Cognitive Behavioral Therapy

Cognitive Behavioral Therapy or CBT is a short-term, practical treatment approach to many types of issues such as eating disorders, relationship issues, drug or alcohol abuse, depression and many more. The focus of CBT is on trying to change the client’s attitude and behavior towards the issue at hand. This is done by focusing on the underlying beliefs and thoughts, and trying to replace the dysfunctional beliefs with more positive solution-focused thoughts and images.

The approach is one of the most researched behavioral treatment interventions (Butler, 2006). Its effect has been demonstrated in multiple conditions such as depression, generalized anxiety disorder, panic disorder, social phobia, post-traumatic stress disorder, childhood anxiety disorders, marital problems, anger disorders, childhood somatic disorders, chronic pain and obsessive-compulsive disorders.

A psychiatrist, Aaron Beck formulated CBT over 50 years ago. He observed that his patients often had an active internal dialogue going on in their mind. This dialogue would be shaped by the client’s beliefs and thoughts and much of this thinking happened automatically. Most importantly, this thinking would have a major influence on how the client felt and acted. For example, a person with social anxiety might find himself or herself in a social gathering talking to a work colleague. A thought might pop up, “I wonder why she isn’t smiling at me. She seems to be smiling at everyone else.” And then the next thought, “It’s always like this. I just don’t fit in.” This would then eventually lead to the person leaving the gathering, withdrawing from the scene. And of course, the dialogue would then repeat itself over and over again into the future.

Beck noticed that the client when asked could verbalize many of these thoughts. Once they were out in the open, it became quite obvious that they were often unrealistic and unhelpful. And it became clear that these negative thoughts were directly related to the negative feeling and the subsequent behavior. It was a logical next step to try to replace these dysfunctional thoughts with healthier, more realistic ones.

Central to the CBT approach is that thoughts are a reflection of our beliefs. What we believe determines what we will think. Our thoughts in turn will influence how we feel and act. One person faced with a certain challenging situation may flee from it, thinking that great harm is imminent. Another person facing the exact same situation may read it quite differently and decide to face it. CBT helps the client examine these deep thoughts and beliefs and identify the ones that are clearly not realistic and partly to blame for the problem behavior.

Said differently, it’s not so much what happens – the event – that makes us feel sad or angry, but it’s the meaning that we attach to it. “She didn’t smile (event) because she doesn’t like me (interpretation). Nobody likes me (belief).”

This phenomenon of wrongly interpreting events through a personal lens, is called cognitive bias. Our brain evaluates events through a filter or a lens that was created based on past events, experiences, memories, beliefs and teachings. This is a very logical thing for the brain to do and usually serves us very well. For instance, you may have burned your fingers on a hot stove when you were 3 years old, but that was the last time you ever did that again! Your brain has done an excellent job of protecting you from getting burned from that point forward. But if you are scared to step onto a plane because of an irrational fear that it is bound to crash, then there is clearly something that has gone awry in this process. CBT is an excellent technique to deal with such situations.

CBT starts by helping the client to objectively identify what is going on. What is the problem? What is the behavior you want to address?

After this we explore what thoughts and beliefs are connected to this behavior or this issue. The client learns to take on the role of observer of his own thought process. Once these thoughts and beliefs are identified, they are then evaluated. Are they realistic? Are they helpful? If not, we put them on the list of thoughts to be replaced.

The dysfunctional thoughts and beliefs are then replaced by more realistic ones. “She doesn’t even know me so it’s not a matter of her not liking me. She would probably be quite engaged if I showed her that I was interested in her. Let me try to find out what she is all about.”

Finally, these new thoughts must be tested in real life. The client is encouraged to try it out. In small incremental steps, the challenging situation is confronted while rehearsing and practicing the new thoughts connected to this situation.

Almost always, the client’s reaction is one of surprise and relief. As the new thought pattern holds up and is tested repeatedly, the brain learns that it is a safe pattern and the dysfunctional pattern decreases and disappears over time.

CBT is obviously not the best tool for every mental disorder in the book. It is however a very effective one in many of them.

Additional interventions or other approaches may be indicated to enhance the effect of CBT, such as antidepressant medication or therapeutic techniques like EMDR.

There is no risk to receiving CBT. You may feel uncomfortable at first during therapy because you will probably revisit painful feelings, emotions and experiences. This is where the trained counselor will be of great help to you. You can feel safe to ‘go there’. And the coping skills that you will learn during your sessions will help you for the rest of your life.

References

Butler, Andrew C., et al. “The empirical status of cognitive-behavioral therapy: a review of meta-analyses.” Clinical psychology review 26.1 (2006): 17-31.