Common problem-solving skills developed in CBT sessions include peaceful conflict management skills, stress management techniques, self-coping with triggers, etc.

    5. Self-Monitoring

    Self-monitoring techniques in CBT involve tracking behaviors, symptoms, or experiences over intermittent periods of time and sharing them with your therapist. This helps the therapist gain insights into the patient’s recovery process and develop better treatment methods. Some common self-monitoring techniques include:

    • Journaling
    • Thought records
    • Habit tracking
    • Activity scheduling
    • Socratic questioning
    • Behavior activation, etc.

    Examples Of CBT

    Listed below are some common cognitive behavioral therapy examples:

    • Exposing yourself to certain triggering situations and healthily coping with the same (like visiting a crowded place if you have social anxiety)
    • Journaling your thoughts (like maintaining a gratitude journal)
    • Recording your feelings and certain habits (like tracking your eating habits if you have an eating disorder)
    • Engaging in mindful meditation and/or yoga
    • Scheduling activities that trigger your anxiety or nervousness
    • Undertaking overwhelming tasks, albeit in small and manageable steps, and finishing them
    • Positively taking into account every tiny goal achieved and encouraging yourself
    • Role-playing to practice and improve social skills, communication skills, etc.

    Read More About Meditation Here

    Applications Of CBT

    The uses of cognitive behavioral therapy can be seen in the treatment of:

    1. Depressive disorders
    2. Anxiety disorders (such as phobia and panic disorders)
    3. Stress disorders (like post-traumatic stress disorder)
    4. Obsessive-compulsive disorder (OCD)
    5. Eating disorders
    6. Sleep disorders
    7. Schizophrenia
    8. Mood disorders
    9. Headache disorders (like migraine)
    10. Substance use disorder
    11. Autism and other neurodevelopmental disorders, etc.

    People are also frequently recommended CBT if they are:

    • Grieving a loss or a death
    • Experiencing problems in intimate relationships
    • Having low-self esteem and confidence
    • Going through major life-changing events
    • Experiencing everyday stress
    • Experiencing emotional distress related to physical illness, pregnancy, etc.

    Read More About Autism Here

    How Effective Is Cognitive Behavioral Therapy?

    Research and clinical practice have proved time and again that cognitive behavioral therapy is the gold standard of psychotherapy 3, working best for both acute and chronic psychiatric disorders. It reaps benefits for not just the individual suffering from mental health conditions, but also their family, friends, and the larger community.

    In recent years, the effectiveness of CBT 4 has been highlighted by several studies:

    • A 2010 study 5 claimed that CBT improves treatment outcomes in post-treatment and at follow-up phases of recovery from major psychiatric disorders like schizophrenia, anxiety and depressive disorders, etc.
    • A 2014 study 6 shows that CBT improves ADHD symptoms in children, even those younger than 6 years of age.
    • A 2018 study 7 testified that CBT can help a person manage effectively, in the long run, the symptoms of chronic stress and anxiety disorders, as well as those caused by a psychological or pill placebo condition.
    • Another 2018 study 8 revealed that CBT helped improve cognitive functioning in people with major depression and PTSD.
    • A 2020 study 9 confirmed that both virtual and internet-based CBT holds promise for effective mental healthcare treatment.
    • A 2021 study 10 revealed that CBT was effective against 13 out of the 20 major mental conditions listed in the WHO’s International Classification of Diseases (ICD).
    • One 2021 study 11 testified to the effectiveness of CBT in treating memory disorders (like dementia, Alzheimer’s disease, Parkinson’s disease, etc.) in the early stages.

    Read More About  Effectiveness Of Cognitive Behavioral Therapy (CBT) Here

    How To Prepare For CBT

    Going to therapy for the first time can be a daunting experience, especially if you are from an environment that espouses the stigmatization of mental health. However, going to therapy can actually reap great benefits for you and ensure that you enjoy a positive, fulfilling life in the long run.

    Consider the following steps to prepare for cognitive behavioral therapy:

    • Acknowledge that you have a mental disorder. Recognize your negative thoughts and emotions and disruptive behavior.
    • Consult a general practitioner about your health conditions. Ask him/her to refer you to a licensed mental health professional in your locality.
    • Read self-help CBT guides to educate yourself better about the therapy.
    • You may also consider your personal preferences for therapy, like online or face-to-face therapy.
    • Contact your health insurance and check if your therapy costs could be covered under the availed plan.
    • Expect your initial experience to be similar to a doctor’s appointment (like filling out medical forms, going through therapy policies, answering psychiatric questionnaires, etc.).
    • Decide on fundamental matters like confidentiality, session timings and length, therapy costs, etc.
    • Be prepared to honestly answer the therapist’s questions related to your mental health symptoms, family history of health conditions, developmental experiences, education, career, interpersonal relationships, etc.
    • Communicate your treatment objectives and general life goals to the therapist.
    • Feel free to clarify doubts about your mental health, therapy sessions, etc.

    Challenging Issues In CBT

    Despite its widespread usefulness, cognitive behavioral therapy is plagued by certain drawbacks 12:

    • CBT is frequently viewed as time-consuming and expensive, with ambiguous rates of recovery.
    • CBT administered online depends heavily on the accessibility of technological resources like the internet, computer, headphones, etc.
    • CBT is considered unsuitable for people with complex mental health needs (like those with autism, dementia, intellectual disabilities, etc.)
    • CBT may set off major, even unmanageable triggers for people suffering from trauma, abuse, etc.
    • High drop-out rates in long-term CBT were found, especially among people suffering from depression, substance abuse disorders, eating disorders, etc.

