Cognitive-Behavioral Therapy has become increasingly popular with therapists and the general public. Surveys completed by therapists indicate that CBT is quickly becoming the preferred method of treatment many clinicians utilize with their patients. Additionally, individuals can utilize CBT self-help books to practice these techniques on their own, and this is becoming a popular trend.
CBT is organized in a structured way, where short and long-term goals can be implemented. This makes it a good fit for scientific research, which allows us to observe and examine the efficacy of CBT.
More than 325 research studies have been conducted on CBT for various clinical populations such those with anxiety, depression, post-traumatic stress disorder, marital distress, anger, oppositional defiant disorder, and chronic pain. Results suggest large improvements for emotional problems in adults and adolescents. Results also indicate that CBT was somewhat more effective than antidepressants, and equally as effective as behavior therapy (behavior therapy includes strategies such as modeling positive behaviors for the client, having the client build skills through practice and rewarding positive behavior) in treating adult depression. CBT has even been shown to be an effective treatment for patients with schizophrenia, when taken in conjunction with medication.
Due to the substantial number of studies that support CBT, treatment guidelines of varying psychiatric conditions list CBT as a preferred method of treatment. Additionally, CBT is now required as one of the psycho-therapies taught in residency training programs in psychiatry. Many feel CBT is easier to implement than other therapeutic approaches because of the highly specified approaches described in CBT manuals, which are designed to be delivered over a relatively short-term duration. Due to its potentially short duration and effectiveness, CBT is viewed at as a therapy that can potentially reduce the costs of mental-health care associated with traditional psychotherapy.
In general, the overall premise of CBT is that mental health conditions/problems such as depression, anxiety, anger problems, PTSD, are often related to:
- faulty information processing
- distorted and dysfunctional thoughts
CBT techniques and strategies to help include:
- Setting personal goals
- Using a problem/solving approach
- Therapist and client collaborate to solve problems/make changes
- Client works with therapist to identify, evaluate, modify, and replace distorted thoughts with more accurate and adaptive ones
- Behavioral experiments are utilized to test out distorted predictions and correct them (for example, if a client thinks no one will talk to him if he goes to a party, he can challenge his belief by going to the party and seeing what happens)
- Other “classic” behavioral techniques are included as part of CBT (e.g., exposure to feared stimuli). For instance, if a client has a fear of snakes, she may watch snake videos with the therapist; look up evidence about the number of snake attacks in her country that year, and which types of snakes committed the attacks; write an informative essay about snakes and snake attacks, visit the pet store to see snakes, eventually ask to hold a snake etc.
The therapist and client work together to correct distorted thoughts to produce improvement in mood and behavior.
The desired outcome of CBT is initial symptom improvement and later functional improvement.
All CBT treatments follow a similar set of guidelines and principles. However, there are a variety of specific treatments that can be categorized as CBT. See a brief description of the different types of CBT approaches below:
In cognitive therapy the therapist challenges the client’s negative thought patterns about the self and the world to alter the client’s perceptions and decrease unwanted behavior patterns
Problem-solving therapy helps to teach clients to effectively manage the negative effects of stressful events that can occur in life (e.g., divorce, death of a loved one).
Problem-solving therapy can provide training in adaptive problem-solving skills as a means of better resolving and/or coping with stressful problems.
Such skills include:
• Making effective decisions.
• Generating creative means of dealing with problems.
• Accurately identifying barriers to reaching one’s goals
Dialectical Behavior Therapy
Dialectical behavior therapy (DBT) provides clients with new skills to manage painful emotions and decrease conflict in relationships. DBT specifically focuses on providing therapeutic skills in four key areas. First, mindfulness focuses on improving an individual’s ability to accept and be present in the current moment. Second, distress tolerance is geared toward increasing a person’s tolerance of negative emotion, rather than trying to escape from it. Third, emotion regulation covers strategies to manage and change intense emotions that are causing problems in a person’s life. Fourth, interpersonal effectiveness consists of techniques that allow a person to communicate with others in a way that is assertive, maintains self-respect, and strengthens relationships.
Meta-Cognitive Therapy helps clients develop new ways of controlling their attention and new ways of relating to negative thoughts and beliefs. Clients also learn to modify beliefs that give rise to unhelpful thinking patterns. Meta-Cognitive Therapy helps clients with patterns consisting of worry, rumination, fixation of attention, etc.
