Learn about Cognitive Behavioral Therapy and Therapists

Cognitive Behavioral Therapy (CBT)

A man gestures as he speaks to a therapistCognitive behavioral therapy (CBT) is a short-term form of behavioral treatment. It helps people problem-solve. CBT also reveals the relationship between beliefs, thoughts, and feelings, and the behaviors that follow. Through CBT, people learn that their perceptions directly influence how they respond to specific situations. In other words, a person’s thought process informs their behaviors and actions.

Cognitive behavioral therapy is not a distinct treatment technique. Instead, it is a general term which refers to a group of therapies. These therapies have certain similarities in therapeutic methodology. The group includes rational emotive behavior therapy, cognitive therapy, and dialectical behavior therapy.

How Cognitive Behavioral Therapy Works

Cognitive behavioral therapy is grounded in the belief that how a person perceives events determines how they will act. It is not the events themselves that determine the person's actions or feelings. For example, a person with anxiety may believe that “everything will turn out badly today.” These negative thoughts may influence their focus. They may then only perceive negative things that happen. Meanwhile, they may block out or avoid thoughts or actions that could disprove the 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 get stronger. The person is at risk of being trapped in a vicious, continuous cycle of anxiety. 

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Cognitive behavioral therapists believe we can adjust our thoughts. This is thought to directly influence our emotions and behavior. The adjustment process is called cognitive restructuring. Aaron T. Beck is the psychiatrist widely considered to be the father of cognitive therapy. He believed a person’s thinking pattern may become established in childhood. He found that certain cognitive errors could lead to depressogenic or dysfunctional assumptions.

Common cognitive errors and their associated dysfunctional assumptions include:

  • Self-references: "People always focuses 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. People in therapy are helped to unlearn negative reactions and learn new ones. These are positive reactions to challenging situations. CBT helps break down overwhelming problems into small, manageable parts. Therapists help people set and reach short-term goals. Then the therapist gradually adjusts how the person in treatment thinks, feels, and reacts in tough situations. Changing attitudes and behaviors can help people learn to address specific issues in productive ways.

CBT Techniques

Cognitive behavioral therapy involves more than sitting and talking about what comes to mind. This structured approach keeps the therapist and the person in treatment focused on the goals of each session. This ensures the time spent in therapy is productive. The person in therapy benefits from a collaborative relationship. They can reveal personal issues without fear of judgment. The therapist helps them understand the issues at hand. However, they do not tell the person in therapy which choices to make. 

CBT techniques incorporate many different therapeutic tools. These tools help people in therapy evaluate their emotional patterns and states. CBT therapists may employ common techniques such as:

  • Journaling
  • Challenging beliefs
  • Mindfulness
  • Relaxation
  • Social, physical, and thinking exercises. These may help someone become aware of their emotional and behavioral patterns.

Homework is completed by the person in treatment. It might include practical exercises, reading, or writing assignments. This helps reinforce the therapy. The homework is done outside of the scheduled time for therapy. Homework is a crucial aspect of many CBT treatment plans. It challenges the person to continue working on their own, even after therapy comes to an end.

Most people who receive cognitive behavioral therapy do so for an average of 16 sessions. Each of these lasts about an hour. People in treatment learn new coping skills to handle their issues. They develop more positive beliefs and behaviors. Some even resolve long-standing life problems.

Mental Health Conditions Treated with CBT

Some factors make people more likely to benefit from CBT. People with clearly defined behavioral and emotional concerns may find CBT helpful. Those with specific problems that affect their quality of life can also benefit from cognitive behavioral therapy. Under these conditions, the therapist and the person in treatment know which issue to target. This makes CBT’s problem-solving and goal-oriented approach a good fit. CBT is used to effectively treat many conditions, including:

CBT is used to treat many mental health issues. But as with any type of therapy, benefits are greatest when people commit fully to the process.

History of Cognitive Behavioral Therapy

Albert Ellis, PhD first presented his rational approach to therapy at the 1957 American Psychological Association convention. He had first learned and practiced various forms of psychoanalytic treatment. But Ellis grew dissatisfied with the lack of efficiency and effectiveness of classical analysis. Ellis agreed with Freud that irrational forces may have significant effects on thoughts and behavior. But he came to believe these forces were not due to unconscious conflicts in early childhood. Ellis had seen too many people in therapy who understood their childhood experiences and unconscious processes. But they remained in a troubled state. With this in mind, Ellis chose to challenge the belief system of people with seemingly irrational thoughts. He encouraged people in therapy to actively work against those beliefs.

Around the same time, Aaron Beck was developing his own approach to therapy. Like Ellis, Beck was a student of the psychoanalytic approach. But evidence from his work on dreams and ideational material led Beck away from psychoanalysis. He formulated a cognitive theory. Beck discovered he could train people in therapy to analyze and test their maladaptive cognitions. He learned that doing so could improve their attitudes and emotions. Cognitive therapy garnered worldwide attention. It sparked extensive research efforts. The approach incorporates various behavioral elements. Due to this, it is widely known as cognitive behavioral therapy.

In addition to Ellis and Beck, others contributed 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.

Who Provides Cognitive Behavioral Therapy?

A growing number of mental health professionals use cognitive behavioral therapy. This is often what makes up most of their regular sessions. Other therapists incorporate CBT techniques into their practices. They may use it alongside other approaches.

A variety of training and certification programs exist for therapists who wish to further their training in CBT. The National Association of Cognitive-Behavioral Therapists (NACBT) is one of the most well-known CBT organizations. It 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. ACT and NACBT certifications may demonstrate a higher level of dedication to and specialized training in CBT. But no certification is required for a therapist to practice CBT.

Concerns and Limitations of Cognitive Behavioral Therapy

CBT is not a quick fix for behavioral and mental health issues. Therapists need to demonstrate considerable expertise in the approach. People in therapy will benefit most when they cooperate fully with the treatment program. People with certain complex mental health needs may not be able to benefit right away from cognitive behavioral therapy. This could include people with issues that stem from severe trauma. In some cases, emotional issues must be addressed before cognitive work can begin.

Some people have vague feelings of unhappiness, without clearly defined symptoms. They may also have limited success with cognitive behavioral therapy. People with long-term health issues such as irritable bowel syndrome or chronic fatigue syndrome can use CBT to better cope with their condition. But the physical symptoms of these conditions cannot be cured with CBT.

Finally, CBT can help people develop more positive thought patterns and behaviors. But without a more traditional approach to therapy, they may not gain deeper insights into the psychological and emotional causes of their behavior.

References:

  1. Liebert, R. M. & Spiegler, M. D. (1998). Personality: Strategies and issues (8th ed.). Pacific Grove, California: Brooks/Cole.
  2. National Association of Cognitive-Behavoral Therapists. (2014). CBT certifications. Retrieved from http://www.nacbt.org/certifications.aspx
  3. National Health Service. (2014). Cognitive behavioural therapy. Retrieved from http://www.nhs.uk/conditions/Cognitive-behavioural-therapy/Pages/Introduction.aspx
  4. Prochaska, J. O. & Norcross, J. C. (2003). Systems of psychotherapy: A transtheoretical analysis (5th ed.). Pacific Grove, California: Brooks/Cole.
  5. Royal College of Psychiatrists. (2013). Cognitive behavioural therapy. Retrieved from http://www.rcpsych.ac.uk/mentalhealthinformation/therapies/cognitivebehaviouraltherapy.aspx

 

Last updated: 06-05-2018

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