Cognitive Behavioral Therapy (CBT): What is it and How does it work?
Cognitive behavioral therapy (CBT) is an extremely widely used methodology to treat a range of mental and physical health disorders.
CBT is a type of psychotherapy that is used to treat mental health conditions such as anxiety and depression. It combines two approaches to psychological treatment: cognitive and behavioral therapy.
What is cognitive behavioral therapy?
Cognitive behavioral therapy recognizes that psychological issues are caused by negative patterns of thinking and problematic beliefs about oneself and the world.
While the number of sessions required to complete cognitive behavioral therapy depends on an individual’s specific needs and situation, it is generally considered a short-term methodology, typically ranging between 12 and 20 sessions.
The primary goal of CBT is to utilize a talking methodology to make individuals realize that their thoughts are linked to their feelings and actions. The therapist aims to enable the individual by providing them with tools to manage their thoughts and behaviors more effectively.
The Department of Psychiatry reports on a study that finds CBT offers long-term benefits for people with depression. The study found that 43% of those who received CBT improved over 46 months, with at least a 50% reduction in symptoms compared with 27% for those who continued their normal care.
How does cognitive behavioral therapy work?
Now that we have established that CBT is an evidence-based treatment that focuses on having conversations to identify an individual’s negative thoughts and behavioral patterns, here is a step-by-step on how cognitive behavioral therapy is used to treat a variety of mental health conditions:
Identifying negative thought patterns
The first step a therapist takes in Cognitive Behavioral Therapy is understanding the negative thought patterns that may be leading the patient to feel emotional distress. These patterns of negative thinking are often referred to as cognitive distortions.
These cognitive distortions refer to when an individual has automatic thoughts that are often biased or irrational. A therapist helps their client pause and reflect on these patterns, bringing to light the thoughts that often arise in specific situations.
For example, a client may think, “I can never do anything right.” In such a situation, the therapist helps the client understand that this is not true in every scenario and is a generalization that they have made about themselves.
Once a client starts to identify and pick up on these distorted thinking patterns and realizes that these thoughts impact their emotions, it helps the therapist build a stronger foundation for moving toward the next steps in cognitive behavioral therapy.
Challenge and reframe thoughts
Now that the client has successfully identified their negative thoughts, the therapist moves towards helping them challenge and reframe these thoughts.
Therapists utilize a technique called cognitive restructuring, in which clients are made to question or challenge their negative thoughts. Often, therapists challenge clients to ask themselves for evidence behind their negative thoughts.
For example, a client who believes they are a failure will be reminded of times when they did succeed or performed very well.
This continuous effort of challenging one’s negative thoughts reduces the intensity of the client’s emotional distress and creates a habit of analyzing thoughts before believing them. While this step takes a lot of practice and consistency, it is an essential part of CBT.
Exposure to fears or triggers
Cognitive Behavioral Therapy is used to treat and manage mental health disorders such as anxiety and phobias. In such cases, therapists utilize a methodology called exposure therapy.
This is a technique where clients are gradually and over time exposed to situations and stimuli that cause them discomfort and distress. This is done so that clients can face their fears while ultimately being in a safe environment and space.
There are different ways of exposure therapy: Some therapists may utilize real-life situations for exposure whereas some may use imagination techniques to present a triggering situation to their client.
Through frequent interaction and exposure to situations of discomfort over time, the client witnesses a decrease in anxiety when facing the situation. Through confrontation, the client learns to be more confident and not fall into a loop of avoidance, which often causes an increase in anxiety.
Mindfulness and awareness
This step in cognitive behavioral therapy involves techniques such as breathing and grounding exercises. It helps clients be present in the moment and be aware of their thoughts and arising emotions.
The therapist encourages the client to acknowledge their thoughts and emotions as temporary instead of the truth. Through this practice, clients can cater to their thoughts instead of repressing them and create an inner cycle of responding to their thoughts more healthily.
Goal-setting and problem-solving
As we discussed at the beginning of this article, Cognitive Behavioral Therapy is a goal-oriented technique. But what does that mean?
In CBT sessions, therapists encourage their clients to set goals for themselves. These goals need to be realistic and measurable. Therefore, when a client set goals, they need to be targeted toward a specific issue, such as reducing or better managing anxiety.
Having a sense of direction in therapy sessions helps clients break down their complex problems in an easier way and it also creates a sense of achievement when goals have been met.
Relapse prevention
The role of the therapist is to provide tools and management techniques to their clients to ensure that once therapy concludes they can take hold of situations and make better decisions and reasonings for themselves.
This step is called relapse prevention. Ensuring that the client has been empowered and has the confidence to face real-life situations that may be sensitive or triggering for them in a healthier and well-balanced manner.
8 Types of cognitive behavioral therapy
There are many ways in which cognitive behavioral therapy can be delivered to a client depending on their unique scenarios.
