Cognitive Behavioral Therapy

Definition: Cognitive-behavioral therapy (CBT) is an action-oriented, time limited form of therapy that assumes that faulty thinking patterns cause counterproductive behavior and negative emotions. The treatment focuses on changing one’s thoughts to be more balanced, resulting in more balanced feelings and behaviors.

Key Points

• CBT is a first-line treatment for anxiety disorders (such as panic disorder, social phobia, and obsessive compulsive disorder), depression, eating disorders such as bulimia, as well as alcohol and substance abuse problems.
• CBT has been scientifically validated in dozens of research studies that demonstrate response rates averaging 60-80% in children and adults who have these disorders.
• CBT usually produces results in a short period of time. A typical course of CBT is 12-16 weeks, in contrast to psychodynamic psychotherapy or psychoanalysis which can sometimes take several years to complete.
• CBT is active therapy where the therapist spends a lot of time “coaching” and teaching, while the patient engages in structured problem solving and even “homework” assignments. CBT patients share in setting treatment goals and in deciding which techniques work best to satisfy their individual needs.
• CBT is more present-centered and forward-looking than traditional therapies.

Example

When treating someone with depression, the CBT therapist will help the person identify negative thoughts and replace them with more balanced ones. For example, if a person is having trouble with a project at work or school, he may think that he isn’t good at anything. The CBT therapist will help him see that this thought is not true/irrational, and replace it with a more balanced thought such as, “I may not be good at doing this task, but there are other things that I do very well.” As homework, this patient would log other negative thoughts and be coached on how to replace them with more balanced thoughts (a process called “cognitive restructuring”). If enough irrational thoughts are changed, this patient may experience considerable relief from his depression. Behaviorally, this same patient could be taught how to break the project down into smaller parts that are easier to do. The patient could set a weekly goal of completing 1 or 2 of the smaller parts until the entire project is done! At the same time, this patient would be taught how to schedule more pleasurable activities into each day (called “behavioral activation”). By succeeding at work/school and spending more time on things he likes to do, this depressed person will eventually begin to enjoy life again.

There are of course, many other applications of CBT. Additional examples of behavior-oriented therapy might include helping someone overcome a fear of public speaking with systematic graded exposures; helping a teenager with persistent anxiety relax with techniques such as controlled breathing, visualization, and progressive muscle relaxation; helping an oppositional and defiant child be better behaved through behavioral modification and conditioning; and helping a socially anxious adult feel more comfortable at parties with assertiveness training and role playing.

CBT is a collaborative, action-oriented therapy effort. As such, it empowers the patient by giving him or her an active role in the therapy process and discourages any over-dependence on the therapist that may occur in other types of therapy. Patients are, practically speaking, taught how to be “their own best therapist.”

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