Rational-Emotive Behavior Therapy (REBT)
The goal of REBT is to help people alter illogical beliefs and negative thinking patterns so they can overcome psychological problems and mental distress. For instance, a client will identify a situation that causes them stress (e.g., failing a test, giving a presentation, trying to make new friends), evaluate their negative beliefs surrounding the situation (e.g., I am not good enough, this happened because I am dumb, I won’t do well at this, people don’t like me), and evaluate their reaction to the event (e.g., fear, nervousness, crying, anger, etc.). Then they will work to alter their belief system. The therapist will challenge their irrational thoughts to try to change their perception.
Cognitive Processing Therapy
Cognitive processing therapy (CPT) is a specific type of cognitive behavioral therapy that is shown to be effective in reducing symptoms of PTSD that have developed after experiencing a variety of traumatic events such as child abuse, combat, rape and natural disasters.
In CPT, patients learn how to challenge and modify unhelpful beliefs related to the trauma. In so doing, they create a new understanding and conceptualization of the traumatic event in order to reduce its ongoing negative effects on current life. This treatment is highly recommended for the treatment of PTSD.
Mindfulness-Based Cognitive Therapy (frequently used for anxiety and depression)
Mindfulness-Based Cognitive Therapy (MBCT) incorporates mindfulness practices such as meditation and breathing exercises. MBCT therapists teach clients how to break away from negative thought patterns that can cause a downward spiral into a depressed state. This helps them fight off depression before it takes hold.
Cognitive-Behavioral Analysis System of Psychotherapy
Cognitive-behavioral analysis system of psychotherapy (CBASP) holds the belief that those with chronic depression experience disconnectedness from their environment and therefore have decreased access to important feedback on problematic interpersonal patterns and relationships. The therapist works with the client to generate empathic behavior, identify and change interpersonal patterns related to depression, and heal interpersonal trauma.
CBASP consists of three techniques:
- Situational Analysis – this is a problem – solving technique designed to help the client realize the consequences of his/her behavior on others and modify it
- Interpersonal Discrimination Exercises – examination of past or present hazardous/toxic relationships with others and differentiating those from healthier relationships
- Behavioral Skill Training/Rehearsal (e.g., assertiveness training to help individuals with depression modify problematic behaviors)
Schema is defined as a “life trap” or a pattern of negative behaviors that an individual repeats over and over again throughout their life. Individuals that would benefit the most from schema focused therapy are those that display self-defeating thought patterns and behaviors (e.g., I’m not good enough, no one loves me, I am worthless).
In order for the therapist to effectively address and improve the client’s thinking patterns in schema-focused therapy; three stages must first take place:
- The therapist identifies the client’s schemas/life traps through conversation or questionnaires.
- The therapist helps the client become aware of their own schemas and learn how to recognize them in their everyday lives.
- The client becomes more involved in improving their thinking patterns outside of treatment. They learn how to replace negative thoughts with positive thoughts for more positive outcomes.
Due to the variety of therapies (discussed above) that incorporate CBT, it is more accurate to consider them cognitive-behavioral therapies in the plural sense because together they form a family of related interventions following underlying principles and assumptions.
Critics of CBT ague that:
- The approach is too mechanical and does not address the concerns of the whole patient.
- Trying to modify or change distorted thoughts or ideas is not necessary (according to research), and clients with major depression improve just as much following a treatment that contains only the behavioral strategies of CBT (e.g., exposure, doing something different, doing something you enjoy, testing out your beliefs), than after a program containing both behavioral strategies and techniques designed to directly modify distorted thoughts/ideas.
- Behavioral action on the part of the client and acceptance of one’s beliefs and emotions is a more effective therapeutic strategy, that trying to change the client’s thoughts and beliefs. The thought is that “it is okay to have these thoughts-they don’t define you. Keep taking care of yourself, trying to reach your goals, and moving forward.”
Because so much of the research backs CBT, but some studies show that only portions of it are beneficial (e.g., behavioral action) a new wave of therapy is emerging that attempts to better balance acceptance and change-based strategies. Dialectical Behavior Therapy (DBT) is actually one of these therapies. DBT is empirically-based and has shown to be effective in the treatment of Borderline Personality Disorder.
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