How Does CBT Work?
Cognitive behavior therapy is a form of psychotherapy (talk therapy) that is proven effective in treating a wide range of behavioral issues and mental health disorders and improving the overall quality of life for children, adolescents, and adults. Also referred to as cognitive-behavioral therapy or CBT, cognitive behavior therapy was founded in the 1960s by Aaron T. Beck. It has grown to become a preferred form of talk therapy treatment for many of today’s mental health practitioners, and for a good reason — it is quite useful.
The Origins of CBT
Like many other types of psychotherapy, CBT has roots in psychoanalysis, a form of therapy originated by Sigmund Freud that explores both conscious and unconscious elements of the mind. Psychiatrist Aaron Beck was practicing psychoanalysis when he observed that his patients seemed to be carrying on an internal dialogue with their thoughts during their sessions.
According to PsychCentral, Beck “realized that the link between thoughts and feelings was very important” and coined the term “automatic thoughts” to describe “emotion-filled thoughts that might pop up in his patients’ mind.” Even though his patients weren’t always aware of their automatic thoughts, Beck found that he could help them identify and share them. He thought this process was the key to helping his client overcome difficulties and institute a behavior change. Because this approach focuses on thinking, Beck called his technique cognitive therapy.
Beck’s concept borrowed from an earlier psychotherapy approach called rational emotive behavior therapy (REBT), which was developed by psychologist Albert Ellis in the 1950s and is still practiced today. Like Beck, Ellis believed that people aren’t always aware of their thoughts, especially those that are negative or irrational.
He believed that even though they didn’t recognize these harmful thoughts and irrational beliefs, these thought patterns negatively impacted their relationships and led them to self-destructive behavior. REBT psychotherapists use mental exercises, self-help material, and homework assignments to reduce negative thoughts and replace them with positive ones.
Ellis and Beck’s work with cognitive therapy and REBT focused more on identifying and replacing negative thoughts or cognitions than on behavioral elements. Eventually, though, cognitive therapy practitioners added behavioral techniques to the treatment, and the comprehensive concept of cognitive-behavioral therapy was born.
Examples of Automatic Thoughts
What Aaron Beck called “automatic thoughts” are now described as “subconscious thoughts that occur in response to everyday events.” They’re often referred to as negative thoughts, and described as “irrational and self-defeating.” There are generally three forms of negative thoughts, which form a “cognitive triad:” a negative view of the self, the world, and the future. The first view, which Beck referred to as a “negative schema,” is standard in depressed people.
The longer you harbor these negative thoughts and allow them to become deeply held beliefs, the more destructive they become within your everyday life. Automatic thoughts can take many forms, including broad generalization. Generalizations take the form of statements such as “I’m completely worthless,” “Nobody likes me,” or “I’ll never amount to anything.” These irrational beliefs lead to dysfunctional assumptions and incorrect perceptions, or “if/then” or “should” statements, like “If I ask for help, people will think I’m incompetent.”
Your automatic, negative thoughts may also lead to “negative predictions,” like “Those people won’t like me, so I’m not going to that party.” These thoughts directly impact your behavior patterns. You think you’re unlovable, so you avoid intimate relationships. You believe you’re stupid, so you stick to menial, unchallenging jobs.
Dysfunctional assumptions, predictions, and irrational generalizations are all types of cognitive distortions or unhelpful ways of thinking. CBT is an effective treatment for cognitive distortions because CBT helps patients become aware of their irrational beliefs and thoughts. It then employs cognitive restructuring to help patients reframe or dispute these thoughts.
