Cognitive behavioral therapy (CBT) is a hands-on therapeutic treatment that helps people understand that their thoughts are directly connected to how they feel, and how they feel is directly connected to their behavior. Recognizing this can help a person realize that if they can change their automatic thoughts in negative situations (using a variety of tips, techniques, and coping skills developed throughout the treatment), they may feel better and their actions and behaviors may change for the better as well.
CBT is a short-term model of therapy, unlike some other forms of treatment. The duration often depends on the condition that is being treated, but most conditions can be treated and completed in 16-20 weeks, or 4-5 months. Some people stay in treatment longer than this using CBT principles, and some are much shorter, but that is the solid average amount of time that treatment can last.
History of CBT
Although it has roots in earlier psychological theories, CBT itself as a treatment model dates back to the 1960s when it was established by the psychiatrist, Dr. Aaron Beck, during his work at the University of Pennsylvania. Dr. Beck had been trained in psychoanalytic therapy, a treatment that involves a therapist helping a patient access their unconscious or deeply buried thoughts and feelings and connects them to past experiences from their childhood that they may have repressed.
Psychoanalytic therapists believe that the repression of experiences or emotions from childhood can often contribute to the way we think, feel, and behave today. Dr. Beck was trained in this theory and wanted to conduct research to show its effectiveness from a scientific perspective. Little did he know, however, that his research would find that, even after receiving psychoanalytic treatment, patients with depression were still experiencing a pattern of negative thinking, often unintentional and practically unconscious, that was maintaining some of their depressive features.
As a result, he began to try to understand his patients differently so he could develop a treatment model that would help them to see research-based improvement of their symptoms, all by changing the way they thought.
It is said that Dr. Beck began thinking about his experiences with patients and recognized that most people have a script that runs in their minds throughout their day. This script is often an internal dialogue of their thoughts and feelings throughout the day, and Dr. Beck noticed that this self-talk may be directly related to the thoughts they are having about the situations that they are in.
If a person was experiencing depression or some other mental health condition, it appeared that their spontaneous self-talk (which he labeled as “automatic thoughts”) was negatively focused, they were more likely to be experiencing negative feelings. From this, he began to study his patients’ cognition, or thought patterns, and began to develop a theory that a patient’s thoughts could be impacting their mental health. From there, he developed his treatment model to involve helping a person develop insight into how their thoughts could be impacting them.
He also taught patients coping skills to help them identify and evaluate their thoughts in order to help them think more realistically (and often more positively), which in turn would help them improve their mood and behavior as well.
Dr. Beck continued to conduct research to determine if his new theory was effective, and he found that when patients learned to reevaluate the thoughts they had about themselves and the situations that they were in, they reported experiencing a substantial improvement of their symptoms that persisted long-term, even after treatment had ended.
CBT has been researched extensively and has been found to be one of the most efficacious treatments for a wide variety of mental disorders and symptoms. CBT has also been expanded and specific treatments for diagnoses have been developed, researched, and deemed evidence-based, which means that there has been statistical confirmation that this treatment is effective in improving a person’s symptoms and overall functioning.
CBT Core Principles
CBT has a core set of principles that guide treatment, including:
- Unhealthy or deficient thought processes may be responsible for some elements of a patient’s psychological distress.
- Patients have developed a behavior pattern that involves unhelpful behaviors, likely learned in childhood, that have persisted and contributed to a patient’s negative thoughts, feelings, and behaviors.
- With the development and use of coping skills, a person can unlearn these unhelpful patterns of behavior and eliminate negative thought processes that are contributing to their distress.
Structure of CBT Therapy Sessions
So now that you know what CBT is and the principles of the treatment, it may be helpful to learn what takes place when you begin participating in CBT sessions. CBT sessions are relatively structured, meaning that the sessions will often involve the same core concepts each week in the therapy session.
CBT is rather regimented, because of its evidence-based nature, so CBT therapists are following a guide of treatment that is predictable and consistent to help their patients obtain successful treatment outcomes. A CBT therapist will begin treatment by getting to know their patient and assessing what the patient believes they need help with.
The therapist then works with the patient to determine a treatment plan that involves goals a patient is hoping to achieve during the treatment, and markers for when a patient is ready to end treatment.
After the initial intake session and treatment plan, therapists will continue to work to get to know their patient through a talk therapy process that helps them to identify their patient’s thought patterns and self-talk, related to the topics and problems they discussed with the therapist during their intake.
The therapist will then help their patient begin to develop insight and awareness into their thought processes and how their automatic thoughts can be negatively contributing to how they feel and behave. Therapists can help shed light on how a person’s thoughts may be contributing to any self-destructive behavior that could be impacting their ability to feel good about themselves and the situations in their lives. In addition to insight building and awareness, therapists will help patients develop coping skills to help them to cope with negative feelings.
