Cognitive Behavior Therapy

We are what we think. All that we are arises with our thoughts. With our thoughts we make the world - Gautama Buddha

People's emotional reactions and behavior are strongly influenced by their thoughts, beliefs and perception about events they experience in their daily lives. Hence, what people think can affect how they feel and in turn how they behave.

When people are in distress, their perspective is often inaccurate and their thoughts may be unrealistic. This changes their behavior and may affect their professional and personal life and relationships.

For example, people with depression have faulty thoughts and beliefs about themselves, about others, and of the world. By correcting such faulty beliefs, the person's emotional state improves and their perception of the world will also change.

What is Cognitive Behavior Therapy (CBT)?

Cognitive behavior therapy is one of the most researched and commonly used forms of psychotherapy. It is a structured and goal-oriented approach used to treat many types of emotional, behavioral and psychiatric problems. For some problems, such as anxiety and depression, CBT is as effective as medication and can also enhance the effects of medication.

CBT helps identify a person's dysfunctional thought patterns and behaviors that are causing the problem. Therapists work along with the person, and help them learn or relearn skills and habits that are constructive, which in turn helps them face life situations in a rational way. The results of CBT are long-term, and one can use their learning to resolve other problems in life.

Effectiveness of CBT for various psychiatric and psychological problems

CBT has been demonstrated to be an effective treatment for a wide variety of disorders, and some of them include:

  • Psychiatric disorders such as depression, anxiety disorders, eating disorders, substance abuse, and personality disorders.
  • Note: For bipolar disorder and schizophrenia, CBT is prescribed along with medication.
  • Medical illness with a psychological component – medical conditions that involve chronic or acute pain, chronic fatigue syndrome, pre-menstrual syndrome, brain injury, obesity, trauma, and somatoform disorders.
  • Psychological problems such as anger, anxiety, relationship difficulties, gambling, etc.
  • Child anxiety disorders or depression among children, behavioral problems in children
  • Other problems such as stress, anxiety, low self-esteem, sleep problems, grief and loss, work-related problems, and problems associated with aging.

What are the benefits of CBT?

CBT is a talk therapy where the therapist helps the person learn cognitive, behavioral, and emotional-regulation skills, which enable them to cope with life situations in a rational and inferential manner.

Some of the benefits of CBT include:

  • The person can openly speak about their hidden thoughts, feelings, and emotions.
  • CBT is compatible with a range of other psychiatric treatments, which a patient receives, such as medication or supportive counseling.
  • The person is actively involved in the therapy and this motivates them to continue it. They need to complete assignments, and also practice what they learn.
  • CBT is flexible and can be customized depending on the severity of the problem and the person's adaptability to the treatment.
  • The person can apply this learning to various life situations, even after they have completed the therapy.

What are the goals of CBT?

CBT is an active and goal-oriented therapy that helps people learn these skills:

  • Analyze their emotions and distinguish between healthy and unhealthy feelings.
  • Increase their self-awareness and emotional-regulation.
  • Understand how distorted perceptions and thoughts contribute to painful feelings.
  • Learn specific techniques to identify and replace negative thoughts with more rational and constructive thoughts.
  • Reduce distress-causing symptoms by examining the current situation and solving current problems.
  • Change core beliefs that are the main cause for suffering, and thereby prevent future episodes of emotional distress.

How does CBT work?

The main objective of CBT is to help a person replace their unhealthy thought patterns with healthy and constructive reasoning.

The therapist helps the person to examine their assumptions, beliefs, reasoning, and the way they process this information leading to automatic negative thoughts about themselves, the world and the future. The irrational patterns of thinking are identified along with the context in which they arise. For example, people with depression are taught to recognize how they select only the negative aspects of a situation (selective attention), over-generalize from a single episode, personalize a situation by assuming they are the cause of the event, see things in black and white, be self-critical, etc.

CBT is a structured and time-limited therapy that includes the following strategies:

  1. As a first step, the therapist conducts a thorough assessment. You will be asked about past experiences and medical history to better understand the nature of difficulties for which you are now seeking treatment.
  2. The therapist explains the CBT process, why and how it will be used, and how it will benefit you.
  3. The therapist then explains how long it may take depending on various factors such as the complexity of the problem, the therapist's availability for subsequent sessions, your cooperation in participating and completing the assignment, and so on.
  4. The therapist educates the person about the nature of the symptoms (example: the physiological basis of anxiety, how it differs from severe conditions such as a heart attack, how symptoms are misinterpreted, etc.)
  5. The therapist will discuss the treatment plan including goals and ways to monitor the progress.
  6. Once this process is completed, the therapist and the person work together in recognizing faulty or negative patterns of thinking, and evaluating how such thinking is affecting the person's behavior in daily life.
  7. Both of them work together and identify problems, select goals and brainstorm alternative solutions, including relative risks and advantages. The person may rehearse a preferred solution before applying them in their lives. For example, if the problem is anger, analyze why and in what situations one gets angry, how to respond rationally in such a situation, learn techniques to control and reduce this feeling of anger, and so on.) 

Activities during therapy

  1. During the course of the therapy, the person is trained to become aware of automatic negative thinking.
  2. They learn to develop alternative ways of thinking, mainly constructive and rational.
  3. They learn coping skills to manage life stressors.
  4. They keep a diary and record negative thoughts and the situations in which they arise.
  5. They work on assignments or homework to practise and apply these learning.
  6. The therapist evaluates the sessions regularly to check if the person has benefited, and changes strategies if required.

Experts who provide CBT

A skillful therapist such as a mental health professional (psychologist, psychiatrist, psychiatric nurse, psychiatric social worker) who is trained in CBT, can administer this treatment. The therapist is expected to practice the code of ethics applicable to their profession.

Duration of CBT

Cognitive therapy is a short-term treatment that is adapted based on the person's difficulties and circumstances. The duration for most problems may be around 5 to 20 weeks. The number of sessions and the treatment time depends on how actively the person gets involved in the therapy to be able to achieve the desired outcome.