What Is Cognitive Behavioral Therapy?

Process, Types, Components, Uses, and Effectiveness

A cognitive behavioral therapist working with clients
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Cognitive behavioral therapy (CBT) is a type of psychotherapeutic treatment that helps patients understand the thoughts and feelings that influence behaviors. CBT is commonly used to treat a wide range of disorders, including phobias, addictions, depression, and anxiety.

Cognitive behavior therapy is generally short-term and focused on helping clients deal with a very specific problem. During the course of treatment, people learn how to identify and change destructive or disturbing thought patterns that have a negative influence on behavior and emotions.

Cognitive Behavioral Therapy Basics

The underlying concept behind CBT is that our thoughts and feelings play a fundamental role in our behavior. For example, a person who spends a lot of time thinking about plane crashes, runway accidents and other air disasters may find themselves avoiding air travel.

The goal of cognitive behavior therapy is to teach patients that while they cannot control every aspect of the world around them, they can take control of how they interpret and deal with things in their environment.

Cognitive behavior therapy has become increasingly popular in recent years with both mental health consumers and treatment professionals. Because CBT is usually a short-term treatment option, it is often more affordable than some other types of therapy. CBT is also empirically supported and has been shown to effectively help patients overcome a wide variety of maladaptive behaviors.

Automatic Negative Thoughts

One of the main focuses of cognitive-behavioral therapy is on changing the automatic negative thoughts that can contribute to and exacerbate emotional difficulties, depression, and anxiety. These negative thoughts spring forward spontaneously, are accepted as true, and tend to negatively influence the individual's mood.

Through the CBT process, patients examine these thoughts and are encouraged to look at evidence from reality that either supports or refutes these thoughts. By doing this, people are able to take a more objective and realistic look at the thoughts that contribute to their feelings of anxiety and depression. By becoming aware of the negative and often unrealistic thoughts that dampen their feelings and moods, people are able to start engaging in healthier thinking patterns.

Types of Cognitive Behavior Therapy

According to the British Association of Behavioural and Cognitive Psychotherapies, "Cognitive and behavioural psychotherapies are a range of therapies based on concepts and principles derived from psychological models of human emotion and behaviour. They include a wide range of treatment approaches for emotional disorders, along a continuum from structured individual psychotherapy to self help material."

There are a number of specific types of therapeutic approaches that involve CBT that are regularly used by mental health professionals. Examples of these include:

  • Rational Emotive Behavior Therapy (REBT): This type of CBT is centered on identifying and altering irrational beliefs. The process of REBT involves identifying the underlying irrational beliefs, actively challenging these beliefs, and finally learning to recognize and change these thought patterns.
  • Cognitive Therapy: This form of therapy is centered on identifying and changing inaccurate or distorted thinking patterns, emotional responses, and behaviors.
  • Multimodal Therapy: This form of CBT suggests that psychological issues must be treated by addressing seven different but interconnected modalities, which are behavior, affect, sensation, imagery, cognition, interpersonal factors and drug/biological considerations.
  • Dialectical Behavior Therapy: This type of cognitive-behavioral therapy addresses thinking patterns and behaviors and incorporates strategies such as emotional regulation and mindfulness.

    While each type of cognitive-behavioral therapy offers its own unique approach, each centers on addressing the underlying thought patterns that contribute to psychological distress.

    The Components of Cognitive Behavior Therapy

    People often experience thoughts or feelings that reinforce or compound faulty beliefs. Such beliefs can result in problematic behaviors that can affect numerous life areas, including family, romantic relationships, work, and academics.

    For example, a person suffering from low self-esteem might experience negative thoughts about his or her own abilities or appearance. As a result of these negative thinking patterns, the individual might start avoiding social situations or pass up opportunities for advancement at work or at school.

    In order to combat these destructive thoughts and behaviors, a cognitive-behavioral therapist begins by helping the client to identify the problematic beliefs. This stage, known as functional analysis, is important for learning how thoughts, feelings, and situations can contribute to maladaptive behaviors. The process can be difficult, especially for patients who struggle with introspection, but it can ultimately lead to self-discovery and insights that are an essential part of the treatment process.

    The second part of cognitive behavior therapy focuses on the actual behaviors that are contributing to the problem. The client begins to learn and practice new skills that can then be put in to use in real-world situations. For example, a person suffering from drug addiction might start practicing new coping skills and rehearsing ways to avoid or deal with social situations that could potentially trigger a relapse.

    In most cases, CBT is a gradual process that helps a person take incremental steps towards a behavior change. Someone suffering from social anxiety might start by simply imagining himself in an anxiety-provoking social situation.

    Next, the client might start practicing conversations with friends, family, and acquaintances. By progressively working toward a larger goal, the process seems less daunting and the goals easier to achieve.

    The Process of Cognitive Behavior Therapy

    • During the process of CBT, the therapist tends to take a very active role.
    • CBT is highly goal-oriented and focused, and the client and therapist work together as collaborators toward the mutually established goals.
    • The therapist will typically explain the process in detail and the client will often be given homework to complete between sessions.
    • Cognitive-behavior therapy can be effectively used as a short-term treatment centered on helping the client deal with a very specific problem.

    Uses of Cognitive Behavior Therapy

    Cognitive behavior therapy has been used to treat people suffering from a wide range of disorders, including:

    • Anxiety
    • Phobias
    • Depression
    • Addictions
    • Eating disorders
    • Panic attacks
    • Anger

    CBT is one of the most researched types of therapy, in part because treatment is focused on highly specific goals and results can be measured relatively easily.

    Compared to psychoanalytic types of psychotherapy which encourage a more open-ended self exploration, cognitive behavior therapy is often best-suited for clients who are more comfortable with a structured and focused approach in which the therapist often takes an instructional role. However, for CBT to be effective, the individual must be ready and willing to spend time and effort analyzing his or her thoughts and feelings. Such self-analysis and homework can be difficult, but it is a great way to learn more about how internal states impact outward behavior.

    Cognitive behavior therapy is also well-suited for people looking for a short-term treatment option for certain types of emotional distress that does not necessarily involve psychotropic medication. One of the greatest benefits of cognitive-behavior therapy is that it helps clients develop coping skills that can be useful both now and in the future.

    Criticisms of Cognitive Behavior Therapy

    Initially, some patients suggest that while they recognize that certain thoughts are not rational or healthy, simply becoming aware of these thoughts does not make it easy to alter them. CBT doesn't tend to focus on potential underlying unconscious resistances to change as much as other approaches such as psychoanalytic psychotherapy.

    It is important to note that CBT does not just involve identifying these thought patterns; it is focused on using a wide range of strategies to help clients overcome these thoughts.  Such strategies may include journaling, role-playing, relaxation techniques, and mental distractions.

    A Word From Verywell

    Cognitive-behavior therapy can be an effective treatment choice for a range of psychological issues. If you feel that you might benefit from this form of therapy, consult with your physician and check out the directory of certified therapists offered by the National Association of Cognitive-Behavioral Therapists to locate a professional in your area.

    Sources

    Beck, J. S. Cognitive behavior therapy: Basics and beyond. New York, NY: The Guilford Press; 2011.

    Coull, G & Morris, PG. The clinical effectiveness of CBT-based guided self-help interventions for anxiety and depressive disorders: a systematic review. Psychological Medicine. 2011;41(11):2239-2252.

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