Let us walk through each type together:
1. Cognitive therapy (CT)
Cognitive therapy is highly focused on the identification of negative thought patterns and understanding how they, in turn, contribute to emotional distress. In Cognitive Therapy, clients are assisted in making connections between their thoughts and emotions.
Once the identification is complete, clients are also encouraged to challenge and replace these thoughts with more reasoned and healthy perspectives.
2. Dialectical behavior therapy (DBT)
This type of cognitive behavioral therapy was initially designed to treat borderline personality disorder. However, it is now used as a modified version of CBT in which mindfulness techniques are used to manage intense emotions and teach clients how to create acceptance and change within themselves.
3. Rational emotive behavior therapy (REBT)
Rational-emotive behavior therapy focuses on combating irrational thoughts and beliefs that cause emotional distress. This is done by encouraging more flexible thought patterns and changing “should” and “must” statements, such as “I must make everyone happy.”
By encouraging clients to rewire their unrealistic expectations of themselves, REBT aims to relieve emotional burdens.
4. Exposure therapy
Exposure therapy exposes clients to situations and scenarios that are the root cause of their emotional stress. It aims to break avoidance patterns, help clients face their fears in a controlled environment, and build their confidence in real-world situations.
5. Acceptance and commitment therapy (ACT)
Often, emotional distress arises when clients are dismissive of their emotions and thoughts. Acceptance and commitment therapy teaches mindfulness and encourages clients to accept their thoughts and feel their emotions.
6. Mindfulness-based cognitive therapy (MBCT)
MBCT utilizes the aspect of mindfulness, which is encouraged in cognitive behavioral therapy, to prevent clients from relapsing once their sessions conclude. It focuses on teaching clients how to sit with their thoughts without judgment and reduce negative thought patterns.
7. Schema therapy
Schemas refer to maladaptive patterns of thinking that often result in individuals engaging themselves in unhealthy situations or facing difficulty in maintaining adult relationships. Often, these schemas are rooted in childhood needs being unmet.
Schema Therapy is a talking method in which clients are made to realize the underlying causes behind their behaviors and eventually change these patterns so that they can cope with their challenges in a healthier manner.
8. Trauma-focused CBT (TF-CBT)
This type of CBT is specifically designed for those individuals who are dealing with trauma-focused children and adolescents. It utilizes trauma-sensitive approaches to help clients process their traumatic memories and build coping skills and emotion management.
What conditions can cognitive behavioral therapy treat?
Cognitive behavioral therapy is beneficial for treating individuals suffering from various situations and conditions.
Keep reading to find out what these conditions are:
Mental health conditions
There are several mental health conditions for which therapists utilize the cognitive behavioral therapy technique:
- Anxiety disorders: Through identifying thought patterns and utilizing cognitive restructuring as well as exposure therapy, CBT is used to treat anxiety disorders.
- Mood disorders: CBT is also used to treat mood disorders such as depression. In such situations reframing thoughts and goal-setting techniques prove to be extremely useful in mood regulation in clients.
- Trauma: trauma-related disorders such as PTSD (post-traumatic stress disorder) can also be treated through CBT. Through trauma-focused therapy, clients’ avoidance patterns are broken.
- Obsessive-compulsive disorder (OCD): Clients with disorders such as OCD can be treated through CBT as well. Through Exposure and Response Prevention, therapists work towards developing healthy behavior patterns for clients.
- Eating disorders: CBT targets underlying body image issues and negative thought patterns about oneself to treat eating disorders.
- Substance use disorders: CBT helps clients build healthy coping mechanisms by first identifying underlying reasons for substance abuse.
Physical health conditions
While cognitive behavioral therapy is widely utilized to treat mental health conditions, it is now increasingly being used to treat physical health conditions as well. This is done by understanding the underlying behavioral and psychological phenomena that may be contributing to physical conditions.
- Chronic pain conditions: If a client is experiencing chronic pain conditions, CBT is used to understand and then alter how they perceive and respond to the pain. Pain reappraisal is utilized to help clients view their pain as being manageable. Through teaching relaxation techniques and coping mechanisms, CBT can help individuals deal with chronic pain conditions.
- Sleep disorders: For conditions such as insomnia, CBT is utilized to understand the behaviors and thoughts that are disrupting the client’s sleep cycles.
- Somatic Symptom Disorders: Here, CBT is used to manage stress and alter unhelpful behaviors, such as frequently visiting a doctor for non-serious issues.
Everyday challenges and life changes
CBT provides tools and methods that help individuals navigate everyday challenges and life changes in a more structured and organized manner. Let us go over some specific areas where CBT can be extremely useful:
- Stress management: CBT helps clients utilize relaxation techniques such as breathing and problem-solving to manage stress in a better way.