Principles of CBT
In her 2011 book Cognitive Behavior Therapy, Second Edition: Basics and Beyond, Dr. Judith Beck outlined ten basic principles of CBT treatment:
- It’s based on an ever-evolving formulation of patients’ current problems in cognitive terms
- It requires an empathetic, trusting, and genuine relationship between the patient and CBT therapist
- It relies on active participation and collaboration
- It’s goal-oriented and problem-focused
- It starts by emphasizing present, here-and-now problems, and evolves into an examination of the past
- It’s an educational process that teaches the patient to be his or her own therapist
- It aims to be a short-term treatment, usually five to 20 sessions
- Therapy sessions are structured for efficiency and effectiveness
- It teaches patients to identify their automatic thoughts or “key cognitions”
- It uses a variety of techniques to change thinking, mood, and behavior
Beck explains that although these principles apply to all CBT patients, specific CBT techniques may vary based on the patient’s goals, preferences, and motivation. According to the American Psychological Association (APA), some strategies a cognitive-behavioral therapist will use during client work may include helping patients to:
- Recognize problem-causing distortions in their thinking and reframe them
- Better understand others’ behavior and motivation
- Use problem-solving skills to better cope with stressful situations
- Develop greater confidence in their abilities
- Face their fears rather than defaulting to avoidance
- Use role-play to prepare for problematic interactions with others
- Learn calming techniques for the mind and relaxation techniques for the body
What a CBT Session Looks Like
As noted in Judith Beck’s CBT principles, CBT is highly structured and uses specific techniques. A patient’s first session with a cognitive-behavioral therapist will usually give the patient time to describe their particular problems and set goals for their ideal results of therapy. At the beginning of each weekly session, the therapist and the patient will review the previous session and the conclusions they reached.
Like Albert Ellis’ REBT approach, CBT usually involves homework, so this part of the CBT session will include reviewing the assignment the client completed from the previous session. Homework assignments might consist of mental exercises, journaling, or keeping a diary of thoughts, feelings, and behaviors.
Next, the therapist and patient will settle on which main topics they’ll explore that day. As the session closes, the therapist will assign a new homework assignment for the following week. This structural approach ensures that the therapist doesn’t miss any critical information and helps the patient to continue the work independently after their therapy sessions end. This critical training component of CBT is one reason CBT dramatically reduces the chance of relapse in many patients.
Who Benefits From CBT
- Major depressive disorder or severe depression
- Anxiety disorders, including panic disorder and social anxiety disorder
- Posttraumatic stress disorder (PTSD)
- Obsessive-compulsive disorder (OCD)
- Substance abuse
- Mood disorders like bipolar disorder
- Eating disorders and sleep disorders
CBT is also helpful for people who haven’t been diagnosed with a mental illness but are dealing with physical or emotional difficulties or stressors, like grief or loss, divorce, or physical symptoms of medical illness like chronic pain.
Types of Cognitive Behavior Therapy
Cognitive behavior therapy has become an umbrella term for several different types of treatment that use the CBT approach.
Exposure therapy is a form of CBT that forces patients to confront in a controlled environment the events or things that trigger their fear or anxiety. For example, exposure therapy for a patient who is afraid of flying or similar situations might involve a supervised session watching planes take off at an airport. It’s especially helpful for patients with PTSD, obsessive-compulsive disorder, and phobias.
Dialectical behavior therapy (DBT) is not a form of CBT but is mostly based on CBT principles. The big difference, though, is that DBT helps people accept rather than overcome their negative thoughts, emotions, and behaviors and “find a balance between acceptance and change.”
Acceptance and commitment therapy (ACT) is another type of treatment that’s based on CBT as well as traditional behavior therapy. According to Psychology Today, ACT helps patients “learn to stop avoiding, denying, and struggling with their inner emotions and, instead, accept that these deeper feelings are appropriate responses to certain situations that should not prevent them moving forward in their lives.” It’s an effective therapy for patients with anxiety disorder, OCD, and chronic pain, among other conditions.
Finding the Right CBT Therapist
When you’re seeking out a mental health professional, it’s not necessary to be overly familiar with the different forms of CBT or other available treatments. The most important thing is finding a therapist with whom you’re comfortable, and who possesses the education, experience, and personal attributes you’re seeking. Most therapists today practice some form of CBT to help patients face and overcome their current problems, and they’ll create a custom treatment plan that best benefits each patient.
If you’re looking for a mental health professional to help you deal with diagnosed disorders, everyday stressors, or emotional issues, consider the Therapy Group of NYC. Our teletherapy and in-person clinicians are some of the best therapists in New York, and we’re familiar with the city’s unique pressures. Therapy Group of NYC offers a new way to get beyond normal and on to your best, most fabulous life.