Cognitive Behavioral Therapy (CBT): The Definitive Guide

As humans, we all get confused and think negatively at times. There is nothing uncommon about it. But, when this negative thinking develops into a regular distorted thinking pattern, it can disturb an individual’s personal and social life alarmingly. Cognitive Behavioral Therapy or CBT is an approach that can help deal with our negative thinking. Would you like to know how? Let’s explore by delving into,

• What is CBT and how it works?
• Types and Techniques of CBT
• The benefits and challenges of this approach

What is Cognitive Behavioral Therapy (CBT)? 

CBT is a psychosocial intervention that allows therapists to help clients reduce suffering and enhance their well-being by identifying and replacing negative thought patterns. It is the treatment of choice for many mental health illnesses.

Why is CBT Important?

CBT helps improve behavioral health by altering one’s thoughts.

In CBT, the therapist examines how thoughts influence our feelings and behavior and helps deal with negative thinking patterns by restating inaccurate and irrational thoughts in logical terms.

For example, a CBT therapist working with a client who thinks that everyone hates him, teaches the client to say things like, “It is fine even if not everyone likes me. Some people like me and I may meet other new people in time.” This reframing of thoughts could lead to new activities such as initiating a conversation with someone or getting involved with a group of people who share similar interests. 

CBT model explains the association of thoughts, feelings, and behavior. Though it is easier to understand situations that give rise to emotions, CBT suggests that the thoughts we have about the situation influences our behaviors and emotions. It facilitates the shift of perspective.

Types of CBT

The type of Cognitive Behaviour Therapy treatment a patient may receive is determined by the issues being addressed. Cognitive therapy can take many forms, including:   

Mindfulness-Based Cognitive Therapy

This type of CBT combines cognitive behavior therapy with meditation. It aids in the development of a nonjudgmental, present-oriented attitude known as mindfulness. Mindfulness-based cognitive therapy develops cognitive therapy principles and it guides people on how to consciously pay attention to their thoughts and feelings without judgements.

Dialectical Behavior Therapy

This is another type of evidence-based cognitive therapy that employs strategies such as problem-solving and acceptance. It often involves a combination of group and individual sessions. DBT is extremely effective in treating strong emotions and severe mental health conditions. DBT can be used effectively for those struggling with Borderline Personality Disorder, ADHD, Bipolar Disorder, and substance abuse.

Acceptance and Commitment Therapy

Positive reinforcement and counter-conditioning are heavily used in this behaviorally-oriented CBT technique. The goal of ACT is to alter your reaction to your inner experiences such as emotions, thoughts, impulses, and feelings. Acceptance and Commitment Therapy teaches you to stop denying, avoiding, and fighting inner emotions. You’ll learn how to recognize deeper feelings. This form of Cognitive Behaviour Therapy assists in learning how to deal with depression, social anxiety disorder, stress, psychosis, chronic pain, and addictions.

Rational Emotive Behavior Therapy

REBT is a type of active therapy that assists in identifying irrational beliefs such as self-defeating feelings and thoughts. You’ll discover how to actively challenge irrational thoughts and eventually recognize and change your thought patterns. REBT teaches you how to replace negative thoughts with more productive, healthy beliefs. REBT is one of the types of CBT that is effective in treating people who are suffering from depression, anxiety, guilt, aggression, and procrastination.

CBT Techniques 

Cognitive Behavior Therapy is more than just recognizing thought patterns. 

It employs a wide range of strategies to assist people in breaking free from these patterns. There are several approaches to CBT depending on the problem and the individual’s goals. Some of the most common CBT techniques are as follows:

Identifying Negative Thoughts

It is critical to understand which thoughts, feelings, and situations are causing maladaptive behaviors. 

This process, however, can be difficult, particularly for those who struggle with introspection. Taking the time to identify these thoughts, on the other hand, can lead to self-discovery and provide insights critical to the treatment process.

Practicing New Skills

Patients are frequently taught new skills that can be applied in real-world situations during cognitive behavioral therapy. Someone with a substance use disorder, for example, may practice new coping skills and ways to avoid or deal with social situations that could potentially trigger a relapse.

Goal-Setting

Goal setting is an important step in mental illness recovery, assisting you in making changes to improve your health and life. A certified and trained therapist can assist you in developing and strengthening your goal-setting skills during cognitive behavioral therapy. This could include teaching you how to identify your goal or how to differentiate between short- and long-term objectives.

Self Monitoring

Self-monitoring is a critical cognitive behavioral therapy technique. It entails keeping track of your behaviors, symptoms, or experiences over time and sharing them with your therapist. Self-monitoring can provide your therapist with the data they require to provide the best treatment possible.

Problem Solving

Learning problem-solving skills during cognitive behavioral therapy can help you learn how to identify and solve problems that may arise as a result of both large and minor life stressors. It can also help to mitigate the negative effects of mental and physical illness.

CBT problem-solving frequently involves five steps: 

• Determine the issue 
• Make a list of possible solutions. 
• Examine the advantages and disadvantages of each potential solution. 
• Select a solution to implement. 
• Put the solution into action.

How To Start With CBT?

Just like other psychological therapies, CBT also starts by gathering information with the focus mostly on the current concerns, background, and history including past therapies and medications.

What Can You Expect?

