People may seek cognitive behavioral therapy (CBT) due to stress, grief, illness, and chronic pain. CBT is a way to reroute patterns to better face the difficult realities of life.
·October 25th, 2021
Cognitive Behavioral Therapy, or CBT, is a thought-based form of behavioral therapy that works to correct problematic thought patterns through structured exercises
CBT focuses on the present rather than the past, and is generally confined to a defined quantity of sessions with targeted goals
CBT sessions focus on identifying and correcting thought patterns around specific situations, and at-home exercises may be used to solidify learnings
CBT can help not only with a spectrum of mental health conditions, but also chronic illness or pain, stress, trauma, relationship issues, grief, and more
Cognitive Behavioral Therapy, commonly known as CBT, is a modality of psychotherapy that guides the client toward seeing where their thinking and behavior patterns have become counterproductive. CBT has been formally studied more than any other behavioral health intervention and has been proven as effective treatments through many studies to bring about measurable positive change.
CBT is a thought-based (as opposed to action-based) technique that is focused on the client’s present thoughts and interactions, and, unlike traditional psychoanalysis and other forms of counseling and therapy, doesn’t focus directly on the client’s history or past trauma (though CBT is frequently used and is highly effective for patients with trauma histories).
Instead, cognitive behavior therapy pays attention to current problems, addressing the client’s present life circumstances and issues. Utilizing a specific sequence of thought exercises, the therapist or psychologist guides the patient in moving away from feeling “stuck” in patterns of thought and behavior.
Where cognitive behavioral therapy comes from and how it works
Cognitive behavior therapy was first developed in the 1960s by a psychiatrist who observed a common pattern in many of his patients—that in their thought lives, they had internal dialogues that went back and forth like conversations, and that these thoughts frequently became negatively emotionally loaded into what he referred to as “automatic thoughts.”
He developed the early techniques of CBT to reconstruct those damaging thought patterns into new, more self-aware and productive thoughts that allowed his patients to move away from their looping inner dialogues. Modern CBT works in much the same way, though the techniques have been honed over the years.
Unlike many other forms of psychotherapy, this type of cognitive therapy is intentionally structured, both within each individual treatment session and in terms of the course of treatment. Generally, a mental health practitioner and client will agree at the outset of treatment how long they will work together—typical courses of treatment range from 5-20 sessions, generally held once or twice per week.
During a session, the therapist will lead the client through a back-and-forth conversation, posing questions for the client to consider and guiding the client through basic steps that can be applied to any situation in the client’s life.
First, the therapist will ask the client to identify a situation or condition in their life that is causing them stress, anxiety, resentment, or other forms of distress. These issues may be major life happenings like divorce, loss of a loved one, loss of a job, or health issues, or they may be subtler or more nuanced concerns like feelings of disconnection in a relationship, imposter syndrome at work, or parenting challenges.
Next, the therapist will ask the client to pay attention to their thoughts, feelings, and beliefs about their problem, and to share their inner thoughts (known in CBT as “self-talk”) about it. This can happen verbally in the space of a session, and/or in a journal that the client keeps at home.
Then, the therapist will help the client identify where their thinking pattern around the problem may be negative or inaccurate. Keeping a keen awareness of the mental, physical, and emotional states that accompany thought patterns is a big part of this step.
Lastly, the therapist will push the client to reshape their thinking, from negative or inaccurate thought patterns to new, more accurate ones that are reflective of the work of observation the client has already done. In this way, the client ends up with new thought patterns that are coherent with the realities of their situations, and they are freed from outdated, problematic, or inaccurate thought patterns that are causing them distress.
At first, this process is highly intentional, takes a lot of conscious effort, and may feel emotionally challenging and uncomfortable for the client. Over time, however, this form of therapy trains a client to “become their own therapist,” using the steps (identify, evaluate, respond)on their own in a self-sustainable way.
Principles and techniques of CBT
There are ten core principles of CBT, upon which all the work relies:
CBT is goal oriented and focuses on specific problems
A strong therapeutic alliance (the relationship between therapist and client) is required
CBT works with the client’s present-day life
The client’s problems and their thought patterns are the basis for work in CBT
CBT emphasizes collaboration between the client and the practitioner
CBT teaches clients to identify, evaluate, and respond to their problematic thought patterns
CBT is educative and teaches the client to become their own therapist
CBT is intentionally time-limited, with a specified length of treatment
CBT sessions are always structured, with an intro, middle, and end
CBT uses many techniques to elicit change in thoughts, feelings, and unhelpful behaviors
Some of the techniques and therapeutic approaches that CBT therapists might use in a session include:
Journaling: Using writing to reveal thoughts
Guided questioning: Questioning assumptions and trying on new points of view
Cognitive restructuring: Examining distorted thought patterns and dismantling them
Thought recording: Thinking of evidence for and against negative thought patterns, then using that evidence to develop a new thought pattern
SMART goals: Setting goals that are specific, measurable, achievable, realistic, and time-limited
Positive experiences: Rewarding activities that improve mood and quality of life
Exposure: Listing the things that cause emotional distress, in order of how distressing they are, to systematically desensitize the client to their impact
During a course of CBT, the therapist or psychologist will decide when and how to use these techniques, always guiding the client through them. CBT often includes homework for the client to do between sessions as well.
Who can benefit from cognitive behavioral therapy?
CBT has been proven to create positive change in people who have mental health conditions. Some conditions that this type of therapy is effective in treating include depression, anxiety disorders, substance use disorder, eating disorders, obsessive compulsive disorder (OCD), sexual disorders, sleep disorders, post-traumatic stress disorder (PTSD), phobias, bipolar disorder, and schizophrenia.
CBT does not seek or claim to “cure” any of these conditions, but rather is part of multi-pronged treatment plans that meet patients where they are and aims to improve their abilities to manage their conditions. People who don’t have mental health condition or mental illness but who want to improve their mental and emotional wellbeing can also benefit greatly from CBT techniques.
Some common reasons for people to seek cognitive behavioral therapy include stress, relationship issues, grief, trauma, medical illness, and chronic pain. In essence, when life is challenging, it is easy to fall into damaging thought patterns around the area of challenge, and cognitive therapy is a way to reroute those patterns to better face the difficult realities of life.
One of the most interesting applications of CBT is for people with gut health conditions like IBS. The connection between behavioral health and gut wellness might not be immediately obvious, but doctors and researchers have discovered that using the techniques of CBT can bring measurable relief from gut symptoms.
Specialized mental health practitioners called gastrointestinal psychologists can implement CBT strategies to address anxiety and looping thoughts around symptoms, which can in turn directly impact physiological health for the better.
Cognitive work for emotional rewards
Doing the emotional and cognitive work of CBT can reap big rewards in terms of overcoming challenging situations, improving quality of life, enjoyment of relationships, and overall wellness, especially if it is undertaken as part of a comprehensive wellness program that considers mental, physical, and emotional health.
A behavioral health specialist who is trained in CBT can be a huge asset to your wellness team, and many practitioners offer both group and individual CBT sessions depending on your wants and needs.
If you think you could benefit from CBT, the right provider can help you build a personalized plan to support your wellbeing. Connect with a credentialed expert and mental health professionals who serves your area here.