- Life transitions: Life changes come with uncertainty which can lead to anxiety through CBT clients can learn goal-setting techniques and learn to have a more adaptive thought process in order to enjoy the changes rather than being intimidated by them.
- Relationship issues: CBT helps to foster in clients empathy and better communication skills which can help reduce any negative thoughts that may disrupt healthy relationships.
- Parenting challenges: Through CBT parents can learn healthy ways of managing stress and utilization of an adaptive thought process for coping with the demands of parenting.
Cognitive behavioral therapy example
Let us see how CBT can be utilized in an actual situation:
Aiman is a young girl in her teenage years who is experiencing anxiety in social settings, which often leads to feelings of embarrassment, shame, and a fear of being judged and disliked.
To combat these feelings, Aiman has adopted isolation techniques such as avoiding social gatherings altogether, avoiding meeting her friends and staying clear about public speaking.
How can CBT help Aiman overcome this fear and anxiety?
In her sessions with her therapist, Aiman first sets her goal of wanting to be comfortable in her own skin and being able to be around new situations and people without the fear of judgment and not being liked.
Her sessions begin with first identifying where these negative thought patterns stem from. As the sessions progress, her therapist utilizes graded exposure therapy to expose Aiman to social situations that she fears, starting from less intimidating and reaching more challenging ones.
In each situation, Aiman slowly learns to combat her negative thoughts with more healthy thought processes by challenging herself and looking for evidence to disprove her negative thoughts.
Through exposure and identification of her thoughts and emotions, Aiman slowly gains the skills and techniques to manage herself in a better way in social situations.
10 Cognitive behavioral therapy techniques
- Cognitive restructuring: This technique helps clients identify negative thought patterns and encourages clients to challenge these thoughts and look for evidence that supports them. By replacing these negative thoughts with more balanced ideas, CBT helps to restructure thought processes.
- Mindfulness practices: CBT helps the client focus on their emotions and teaches the art of acceptance of emotions rather than dismissing them. Through practicing body scans and grounding exercises, clients become more in tune with their thoughts and bodies.
- Journaling: CBT promotes using journaling to document daily activities and thoughts to not only acknowledge them but also to identify any thought patterns that may be contributing to mental distress.
- Problem-solving skills: CBT teaches clients how to utilize a more structured approach: breaking down complex problems into step-by-step solutions to tackle any challenges that life may bring towards them.
- Goal Setting: CBT helps individuals set realistic, measurable, and achievable targets through which clients can better track their progress and feel a sense of accomplishment upon completion.
- Behavioral activation: This technique of CBT encourages clients to increase their engagement in rewarding activities to help uplift their mood and create motivation.
- Exposure therapy: By helping clients gradually be exposed to situations that may be distressing, exposure therapy combats avoidance behaviors.
- Graded exposure: This technique utilizes a step-by-step approach towards exposure therapy whereby clients are exposed to situations gradually increasing in intensity. This helps gradually build the client’s confidence.
- Role-playing: Simulation of real-life situations between the therapist and client helps them feel more confident about facing similar situations on their own in an uncontrolled environment.
- Relaxation techniques: Deep breathing and muscle relaxation exercises are extremely useful in managing stress and reducing tension in the body.
What to expect from cognitive behavioral therapy?
Therapy can feel intimidating, and therefore, here are some things you can expect when going for cognitive behavioral therapy:
- An initial assessment will be conducted so the therapist can understand your background, concerns, and what you want to address in your sessions.
- CBT sessions are extremely collaborative, meaning it will be a hands-on approach with your therapist to work towards solving your emotional distress.
- CBT often involves homework exercises such as journaling, thought recording or practicing methods discussed during sessions.
- CBT is a short-term methodology lasting between 12-20 sessions on average.
- Throughout your sessions, you will be measuring your outcomes against the goals you set at the beginning.
- CBT will equip you with long-term solutions.
Frequently asked questions
What is the role of a cognitive behavioral therapist?
The cognitive behavioral therapist guides the client through the structured sessions and helps clients set goals in the beginning. Moreover, throughout the sessions, the therapist explores thought patterns through talking methodologies and helps clients grasp techniques that will help them manage and overcome their issues.
How long does CBT generally take to be effective?
Depending on the individual and the issues at hand CBT takes anywhere between 12-20 sessions to be effective.
Conclusion
Cognitive Behavioral Therapy utilizes a wide range of methodologies to target underlying thought processes that often get wired into negative loops and help individuals understand their own emotions more concretely and logically.
CBT equips clients with long-term solutions enabling them with tools and techniques that will help them healthily manage their thoughts and emotions.
Dr. Carlos Todd PhD LCMHC specializes in anger management, family conflict resolution, marital and premarital conflict resolution. His extensive knowledge in the field of anger management may enable you to use his tested methods to deal with your anger issues.
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