Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is a short-term, goal-oriented psychotherapy treatment that takes a hands-on, practical approach to problem-solving. Its goal is to change patterns of thinking or behavior that are behind people’s difficulties, and so change the way they feel. It is used to help treat a wide range of issues in a person’s life, from sleeping difficulties or relationship problems, to drug and alcohol abuse or anxiety and depression. CBT works by changing people’s attitudes and their behavior by focusing on the thoughts, images, beliefs and attitudes that are held (a person’s cognitive processes) and how these processes relate to the way a person behaves, as a way of dealing with emotional problems.
An important advantage of cognitive behavioral therapy is that it tends to be short, taking five to ten months for most emotional problems. Clients attend one session per week, each session lasting approximately 50 minutes. During this time, the client and therapist are work together to understand what the problems are and develop new strategies for tackling them. CBT introduces patients to a set of principles that they can apply whenever they need to, and that’ll last them a lifetime.
Cognitive behavioral therapy can be thought of as a combination of psychotherapy and behavioral therapy. Psychotherapy emphasizes the importance of the personal meaning we place on things and how thinking patterns begin in childhood. Behavioral therapy pays close attention to the relationship between our problems, our behavior and our thoughts. Most psychotherapists who practice CBT personalize and customize the therapy to the specific needs and personality of each patient.
Where Do Negative Thoughts Come From?
Beck suggested that these thinking patterns are set up in childhood, and become automatic and relatively fixed. So, a child who didn’t get much open affection from their parents but was praised for school work, might come to think, “I have to do well all the time. If I don’t, people will reject me.” Such a rule for living (known as a dysfunctional assumption) may do well for the person a lot of the time and help them to work hard.
But if something happens that’s beyond their control and they experience failure, then the dysfunctional thought pattern may be triggered. The person may then begin to have automatic thoughts like, “I’ve completely failed. No one will like me. I can’t face them.”
Cognitive-behavioral therapy acts to help the person understand that this is what’s going on. It helps him or her to step outside their automatic thoughts and test them out. CBT would encourage the depressed woman mentioned earlier to examine real-life experiences to see what happens to her, or to others, in similar situations. Then, in the light of a more realistic perspective, she may be able to take the chance of testing out what other people think, by revealing something of her difficulties to friends.
Clearly, negative things can and do happen. But when we are in a disturbed state of mind, we may be basing our predictions and interpretations on a biased view of the situation, making the difficulty that we face seem much worse. CBT helps people to correct these misinterpretations.
What Does CBT Treatment Look Like?
Cognitive-behavioral therapy differs from many other types of psychotherapies because sessions have a structure, rather than the person talking freely about whatever comes to mind. At the beginning of the therapy, the client meets the therapist to describe specific problems and to set goals they want to work towards. The problems may be troublesome symptoms, such as sleeping badly, not being able to socialize with friends, or difficulty concentrating on reading or work. Or they could be life problems, such as being unhappy at work, having trouble dealing with an adolescent child, or being in an unhappy marriage.
These problems and goals then become the basis for planning the content of sessions and discussing how to deal with them. Typically, at the beginning of a session, the client and therapist will jointly decide on the main topics they want to work on this week. They will also allow time for discussing the conclusions from the previous session. And they will look at the progress made with the homework the client set for him- or herself last time. At the end of the session, they will plan another assignment to do outside the sessions.
How else does it differ from other therapies?
Cognitive behavioral therapy also differs from other therapies in the nature of the relationship that the therapist will try to establish. Some therapies encourage the client to be dependent on the therapist, as part of the treatment process. The client can then easily come to see the therapist as all-knowing and all-powerful. The relationship is different with CBT.
CBT favors a more equal relationship that is, perhaps, more business-like, being problem-focused and practical. The therapist will frequently ask the client for feedback and for their views about what is going on in therapy. Beck coined the term ‘collaborative empiricism’, which emphasizes the importance of client and therapist working together to test out how the ideas behind CBT might apply to the client’s individual situation and problems.
Who Benefits from Trying CBT?
People who describe having particular problems are often the most suitable for CBT, because it works through having a specific focus and goals. It may be less suitable for someone who feels vaguely unhappy or unfulfilled, but who doesn’t have troubling symptoms or a particular aspect of their life they want to work on.
It’s likely to be more helpful for anyone who can relate to CBT’s ideas, its problem-solving approach and the need for practical self-assignments. People tend to prefer CBT if they want a more practical treatment, where gaining insight isn’t the main aim.
CBT can be an effective therapy for the following problems:
- anger management
- anxiety and panic attacks
- child and adolescent problems
- chronic fatigue syndrome
- chronic pain
- eating problems
- general health problems
- habits, such as facial tics
- mood swings
- obsessive-compulsive disorder
- post-traumatic stress disorder
- sleep problems