These coping skills involve being able to examine and modify their thoughts if their automatic thoughts are not based in reality, as well as activities that can be used to help a patient practice regulating the physical feelings that come along with mental health issues.
In addition to the work inside the therapy room, CBT therapists often use “homework” as a way to help a person practice the skills they have learned in session. For example, if a person was struggling with feeling unmotivated to exercise (even though they identify that exercising helps with their mental health), a CBT therapist may have them complete a “thought record” where they record all of the thoughts that contributed to the patient deciding not to exercise that week.
Then, during the next session, they would examine those thoughts and help to identify more healthy ways of thinking that could improve the patient’s motivation to exercise for the following week. Many other activities can be done for homework as a way to help a patient practice what they are learning in therapy sessions.
Disorders and Symptoms Treated With CBT
CBT has been widely researched to determine its effectiveness with a wide array of diagnoses and symptoms and has been found effective for many of them. Here is a list of some of the most common disorders that are treated with CBT based on the research behind it:
- Anxiety disorders
- Bipolar disorder
- Eating disorders
- Mood disorders
- Personality disorders
- Psychotic disorders
- Sleep disorders
- Substance abuse disorders
- Attention-related disorders
CBT has also been found to help people struggling with the following symptoms:
- Emotional dysregulation – CBT helps patients develop skills to recognize their emotions and help them use coping skills to regulate them before they cause problems in their life.
- Grief – Patients learn ways to process grief to help them cope with the loss of a loved one.
- Physical complaints – Patients are taught how to recognize when physical ailments may be related to their negative automatic thoughts and helps them use coping skills to redirect their thoughts to alleviate some of their physical pain.
- Trauma symptoms – Therapists often use CBT to help patients obtain information about how trauma has affected their thoughts and how it has contributed to self-destructive behavior that may have resulted following a traumatic event.
- Communication and relationship problems – CBT therapists can help a person identify their own automatic thoughts that are affecting the way they communicate in relationships and can help people resolve conflict in a healthier way.
- Organization and attention-related issues – Patients can learn the ways to develop organizational skills and can help them to identify ways to use CBT coping skills to stay on task and stay motivated to complete necessary daily tasks.
- Stress – Therapists can use CBT coping skills to help a person develop stress-reducing techniques that they can use, no matter where they are, to improve their functioning in the moment and over time.
- Relapse and substance abuse – Having awareness of the thoughts that contribute to a relapse can help someone struggling with substance dependence to help get a handle on their triggers and their relapse behavior.
Finding a CBT Therapist
If you are experiencing any of the mental health conditions or symptoms above, or if you believe that CBT may help improve your life, seeking out a trained CBT therapist would be a great way to learn some skills and improve your emotional health.
CBT is a fairly common treatment approach for most clinicians, so when you search for therapists, you will likely come across many CBT-trained counselors who are ready to help you. Even if you prefer to engage in counseling through one of the providers of online counseling, you should not expect to encounter any difficulty in connecting with a CBT provider.
In addition to finding a trained therapist, it is important to find one that you feel you can trust and confide in. Unlike other treatment models where therapists are held in power positions or seen as the ones with all the answers, a CBT therapist should work to develop a trusting and relatively equal relationship, so that the patient feels comfortable and willing to work toward solutions to their problems without relying completely on a therapist to “heal” them. Once you begin counseling, be sure to follow the program as outlined by your therapist in order to maximize the chances for successfully improving your mental health and well-being.
Sources
- Beck Institute for Cognitive Behavior Therapy. (n.d.). Aaron T. Beck. Beck Institute. https://beckinstitute.org/about/dr-aaron-t-beck/
- Institute for Quality and Efficiency in Health Care. (2013, August 7). Cognitive behavioral therapy. InformedHealth.Org. https://www.ncbi.nlm.nih.gov/books/NBK279297/
- van Dis, E. A. M., van Veen, S. C., Hagenaars, M. A., Batelaan, N. M., Bockting, C. L. H., van den Heuvel, R. M., Cuijpers, P., & Engelhard, I. M. (2020). Long-term Outcomes of Cognitive Behavioral Therapy for Anxiety-Related Disorders. JAMA Psychiatry, 77(3), 265. https://doi.org/10.1001/jamapsychiatry.2019.3986
- Fenn, K., & Byrne, M. (2013). The key principles of cognitive behavioural therapy. InnovAiT: Education and Inspiration for General Practice, 6(9), 579–585. https://doi.org/10.1177/1755738012471029
- Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive Therapy and Research, 36(5), 427–440. https://doi.org/10.1007/s10608-012-9476-1
Dr. Shannon McHugh is a Licensed Clinical and Forensic Psychologist in Los Angeles, California. She specializes in assessment and treatment of children, adolescents, and adults who have developmental and social delays, behavioral difficulties, and those who have experienced traumatic events