Cognitive Behavior Therapy (CBT)

What is Cognitive Behavior Therapy?

Cognitive Behavior Therapy (CBT) is a time-limited, problem-focused, and collaborative approach. It teaches individuals how to identify core beliefs; change maladaptive thoughts and behaviors; and develop healthy cognitive, behavioral, and physiologic responses. Cognitive Behavior Therapy utilizes numerous techniques including (but not limited to) behavior modification and rehearsal, cognitive restructuring, and physiologic techniques. The primary goal in Cognitive Behavior Therapy is to teach the individual to become their own CBT therapist, continuing to utilize the strategies learned in therapy in between sessions and after therapy has ended.

A central idea in CBT is those core beliefs about oneself, the world in general, and the future have an impact on feelings, thoughts, and behaviors. Core beliefs are often formed in childhood and they are what the individual “knows” to be true. For example, someone with a core belief “I am a failure” is likely to have different thoughts, feelings, and behaviors than someone with a core belief “I can do most things very well.” Inaccurate and harmful beliefs are identified and replaced with adaptive, helpful, and accurate core beliefs.

Who Benefits from CBT?

Cognitive Behavior Therapy (CBT) is an evidence-based practice with demonstrated effectiveness in over 400 clinical trials used alone or in conjunction with medication. It has been shown to be an effective treatment for a wide variety of mental health issues including (but not limited to), depression, anxiety, eating disorders, substance abuse, personality disorders, anger, relationship difficulties, low self-esteem, grief and loss, and problems associated with aging. CBT is also an effective treatment for physical health issues including chronic/acute pain, chronic fatigue syndrome, colitis, sleep disorders, obesity, irritable bowel syndrome, hypertension, post-myocardial infarction, non-cardiac chest pain, cancer, diabetes, and migraine. CBT can be utilized with adults, children, or older adults in individual or in group settings. A typical treatment episode may include 8-14 sessions.

Examples of CBT Strategies:

Cognitive

A key component of Cognitive Therapy is assisting the individual in identifying irrational or maladaptive thoughts and replacing them with more realistic and helpful thoughts. Example – Ruth wants to ask a neighbor if she would like to come over for coffee tomorrow morning. Her automatic thought is, “She will not want to have coffee with me.” This thought makes her feel very sad. In the past, this type of situation would have resulted in her not asking her neighbor and continuing to feel isolated. When she looks more closely at the situation with her therapist, she is able to see that her neighbor is very friendly toward her, that she could not know whether she would accept if she doesn’t ask.

Behavioral

Behavioral strategies are utilized to improve action toward goals and symptom reduction. Problem-solving activities and scheduling can improve depressed mood, general health, and motivation. Activity scheduling, breaking down goals into manageable achievements, and social skills training are examples of behavioral techniques.

Physiologic

When an individual becomes anxious or stressed, breathing may become rapid and shallow. Training an individual to take slow deep breaths can lessen physiologic symptoms that accompany anxiety. Progressive muscle relaxation training (systematic tensing and relaxing of muscles) can be used to teach an individual how to reduce stress on their own when needed.

References

Beck, J. S. (1995). Cognitive Therapy: Basics and Beyond. New York: The Guilford Press.

Beck, J. S. (2005). Cognitive Therapy for Challenging Problems. New York: The Guilford Press.

Cox, D., D’Oyley, H. (2011). Cognitive-behavior therapy with older adults. British Columbia Medical Journal, 53(7); 348-352.

Friedberg, R. D., McClure, J. M., Garcia, J. H. (2009). Cognitive Therapy Techniques for Children and Adolescents. New York: The Guilford Press.

Winterowd, C., Beck, A. T., Gruener, D. (2003). Cognitive Therapy with Chronic Pain Patients. New York: Springer Publishing Company.