Assessment

Assessment includes a clinical interview, Mental Status Examination (MSE), administration of diagnostic tools, behavior observation, and information from caregivers and other informants if any. It may take 3-4 sessions to understand client’s emotional health, concerns, and prognosis. Based on this, the therapist will decide whether the client is suitable for CBT. Having a comfortable space with the therapist is important for the success of CBT. The therapist may also recommend if the client will benefit from other treatments or medications.

Orientation

After assessment, the initial sessions would be a discussion on how CBT works and how the current concerns can be framed and worked on using CBT. Orientation discussion may also include the therapy time frame, number of sessions required, and the rationale for selecting CBT. 

Therapy Plan

Client’s concerns, current functioning level, and past history helps in developing a therapeutic plan. The client should have a clear understanding of how the therapy is conducted. The CBT model will be explained with help of the client’s concerns as well as other examples similar to the client. The therapist may also describe some of the common symptoms of the disorder the client is diagnosed with.

Goal Setting

After the initial orientation sessions and therapy plan, next is identifying goals that are observable, measurable, and achievable to the client’s present condition. Goals are prioritized and can be changed or modified as therapy progresses. 

Length of Therapy

Duration of therapy depends on the problem under focus, the client’s active involvement, and regular follow-up of home programs. Goals help assess the progress of therapy more objectively.

Confidentiality

Confidentiality plays a prime role in therapy. Only a comfortable client who feels safe and secure will open up and cooperate with the therapist. Maintaining confidentiality and getting feedback from the client as the therapy progresses help build trust and rapport which is essential. Except in very special circumstances like safety threat or requirement from legal authorities, the conversations with the client will remain confidential and secure with the therapist.

Results

Generating hope and getting the client empowered is important from the beginning throughout the sessions. Goals are reviewed regularly and based on the progress, they are modified or upgraded. Skill acquisition is the key to the success of CBT and that makes it different from supportive psychotherapy or talk therapy. 

How Does CBT Help and Who Can Benefit From CBT? 

CBT helps people to identify their thinking, emotions, physical sensations, and negative thoughts. It helps people with depression, low mood, anxiety, worry, stress, or panic. Cognitive therapy uses problem-solving skills to cope with difficult situations. CBT helps to deal with

• Addiction
• Anger issues
• Anxiety 
• Bipolar
• Depression
• Eating disorders
• Panic attacks
• Personality disorders
• Phobias

Not Just For Mental Health, CBT Can Do More  

Mental illness can impact an individual’s thoughts, perceptions, feelings, and personal relationships. Cognitive behavior therapy helps manage severe mental health problems, marital problems, drug use, and eating disorder. It is a helpful tool for stress management.

CBT can also be useful in,

• Chronic pain/ serious illnesses
• Divorce
• Grief /loss
• Insomnia
• Low self-esteem
• Relationship problems

Benefits of Cognitive Behavioral Therapy 

The goal of CBT is to assist people in becoming their own personal therapists. 

A Cognitive Behavior Therapist guides client to look at their concerns from a new perspective and helps them to learn coping skills to overcome their negative thoughts through exercises in the session and home programs.

Benefits include,

• CBT helps the patient become more competent by actively replacing negative thoughts and destructive actions with healthy ones. It helps alter their thinking, problematic emotions, and behavior. 
• CBT allows patients to build self-esteem by working toward the solution and enhancing their belief in themselves. 
• Aids patients in managing their emotions and improving their communication skills.
• CBT helps prevent relapse as the client becomes better equipped to recognize the thought patterns they need to avoid. 
• CBT also assists patients in mending broken relationships, coping with loss or grief, or coping with a medical condition. 
• Additionally, CBT is effective in treating emotional trauma caused by abuse or violence. 

CBT helps the patients become more self-aware and gain a more positive outlook on life. 

• Increased self-awareness often leads to a better understanding of oneself and thus the person can be more prepared for stressful situations and proper reactions. This can help alleviate or prevent future problems. 
• CBT is a non-invasive method and has minimal risks involved.

Effectiveness of CBT

CBT not only helps reduce the relapse rate in mental health conditions but also addresses and reduces many of the symptoms associated with these mental health illnesses. Depending on the situation, it may be used in conjunction with other therapies or on its own to achieve positive changes more quickly.

Challenges In Cognitive Behavior Therapy

Cognitive behavioral therapy can raise several challenges for people. Here are some to consider:

Change is hard: Some people initially state that even though they are aware that some thoughts are illogical or unhealthy, simply being aware does not make it simple to change them.

CBT is very structured: Unlike other approaches like psychoanalytic psychotherapy, cognitive behavioral therapy does not place as much emphasis on underlying, unconscious resistance to change. It is highly structured; therefore those who would find structure difficult may not find it suitable.

You Must Have the Will to Change: To benefit from cognitive behavioral therapy, you must be prepared to put in the time and effort necessary to examine your thoughts and feelings. Although this self-analysis might be challenging, it is a terrific approach to understanding how our inner thoughts influence our actions on the outside.

Progress is often slow: Most of the time, CBT is a progressive procedure and one cannot expect results overnight. Progress towards behavior change may be slow as it goes step by step.

Conclusion

Cognitive Behavior Therapy is a talking therapy that helps you manage mental health problems by changing your thoughts and behavior. As a structured therapy, it offers practical ways to get out of your problem thoughts and its vicious cycle. Though CBT may not provide a cure or make your problem disappear, it can positively help you cope with the situation in the healthiest manner possible.