Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is a short-term, problem-focused form of behavioral treatment that helps people see the relationship between beliefs, thoughts, and feelings, and subsequent behavior patterns and actions. Through CBT, people learn that their perceptions directly influence their responses to specific situations. In other words, a person’s thought process informs his or her behaviors and actions. Cognitive behavioral therapy is not a distinct treatment technique; rather, it is a general term which refers to a group of therapies that have certain similarities in therapeutic methodology. The group includes rational emotive behavior therapy, cognitive therapy, and dialectical behavior therapy, for example.
Cognitive behavioral therapy is grounded in the belief that it is a person’s perception of events—rather than the events themselves—that determines how he or she will feel and act. For example, if a person with anxiety strongly believes that “everything will turn out badly today,” then these negative thoughts may influence him or her to focus only on the perceived negative things that may happen while blocking out or completely avoiding thoughts or actions that may disprove that negative belief system. Afterward, when nothing appears to go right in the day, the person may feel even more anxious than before, the negative belief system may be strengthened, and the person is at risk of being trapped in a vicious, continuous cycle of negativity and anxiety.
Cognitive behavioral therapists believe that by adjusting our thoughts, we can directly influence our emotions and behavior. This adjustment process is referred to as cognitive restructuring. Aaron T. Beck, the psychiatrist widely considered to be the father of cognitive therapy, believed that a person’s thinking pattern may become established in childhood and that certain cognitive errors could lead to depressogenic or dysfunctional assumptions.
Common cognitive errors and their associated dysfunctional assumptions include:
- Self-references: Each person always focuses his or her attention on me, especially when I fail.
- Selective abstraction: Only my failures matter. I am measured by my failures.
- Overgeneralizing: If something is true in one setting, it is true in every setting.
- Excessive responsibility: I am responsible for every failure and every bad thing that happens.
- Dichotomous thinking: Viewing the world in extremes, black or white, with nothing in between.
The cognitive behavioral process is based on an educational model where people in therapy are helped to unlearn negative reactions and learn new, positive emotional and behavioral reactions to challenging situations. By breaking down overwhelming problems into small manageable parts, and then setting and reaching short-term goals, the therapist gradually adjusts the way the person in treatment thinks, feels, and reacts in challenging situations. Changing attitudes and behaviors can help people learn to address specific issues in positive and productive ways.
Cognitive behavioral therapy involves much more than just sitting and talking about whatever comes to mind. This structured approach ensures that the therapist and the individual in treatment are focused on the goals of each session, ensuring that the time spent in therapy is productive. The person in therapy benefits from a collaborative relationship in which he or she is able to reveal personal issues without fear of judgment and is helped to understand the issues at hand without being told which choices he or she should make.
CBT techniques incorporate many different therapeutic tools to help people in therapy evaluate their emotional patterns and states. CBT therapists may employ common techniques such as:
- Challenging beliefs
- Social, physical, and thinking exercises to make a person aware of his or her emotional and behavioral patterns
To reinforce the therapy, homework (such as practical exercises, reading, or writing assignments) is completed by the individual in treatment, outside of the scheduled time for therapy. Homework is a crucial aspect of many CBT treatment plans and challenges the affected individual to continue working independently, even after therapy comes to an end.
Most people who receive cognitive behavioral therapy usually do so for an average of 16 sessions, each of which lasts about an hour. People in treatment learn new coping skills in order to better handle their issues, develop more positive beliefs and behaviors, and may even resolve long-standing life problems.
People with clearly defined behavioral and emotional concerns and people with specific problems affecting their quality of life tend to reap the greatest benefits from cognitive behavioral therapy. Under these conditions, the therapist and the person in treatment know exactly which issue to target, making CBT’s problem-solving and goal-oriented approach a good fit. CBT is used to effectively treat a wide variety of conditions, including:
- Mood issues
- Posttraumatic stress
- Obsessions and compulsions
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- Chronic fatigue syndrome (CFS)
- Irritable bowel syndrome (IBS)
- Substance dependency
- Disordered eating
- Persistent pain
- Erratic sleep patterns
- Sexual issues
- Anger management issues
While CBT is used in the treatment of many mental health issues, as with any type of therapy, therapeutic benefits are maximized when people in therapy are fully committed to the process.
