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Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT), as the name suggests, is a form of psychotherapy that combines the techniques of Cognitive Therapy with Behavioral Therapy.

Behavioral Therapy is discussed at length in its own PsychVisit article; it sees the symptoms of mental health problems as being essentially a set of maladaptive behaviors that need to be unlearned. Cognitive Therapy, on the other hand, places great importance on people's conscious thoughts, attitudes and core beliefs as being at the root of their mental health problems.

The idea is that people's thoughts, emotions and behaviors all tend to influence and reinforce each other in the same direction. The way one thinks about something will inform how one feels and behaves towards it; emotions will influence our thoughts and behaviors; and often when we behave in a certain way our thoughts and feelings can change to fit with those behaviors. CBT will thus try to help clients (ie. patients) modify their thoughts and behaviors so as to improve their emotional states and also reduce any problematic behaviors.

For example, people who are depressed can experience very low self-esteem and see themselves as worthless, useless, and without the skills to manage their affairs and challenges. These thoughts may stem from their depressed moods, but they also reinforce and intensify those moods. A Cognitive Therapy approach will seek to challenge and correct those thoughts, which in any case are clearly exaggerated and false. If the depressed individual has also withdrawn from friends, family and their usual activities, then a Behavioral Therapy approach will be used to help the person become active once again, which can in turn help to brighten their moods.

Challenging Cognitive Distortions

According to the tenants of Cognitive Therapy, there are a variety of common cognitive distortions, or erroneous thoughts, that people will hold and that will perpetuate their mental health problems. One of the goals of CBT is for the therapist to put into question these erroneous ideas so that the client can then develop healthier ways of thinking about themselves and their life situations.

The method of challenging these cognitive distortions is sometimes called collaborative empiricism or socratic questioning. The therapist encourages the client to examine their thoughts not as givens, but as theories that can be put to the test and proven or disproven based on real life evidence. For example, a client who believes that they are incompetent at handling life's challenges will be asked to provide proof of this, as well as examples of instances where they in fact successfully managed certain difficulties. Questioning these thoughts in this way can help the client gain a new and more positive perspective on themselves.

The following are examples of common cognitive distortions that therapists can often identify and challenge:

  • All-or-nothing thinking: involves thinking about things in absolute terms, and using words like "always," "every," "never," and "there is no alternative." Few things in life are ever absolute.
  • Over-generalization: involves making sweeping generalizations based on a few isolated incidents.
  • Mental filter: involves focusing mainly on the negative aspects of situations while ignoring any positive aspects.
  • Disqualifying the positive: involves constantly refuting or discrediting positive experiences for arbitrary and loose reasons.
  • Jumping to conclusions: involves drawing conclusions (usually negative ones) from little if any evidence. Includes the following examples:
    • Mind-reading: assuming that one can easily and accurately know the true intentions or thoughts of others.
    • Fortune telling: thinking that one can know exactly how things will turn out before they happen.
  • Magnification and minimization: involves exaggerating or minimizing the positive or negative aspects of a person, event or situation.
  • Catastrophizing: involves expecting the worst possible outcome, however unlikely, of a situation, or thinking that a situation is unbearable or impossible when it is really just uncomfortable.
  • Emotional reasoning: involves making decisions and arguments based on intuitions or gut feelings rather than on sound logic or objective evidence.
  • Should statements: involves convictions about that way things "should" or "ought to be" regardless of the true reality, or having rigid rules that one believes will "always apply" no matter what the circumstances.
  • Labeling and mislabeling: involves explaining-away behaviors or events merely by naming them, often by using language that is highly colored and emotionally loaded.
  • Personalization: involves attributing personal responsibility for events over which one has little or no control.

Practice and Uses of Cognitive Behavioral Therapy

CBT is a time-limited form of therapy, where at the outset the goals of the treatment are defined based on the symptoms and behaviors that the client wishes to address and resolve, and then a certain number of sessions are offered in order to meet those goals. On average, courses of CBT tend to involve about 10-20 sessions.

The interactions between the client and therapist are characterized by very frank and straightforward discussions about the client's issues that focus on the client's current thoughts, feelings and behaviors related to the problem at hand. The therapist will focus on modifying the clients' ways of thinking in the ways described above, and also on modifying their behaviors according to the processes described in the article on Behavioral Therapy.

As a general rule, CBT tends not explore clients' early childhood experiences or life-stories, unless there is some direct and obvious relation to their current symptoms. Instead, the therapy takes a very practical and pragmatic here-and-now approach. Therapists will tend to be very open and direct with the client about the reasons for their questions and interventions, and will often explain the theories of CBT so that the client can understand the logic of the process. It is also common for therapists to give clients homework assignments to complete in between sessions.

CBT is the most thoroughly researched of all the psychotherapies, with a large number of studies supporting its use for various conditions [ref, ref], including all Mood Disorders, all Anxiety Disorders, all Eating Disorders, various types of Addictions, Psychotic Disorders where individuals are able to question their psychotic symptoms, and certain Sleep Disorders.

Derivations of CBT, such as Dialectical Behavioral Therapy and Schema-Focused Therapy, are also used for treating Personality Disorders.