CBT

What Is Cognitive Behavioral Therapy (CBT)?

Cognitive Behavioral Therapy (CBT), developed by Dr. Aaron Beck in the 1960s, focuses on cognitive change (changes in thought patterns and belief systems) to bring about lasting emotional and behavioral change. According to cognitive therapy, when people learn to evaluate their thoughts in a more realistic and adaptive way, improvements occur in their emotional states and behaviors as well.

While some therapy approaches focus primarily on understanding a person’s past and shedding light on childhood experiences, CBT examines how past experiences are reflected in a person’s current life. Therefore, detailed information about the individual’s past is also gathered; however, the primary focus of therapy is on moving forward in time to develop more effective ways of coping with life.

CBT places importance on helping individuals learn to become their own therapists. In addition to in-session work, clients are supported through “homework” exercises between sessions, which help them make sense of their own thoughts, intense emotions, and behaviors, and develop skills to cope with the problems they encounter.

What Are the Methods of Cognitive Behavioral Therapy?

1. Cognitive restructuring or reframing
This method helps you recognize negative and unproductive thought patterns (such as overgeneralization, catastrophizing, minimizing or dismissing the positive, and personalization) and reconsider them from a more realistic and constructive perspective.

2. Guided discovery through Socratic questioning
With this method, the therapist tries to understand and make sense of your perspectives and thought processes about yourself, others, and the world. The therapist then continues to ask questions to uncover deeper underlying beliefs. During this process, you are asked to find evidence that supports and does not support your beliefs and assumptions. By broadening your perspective, you become aware of alternatives you may not have considered before.

3. Exposure
Exposure can be used to confront fears, anxiety, and phobias. While the therapist provides guidance on how to systematically cope with identified fears or anxieties, you are gradually exposed to the people, objects, emotions, or situations that cause fear or worry. Exposure can help you feel more in control and increase confidence in your ability to cope.

4. Journaling and thought records
Writing is an effective way to connect with your own thoughts. The therapist may ask you to list the negative thoughts you experience between sessions, as well as alternative positive thoughts you could choose instead. Another writing exercise involves keeping a record of new thoughts and behaviors you have put into practice since the last session. Writing down the changes you observe in yourself helps you gain insight and awareness into your emotions, behaviors, and thoughts.

5. Activity scheduling and behavioral activation
If there is an activity you tend to postpone or avoid due to fear or anxiety, including it in the therapy plan can be effective. In sessions, breaking the goal you want to focus on into small steps and planning them in detail can increase the likelihood of putting that goal into action. Activity scheduling helps build positive habits and provides opportunities to apply what you have learned.

6. Behavioral experiments
Behavioral experiments are planned experiential activities designed to test the validity of anxious thoughts and negative beliefs. In these experiments, individuals gather information from their environment to test the accuracy of their beliefs (about themselves, others, and the world). During sessions, the therapist may ask you to predict what will happen in a situation or behavior that worries you. As homework, you are then guided to test this behavior in different ways and observe the outcomes. Through these experiments, the aim is to help you see that the predicted “catastrophe” is unlikely to occur and to restructure your beliefs accordingly.

7. Relaxation and stress reduction techniques
The therapist may teach relaxation techniques such as breathing exercises, muscle relaxation, and visualization. These techniques are practical skills that help reduce stress and increase your sense of control. Breathing and relaxation exercises are effective in coping with phobias, social anxiety, and other stressors.

8. Role-playing
Role-playing helps you practice different behaviors in potentially challenging situations. Acting out possible scenarios can be used to reduce fear, develop problem-solving skills, gain familiarity and confidence in specific situations, and improve social and communication skills.

What Does Cognitive Behavioral Therapy Aim to Achieve?

CBT aims to equip clients with sufficient skills to cope with the behaviors and situations they identify as problematic, as well as with potential difficulties that may arise after therapy ends. Sessions generally involve efforts to change thought and behavior patterns. Some of these strategies include:

Learning to recognize distortions in problematic thinking and reevaluate them from a more realistic perspective
Better understanding others’ behaviors and motivations
Using problem-solving skills to cope with difficult situations
Learning to develop greater confidence in one’s own abilities
Confronting fears and anxieties instead of avoiding them
Using role-playing to prepare for potentially problematic interactions with others
Learning to calm the mind and relax the body

Is Cognitive Behavioral Therapy Effective?

Cognitive behavioral therapy is a form of psychological treatment that has been supported by scientific research as effective for a range of issues, including depression, anxiety disorders, alcohol and substance use problems, marital problems, eating disorders, and obsessive-compulsive disorder. Numerous studies show that CBT helps produce significant improvements in functioning and quality of life. Although CBT is effective in addressing many psychological problems, factors such as the client’s motivation and suitability for CBT, the therapeutic alliance between therapist and client, and the way the therapist conveys this approach all play an important role in the effectiveness of therapy.

In Which Situations Might Cognitive Behavioral Therapy Be Insufficient?

The structured nature of CBT sessions may not be suitable for individuals with more complex psychological difficulties or learning impairments.

Because cognitive therapy methods teach clients to face intense emotions such as anger, fear, anxiety, and sadness, individuals may feel more anxious, emotionally intense, or unsettled in the early stages of therapy.

One commonly criticized aspect of CBT is its focus on the “here and now” and on current problems; as a result, it may be insufficient for clients with stressful childhood experiences in terms of fully understanding and processing past experiences.

Since CBT focuses on an individual’s capacity for personal change, it may be limited when addressing problems at the societal level or within family structures that have a significant impact on a person’s health and well-being.

References

American Psychological Association. (n.d.). What is cognitive behavioral therapy? American Psychological Association. Retrieved February 28, 2022, from https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral

Beck, J. S., & Beck, A. T. (2021). Cognitive behavior therapy: Basics and beyond. The Guilford Press.

Pietrangelo, A. (2019, December 12). CBT techniques: Tools for cognitive behavioral therapy. Healthline. Retrieved March 4, 2022, from https://www.healthline.com/health/cbt-techniques#types-of-cbt-techniques