Cognitive Behavior Therapy (CBT)

Cognitive Behavior Therapy, also known more simply as CBT, has received much attention from researchers and academics in the past several decades as its level of efficacy often surpasses similar techniques.

What Is Cognitive Behavior Therapy (CBT) and How It Works

Table of Contents

    What is Cognitive Behavior Therapy?

    Cognitive Behavior Therapy, also known as CBT or Cognitive Therapy, is a brief, problem-centered, solution-focused therapy.  This approach means CBT takes significantly less time to work than other modalities like Psychoanalysis or traditional “talk therapy.”

    The basic premise of CBT psychotherapy is that what we think affects how we feel and how we feel affects our behavior. Our behavior than either reinforces our negative thoughts or challenges them.  Thoughts are often negative in people with mental health and mood disorders, and they are usually unrealistic as well.  Not only that, but they tend to happen automatically.

    This image describes the link between our thoughts, emotions and behaviors.  Each one affects the others.

    Negative automatic thoughts can be thought of as different manifestations of one or more negative, distorted core beliefs.  Many people with depression and anxiety have been experiencing the same negative thoughts, or close variations, for so long they pass by hardily even noticed.  Yet, at the threshold of consciousness, they take their toll: eroding self-esteem, entrenching negative mood states like depression/anxiety, and encouraging behavior that reinforces negative thoughts and beliefs. 

    CBT is versatile and can be used as a primary treatment or as a supplemental approach. 

    How does CBT work?

    “CBT works by reframing your outlook on life and your behaviors by identifying the thoughts, beliefs, and cognitions that negatively impact your emotional experience and lead to problematic behaviors.”

    Cognitive Behavioral Therapy works by identifying, challenging, and changing negative thoughts, beliefs, and behaviors.  Once patients begin to see the connection between what they think and how they feel, change occurs quite rapidly.  Patients stop feeling like they are at the mercy of ever-changing moods and behaviors beyond their control. 

    Cognitive therapies are not about trying to change every emotion you have.  Negative emotions are not always unhealthy.  For example, it is natural for someone who recently lost a loved one to feel grief for a time.  Someone who has had a romantic rejection or career reversal is bound to feel disappointed.  However, when negative moods persist for a long time or significantly impact your quality of life, it might be time to move beyond acceptance strategies to a change based approach like CBT. 

    A brief history of CBT

    Cognitive therapies are an offshoot of an earlier treatment called Behaviorism, made famous by Psychologist BF Skinner in his work on reinforcements.  The origins of CBT go back to the 1950s when Albert Ellis devised a therapy called Rational Emotive Behavior Therapy.  

    In the 1960s, these ideas were further refined by Arron Beck, who invented Cognitive Therapy (CT).  Beck noted that certain types of thinking contributed to emotional problems. He labeled these “automatic negative thoughts” and developed the process of cognitive therapy. The cognitive approach addressed how thoughts and feelings affect behaviors, whereas earlier behavior therapies focused almost exclusively on associations, reinforcements, and punishments to modify behavior.

    In the late 80s and early 90s, Dr. David Burns took things a step further by creating Cognitive Behavior Therapy.  The difference between previous versions like REBT and CT and CBT has to do with recognizing that behavior either weakens or reinforces negative thoughts and beliefs.  Furthermore, without the right behavioral changes, efforts at cognitive restructuring will be limited. 

    During the last several decades, CBT has emerged as an effective first-line treatment for many disorders and conditions.

    CBT is one of the most researched types of therapy because treatment is focused on highly specific goals and results that can be measured relatively easily.  In fact, CBT has been designated the gold standard of psychotherapy by researchers.