    Takeaway

    Cognitive behavioral therapy is one of the most studied and effective forms of psychotherapy. It can enable people suffering from psychiatric disorders to alter their beliefs and perceptions, as well as replace their negative thoughts with more positive outlooks.

    By addressing mental health symptoms and helping us develop healthy coping methods—CBT aids us in effectively managing our mental health for the better. By avoiding severe mental health conditions in the future, we can live a happier, more fulfilling life.

    At A Glance

    1. Cognitive Behavioral Therapy (CBT) is a type of psychotherapy that effectively treats several psychiatric conditions.
    2. It is an integration of two separate psychotherapy techniques, namely, cognitive and behavioral therapies.
    3. It is based on the notion that our thoughts, emotions, behaviors, and actions are interrelated.
    4. It can be administered both online (with online counseling) and offline (with face-to-face traditional therapy).
    5. It is typically administered by a licensed mental health professional (MHP).
    6. CBT is substantially effective in treating depression, anxiety disorders, eating disorders, stress disorders, etc.
    7. CBT is the most effective form of mental health treatment when coupled with medication.

    Frequently Answered Questions (FAQs)

    1. What is the goal of CBT?

    The goal of CBT is to help a person change their maladaptive thoughts, behaviors, and resulting emotions to lead a better and more fulfilling life.

    2. What does a cognitive behavioral therapist do?

    A cognitive behavioral therapist helps a person change their troubling thought patterns and conduct as well as develop healthy coping habits. This can help the patient deal better with their emotional dysfunction, interpersonal issues, etc.

    3. What questions do CBT therapists ask?

    A CBT therapist during a typical therapy session asks about a patient’s personal history, family history of mental illness, triggers and fears, the sufferer’s personal interpretation of problems and challenges, including when they began, how they cope with it, etc.

    4. Who can be a CBT therapist?

    Different countries have their own guidelines for certification. In most countries to become a CBT therapist, a person has to earn a Ph.D. or Psy.D. in clinical, counseling, or school psychology or an M.Phil.

    5. When to end CBT therapy?

    Traditional CBT treatment usually lasts between 5 to 20 weeks. However, in cases of severe and chronic psychiatric disorders, CBT therapy treatment lasts longer—sometimes accompanied by a strict regime of medication and in-patient treatment.

    6. Does cognitive behavioral therapy involve medication?

    Cognitive behavioral therapists do not prescribe medication. However, for severe forms of depression, anxiety, and other mental disorders, they may recommend consulting a psychiatrist. Often, therapy and medication go hand in hand for such conditions.

    7. What is the difference between cognitive therapy and behavioral therapy?

    Cognitive therapy modifies the thought processes of a person, whereas, behavioral therapy seeks to correct the patient’s dysfunctional conduct and maladaptive coping behavior.

    👇 References:
    1. Cognitive Therapy: Basics and Beyond. (1997). The Journal of Psychotherapy Practice and Research, 6(1), 71–80. []
    2. Ruggiero, G. M., Spada, M. M., Caselli, G., & Sassaroli, S. (2018). A historical and theoretical review of cognitive behavioral therapies: From structural self-knowledge to functional processes. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 36(4), 378-403. https://doi.org/10.1007/s10942-018-0292-8 []
    3. David, D., Cristea, I., & Hofmann, S. G. (2018). Why Cognitive Behavioral Therapy Is the Current Gold Standard of Psychotherapy. Frontiers in psychiatry, 9, 4. https://doi.org/10.3389/fpsyt.2018.00004 []
    4. Chand SP, Kuckel DP, Huecker MR. Cognitive Behavior Therapy. [Updated 2022 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470241/ []
    5. Tolin D. F. (2010). Is cognitive-behavioral therapy more effective than other therapies? A meta-analytic review. Clinical psychology review, 30(6), 710–720. https://doi.org/10.1016/j.cpr.2010.05.003 []
    6. Felt, B. T., Biermann, B., Christner, J. G., Kochhar, P., & Harrison, R. V. (2014). Diagnosis and management of ADHD in children. American family physician, 90(7), 456–464. []
    7. Carpenter, J. K., Andrews, L. A., Witcraft, S. M., Powers, M. B., Smits, J., & Hofmann, S. G. (2018). Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials. Depression and anxiety, 35(6), 502–514. https://doi.org/10.1002/da.22728 []
    8. Furukawa, T. A., Karyotaki, E., Suganuma, A., Pompoli, A., Ostinelli, E. G., Cipriani, A., Cuijpers, P., & Efthimiou, O. (2018). Dismantling, personalising and optimising internet cognitive–behavioural therapy for depression: A study protocol for individual participant data component network meta-analysis. BMJ Open, 8(11), e026137. https://doi.org/10.1136/bmjopen-2018-026137 []
    9. Lungu, A., Jun, J. J., Azarmanesh, O., Leykin, Y., & Chen, C. E. (2020). Blended care-cognitive behavioral therapy for depression and anxiety in real-world settings: Pragmatic retrospective study. Journal of Medical Internet Research, 22(7), e18723. https://doi.org/10.2196/18723 []
    10. Fordham, B., Sugavanam, T., Edwards, K., Stallard, P., Howard, R., das Nair, R., Copsey, B., Lee, H., Howick, J., Hemming, K., & Lamb, S. E. (2021). The evidence for cognitive behavioural therapy in any condition, population, or context: a meta-review of systematic reviews and panoramic meta-analysis. Psychological medicine, 51(1), 21–29. https://doi.org/10.1017/S0033291720005292 []
    11. Nakao, M., Shirotsuki, K., & Sugaya, N. (2021). Cognitive-behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies. BioPsychoSocial medicine, 15(1), 16. https://doi.org/10.1186/s13030-021-00219-w []
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