What is Cognitive Behavior Therapy (CBT)?
Cognitive Behavioral Therapy (CBT) is the term used for a group of psychological treatments that are based on scientific evidence. These treatments have been proven to be effective in treating many psychological disorders.
Some people have an inaccurate view of what psychological therapy is, perhaps because of the old-fashioned treatments shown on TV or in the movies. For example, on TV, psychotherapy may seem to involve dream interpretation or complex discussions of one's past childhood experiences. This type of psychotherapy is outdated. In fact, very few psychotherapists (e.g., psychologists, social workers, or psychiatrists) use this type of treatment.
Cognitive and behavioral therapies usually are short-term treatments (i.e., often between 6-20 sessions) that focus on teaching clients specific skills. CBT is different from many other therapy approaches by focusing on the ways that a person's cognitions (i.e., thoughts), emotions, and behaviors are connected and affect one another. Because emotions, thoughts, and behaviors are all linked, CBT approaches allow for therapists to intervene at different points in the cycle.
There are differences between cognitive therapies and behavioral therapies. However, both approaches have a lot in common, such as:
We introduce cognitive therapy and behavior therapy in more detail below.
- The therapist and client work together with a mutual understanding that the therapist has theoretical and technical expertise, but the client is the expert on him- or herself.
- The therapist seeks to help the client discover that he/she is powerful and capable of choosing positive thoughts and behaviors.
- Treatment is often short-term. Clients actively participate in treatment in and out of session. Homework assignments often are included in therapy. The skills that are taught in these therapies require practice.
- Treatment is goal-oriented to resolve present-day problems. Therapy involves working step-by-step to achieve goals.
- The therapist and client develop goals for therapy together, and track progress toward goals throughout the course of treatment.
The basis of cognitive therapy is that thoughts can influence feelings, and that one's emotional response to a situation comes from one's interpretation of that situation. An example is below.
Imagine experiencing the sensations of your heart racing and shortness of breath. If these physical symptoms occurred while sitting quietly on a park bench, they would likely be attributed to a medical condition, such as a heart attack, may cause fearful and anxious emotions. In contrast, if these physical symptoms occurred while running on a treadmill, they likely would not be attributed to a medical ailment, and may not lead to fear or anxiety. In short, different interpretations of the same sensations could lead to entirely different emotions.
Cognitive therapy suggests that many of our emotions are due to our thinking - i.e., the ways that we have perceived or interpreted our environments. Sometimes these thoughts may be biased or distorted. For instance, one might interpret an ambiguous phone message as suggesting interpersonal rejection, or physical symptoms as suggesting a medical disorder. Others may set unrealistic expectations for themselves, or harbor pervasive concerns regarding their acceptance among others. These types of thoughts can contribute to distorted, biased, or illogical thinking processes that then affect feelings.
In cognitive therapy, clients learn to:
- Distinguish between thoughts and feelings.
- Become aware of the ways in which thoughts can influence feelings in ways that sometimes are not helpful.
- Learn about thoughts that seem to occur automatically, without even realizing how they may affect emotions.
- Evaluate critically whether these "automatic" thoughts and assumptions are accurate, or perhaps biased.
- Develop the skills to notice, interrupt, and correct these biased thoughts independently.
Behavioral approaches vary; however, they focuses mostly on how some thoughts or behaviors may accidentally get "rewarded" within one's environment, contributing to an increase in the frequency of these thoughts and behaviors. Behavior therapies can be applied to a wide range of psychological symptoms to adults, adolescents, and children. A couple of examples are below.
Example #1. For instance, imagine a teenager that persistently requests permission to use the family car to go out with friends. After repeated requests to parents, and repeated denials for permission, the teenager becomes angry, irritable, and disobedient towards his/her parents. Following a tantrum, the parents decide they can not take the hassle any more and allow their child to borrow the car. By granting permission, the child actually has received a "reward" for throwing a tantrum. Behavior therapists say that by granting permission after to a tantrum, the child has "learned" that disobedient behavior is an effective strategy for getting permission. Behavior therapy seeks to understand such links between behaviors, rewards, and learning, and change negative patterns. In other words, in behavior therapy, parents and children can "un-learn" unhealthy behaviors, and instead reinforce positive behaviors.
Example #2. Imagine being afraid to ride in an elevator. To avoid the fear and anxiety, you might eventually choose to avoid all elevators, and walk up flights of stairs instead. The extra time and energy that is needed to walk the stairs could cause you to be constantly late for work or events with friends. However, despite these consequences, the fear that comes with riding an elevator is too great to bear. Behavior therapists suggest that avoiding the elevator has been rewarded with the absence of anxiety and fear. Behavioral treatments would involve supervised and guided experience with riding elevators until the "rewards" associated with avoidance have been "un-learned," and the negative associations you have with elevators has been "un-learned."
Although behavioral therapies are different from disorder to disorder, a common thread is that behavioral therapists encourage clients to try new behaviors and not to allow negative "rewards" to dictate the ways in which they act.