    What is CBT Used For

    CBT therapy is effective in treating the following mental health, behavioral health, and mood disorders:

    Distorted Thinking In CBT

    CBT emphasizes ten common forms of negative thinking patterns, called distortions.  These distorted thinking patterns are often found in people with mental health and mood disorders.  People with conditions like depression and anxiety, among others, often fall prey to these patterns:

    • All or nothing thinking – Viewing people, events, and situations in black and white; things are either great or terrible with no middle ground
    • Overgeneralization – A thought distortion in which an adverse event is seen as a never-ending pattern of defeat.  Someone who lost their job might think, “this is always happening to me”
    • Mental filter – Picking out a single adverse event and focusing on it exclusively.  For example, someone who got a 96% on a test might focus only on the fact that it wasn’t a perfect score.
    • Discounting the positive – in this thought distortion, someone will undermine or “devalue” one or more positive traits or situational outcomes
    • Jumping to conclusions – founder Dr. David Burns described this thought distortion as “you interpret things negatively without facts to support your conclusion.” There are two different kinds of “jumping to conclusions.” Mind reading occurs when you assume someone is reacting negatively to you without any evidence.  Fortune telling involves predicting that an event will turn out badly. 
    • Magnification – This refers to making problems out to be much more than they are.  This distortion is also known as “catastrophizing.” 
    • Emotional reasoning – Assuming unrealistic and negative emotions represent reality
    • Should statement – Telling yourselves things should be different than the way they are “I shouldn’t get stuck in traffic” or “the train shouldn’t be late.” These are all forms of resisting reality.  Another form of a should statement involves self-directed should like “I should go to the gym.”
    • Labeling – Using emotionally charged language like “I’m such a jerk.”
    • Personalization and blame – Blaming yourself for something that was not entirely your fault.
    CBT triangle- the connection between thoughts feelings and behavior
    The CBT Triangle: The Connection Between Thoughts, Feelings, And Behavior

    CBT Strategies

    Examine the evidence – This strategy aims to facilitate a move past subjective experience to consider what can be objectively known about a situation.

    The double standard method – Next time you have a self-critical thought, ask yourself if you would say the same thing to a friend or loved one.

    The experimental technique – The goal with this strategy is testing unrealistic, negative thoughts.  Once a patient sees that their negative thoughts are not representative of reality and are overly negative and unrealistic, it becomes easier for them to be replaced with a healthier, more realistic alternative. 

    Thinking in shades of grey – This strategy illuminates the middle group and helps patients move beyond all or nothing thinking.  With this strategy, you remind yourself that things are rarely 0% or 100% but are usually somewhere in the middle.

    The survey method – Asking others directly for feedback instead of assuming you know what they are thinking is an excellent CBT behavior strategy to combat “mind-reading.”

    The semantic method – Instead of saying to yourself, “I should go to the gym,” try, “It would be beneficial for me to go to the gym.” A lot of times, this subtle shift is enough to take the pressure off. 

    Reattribution – this one focuses on personalization and blame.  In this strategy, the patient “reattributes” the cause of a problem away from the “patients badness.” 

    Cost-benefit analysis – This one is a bit different.  It focuses on the motivation behind negative thoughts/behaviors, prompting the patient to think, “how is this negative thought/behavior helpful to me?  Is there some hidden pay off like getting attention from others that this thought is tied to?”

    Benefits of CBT

    • It treats a wide variety of mental health illnesses and mood disorders
    • Cognitive Behavior Therapy works quick, often getting results within several weeks
    • Cognitive Behavior Therapy is intuitive and easy to grasp
    • Many of the techniques in CBT offer immediate relief

    In Closing

    Wellness Center New Jersey provides outpatient mental health and substance abuse treatment in Cliffside Park, NJ.  If we can be of assistance, please reach out via our phone number 201-945-2905 or contact form.  You may also wish to contact one of our primary therapists, which you can do at this E-mail: mentalhealthwellnessnj@gmail.com