Albert Ellis, PhD, first presented his rational approach to therapy at the 1957 American Psychological Association convention. Despite initially learning and practicing various forms of psychoanalytic treatment, Ellis grew dissatisfied with the lack of efficiency and effectiveness of classical analysis and psychoanalytic psychotherapy. While Ellis agreed with Freud that irrational forces may have significant effects on a person’s thoughts and behavior, he eventually came to believe that these forces were not due to unconscious conflicts in early childhood. According to Ellis, he had witnessed too many people in therapy who, despite having a great understanding of their childhood experiences and unconscious processes, continued to keep themselves in a troubled state. It is with this in mind that Ellis decided to directly challenge the belief system of people with seemingly irrational thoughts, and encouraged individuals in therapy to actively work against their irrational premises.
Around the same time, Aaron Beck was developing his own approach to therapy. Like Ellis, Beck was a student of the psychoanalytic approach. Evidence from his experimental work on dreams and ideational material, however, led Beck away from psychoanalysis to formulate a cognitive theory. Beck discovered that by training people in therapy to analyze and test their maladaptive cognitions, their attitudes and emotions would improve. Cognitive therapy garnered worldwide attention and sparked extensive research efforts. As the approach incorporates various behavioral elements, it is now widely known as cognitive behavioral therapy.
In addition to Ellis and Beck, it should be noted that several other people made telling contributions to the development and global recognition of CBT. Some of these contributors include Maxie Maultsby, Michael Mahoney, Donald Meichenbaum, David Burns, Marsha Linehan, and Arthur Freeman.
A growing number of mental health professionals employ cognitive behavioral therapy as the primary orientation within their regular therapeutic sessions, and many other therapists incorporate CBT techniques into their practices along with other therapeutic approaches.
For those therapists who want further training in cognitive behavioral therapy, a variety of training and certification programs exist. The National Association of Cognitive-Behavioral Therapists (NACBT), established in 1995 in Weirton, West Virginia, is one of the most well-known CBT organizations and provides four certifications for qualified cognitive behavioral therapists to earn including:
- Diplomate in Cognitive-Behavioral Therapy
- Certified Cognitive-Behavioral Therapist
- Certified Cognitive-Behavioral Group Therapist
- Certified Cognitive-Behavioral Group Facilitator
The highest certification awarded by the NACBT is the Diplomate in Cognitive-Behavioral Therapy. The Academy of Cognitive Therapy (ACT) is another well-known organization that offers training and certification in cognitive therapy. Although ACT and NACBT certifications may demonstrate a higher level of dedication to and specialized training in CBT, no certification is required for a therapist to practice CBT.
CBT is not a quick fix for behavioral and mental health issues. Therapists need to demonstrate considerable expertise in the approach, and clients will benefit most when they cooperate fully with the treatment program. As such, people with certain complex mental health needs, such as those stemming from severe trauma, may not be able to immediately benefit from cognitive behavioral therapy techniques. In some cases, emotional issues need to be addressed before cognitive work can begin.
People who experience vague feelings of unhappiness, without clearly defined symptoms or issues, may also have limited success with cognitive behavioral therapy. Additionally, while individuals with long-term health issues such as irritable bowel syndrome or chronic fatigue syndrome can use CBT to better cope with their condition, the physical symptoms of these conditions cannot be cured with CBT.
Finally, CBT can help a person in treatment develop more positive thought patterns and behaviors, but without a more traditional approach to therapy, he or she may not necessarily gain deeper insights into the psychological and emotional underpinnings of his or her behavior.
- Liebert, R. M. & Spiegler, M. D. (1998). Personality: Strategies and issues (8th ed.). Pacific Grove, California: Brooks/Cole.
- National Association of Cognitive-Behavoral Therapists. (2014). CBT certifications. Retrieved from http://www.nacbt.org/certifications.aspx
- National Health Service. (2014). Cognitive behavioural therapy. Retrieved from http://www.nhs.uk/conditions/Cognitive-behavioural-therapy/Pages/Introduction.aspx
- Prochaska, J. O. & Norcross, J. C. (2003). Systems of psychotherapy: A transtheoretical analysis (5th ed.). Pacific Grove, California: Brooks/Cole.
- Royal College of Psychiatrists. (2013). Cognitive behavioural therapy. Retrieved from http://www.rcpsych.ac.uk/mentalhealthinformation/therapies/cognitivebehaviouraltherapy.aspx
Last updated: 07-02-2015
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