    Citations

    1. Dutra L, Stathopoulou G, Basden SL, Leyro TM, Powers MB, Otto MW. A meta-analytic review of psychosocial interventions for substance use disorders. The American Journal of Psychiatry. 2008;165:179–187
    2. Gould RA, Mueser KT, Bolton E, Mays V, Goff D. Cognitive therapy for psychosis in schizophrenia: An effect size analysis. Schizophrenia Research. 2001;48:335–342. [PubMed] [Google Scholar]
    3. van Straten A, Geraedts A, Verdonck-de Leeuw I, Andersson G, Cuijpers P. Psychological treatment of depressive symptoms in patients with medical disorders: a meta-analysis. J Psychosom Res. 2010 Jul;69(1):23-32. doi: 10.1016/j.jpsychores.2010.01.019. Epub 2010 Mar 16. PMID: 20630260.
    4. Gregory VL Jr. Cognitive-behavioral therapy for depression in bipolar disorder: a meta-analysis. J Evid Based Soc Work. 2010 Jul;7(4):269-79. doi: 10.1080/15433710903176088. PMID: 20799127.
    5. Hofmann SG, Smits JA. Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. J Clin Psychiatry. 2008 Apr;69(4):621-32. doi: 10.4088/jcp.v69n0415. PMID: 18363421; PMCID: PMC2409267.
    6. Taylor S, Asmundson GJG, Coons MJ. Current directions in the treatment of hypochondriasis. Journal of Cognitive Psychotherapy. 2005;19:285–304.
    7. Thompson-Brenner HJ. Implications for the treatment of bulimia nervosa: A meta-analysis of efficacy trials and a naturalistic study of treatment in the community. Michigan: University of Michigan; 2002.
    8. Okajima I, Komada Y, Inoue Y. A meta-analysis on the treatment effectiveness of cognitive behavioral therapy for primary insomnia. Sleep and Biological Rhythms. 2011;9:24–34. [Google Scholar] [Ref list]
    9. Leichsenring F, Leibing E. The effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders: a meta-analysis. Am J Psychiatry. 2003 Jul;160(7):1223-32. doi: 10.1176/appi.ajp.160.7.1223. PMID: 12832233.
    10. Del Vecchio T, O’Leary KD. Effectiveness of anger treatments for specific anger problems: a meta-analytic review. Clin Psychol Rev. 2004 Mar;24(1):15-34. doi: 10.1016/j.cpr.2003.09.006. PMID: 14992805.
    11. Ipser JC, Sander C, Stein DJ. Pharmacotherapy and psychotherapy for body dysmorphic disorder. Cochrane Database Syst Rev. 2009 Jan 21;2009(1):CD005332. doi: 10.1002/14651858.CD005332.pub2. PMID: 19160252; PMCID: PMC7159283.
    12. van der Klink JJ, Blonk RW, Schene AH, van Dijk FJ. The benefits of interventions for work-related stress. Am J Public Health. 2001 Feb;91(2):270-6. doi: 10.2105/ajph.91.2.270. PMID: 11211637; PMCID: PMC1446543.
    13. Luckett T, Britton B, Clover K, Rankin NM. Evidence for interventions to improve psychological outcomes in people with head and neck cancer: a systematic review of the literature. Support Care Cancer. 2011 Jul;19(7):871-81. doi: 10.1007/s00520-011-1119-7. Epub 2011 Mar 4. PMID: 21369722.
    14. Malouff JM, Thorsteinsson EB, Rooke SE, Bhullar N, Schutte NS. Efficacy of cognitive behavioral therapy for chronic fatigue syndrome: a meta-analysis. Clin Psychol Rev. 2008 Jun;28(5):736-45. doi: 10.1016/j.cpr.2007.10.004. Epub 2007 Nov 1. PMID: 18060672.
    15. Sockol LE, Epperson CN, Barber JP. A meta-analysis of treatments for perinatal depression. Clin Psychol Rev. 2011 Jul;31(5):839-49. doi: 10.1016/j.cpr.2011.03.009. Epub 2011 Mar 27. PMID: 21545782; PMCID: PMC4108991.
    16. Santacruz I, Orgilés M, Rosa AI, Sánchez-Meca J, Méndez X, Olivares J. Generalized anxiety, separation anxiety and school phobia: The predominance of cognitive-behavioural therapy / Ansiedad generalizada, ansiedad por separación y fobia escolar: el predominio de la terapia cognitivo-conductual. Behavioral Psychology/Psicología Conductual. 2002;10(3):503–521.

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