CBT stands for cognitive-behavioral therapy. It is an evidence-based treatment that can help with a variety of mental health issues. Today, it is one of the most widely used theories in psychotherapy.
Don’t miss the video toward the end of this article showcasing a mock CBT session. Let’s get into what you need to know and if this treatment could be right for you.
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History of CBT
Dr. Aaron Beck developed CBT in the 1960s. At the time, he was a psychiatrist working for the University of Pennsylvania. His original psychological work was rooted in psychoanalysis.
Beck began researching different ways to conceptualize depression. He discovered that many of his depressed patients experienced negative thoughts that appeared to happen automatically. He labeled these as “automatic thoughts.” He recognized that these thoughts fell into three distinct categories:
- Feeling negatively about oneself
- Feeling negatively about the world
- Feeling negatively about the future
He started supporting his patients in identifying and testing these automatic thoughts. Through this work, he found he could help them think more realistically. Once people started having more realistic thoughts, they felt better and made better behavioral choices.
In other words, Beck recognized the interconnectedness between thoughts, feelings, and behaviors. Since its inception, hundreds of studies have highlighted CBT’s efficacy. Today, it is one of the most popular methods for treating major issues like depression and anxiety.
Core Principles of CBT
CBT derives from numerous core principles, which include:
- Thoughts, feelings, and behaviors all reinforce one another.
- Thoughts are subjective and can be changed.
- Negative feelings often stem from unhelpful thinking patterns.
CBT focuses on raising awareness of unhelpful thinking patterns. These patterns are known as cognitive distortions. Some common examples of cognitive distortions include:
- Dichotomous thinking: You think only in extremes. Things are black or white. If you don’t do something perfectly, it means you have failed.
- Mental filtering: You ignore the positive aspects of a situation, and you only focus on the negatives. For example, if you have a performance review, you dwell on the one constructive criticism your supervisor gave you- and you disregard all the compliments.
- Overgeneralization: You make assumptions based on a single piece of evidence. If a girl broke up with you, you assume that no woman wants to date you.
- Personalization: You believe other people’s actions are personal to you. If someone is late to your party, you assume it’s because they don’t care about your feelings.
- Emotional reasoning: You mistake your feelings for facts. If you think you’re stupid, you assume you legitimately are stupid.
- Catastrophizing: You believe the worst outcome will happen. If you have a slight headache, you jump to assuming that you have a brain tumor.
- Control fallacies: You believe you either do (or do not) have control over particular situations. For example, you might think that, if only you hadn’t gotten into a fight with your mother that morning, she wouldn’t have been flustered and gotten into a car accident.
CBT practitioners help people explore their cognitive distortions. You will also discuss the maladaptive behaviors you use in response to these thoughts.
What Does CBT Treat?
CBT can treat a variety of issues, including:
- Eating disorders
- Communication problems
- Grief and loss
- Obsessive-compulsive disorders
- Substance abuse
- Low self-esteem
- Relationship problems
Many people engage in CBT as a standalone treatment. Some people participate in it in conjunction with other therapies or medication.
Common CBT Interventions
CBT provides action-based solutions for managing distress. Often, therapists maintain structured sessions and assign homework to keep patients on track. However, many people engage in CBT via a self-help approach. Let’s review some common CBT techniques.
Cognitive restructuring entails examining your cognitive distortions. For example, let’s say you struggle with depression. You also realize that you tend to catastrophize the future (you assume terrible things will happen). This cognitive distortion continues to make you feel depressed! Because you feel depressed, you withdraw from loved ones.
The cognitive restructuring aims to shift your thinking. You can do this by:
- Examining the evidence: On a scale from 0-100%, how certain are you that bad things will happen?
- Identifying exceptions: When have good or even neutral things happened even when you assumed the worst would happen?
By identifying a more realistic thought, your feelings may also improve. As a result, you may feel more motivated to engage in healthier coping skills.
Many people struggle to make time for self-care. They wait to be motivated, but that motivation doesn’t come. That’s why activity scheduling can be so effective. You learn to schedule these tasks in your daily life.
Activity scheduling can be as simple as jotting down a few good habits you want to maintain each week. For example, you might want to:
- Exercise for 30 minutes 3x a week
- Call your best friend
- Meditate for 10 minutes at least 2x a week
- Finish reading your new book
With a schedule, you would write down each of these activities and identify when you plan to do them. You might also rank how you feel before and after completing the activity.
Progressive Muscle Relaxation
Mindfulness is an important component of CBT. Mindfulness refers to making a conscious effort to stay in the present moment. The more you can practice this skill, the easier emotional regulation tends to be.
Progressive muscle relaxation includes tightening and releasing different body parts. To start, sit or lie down in a comfortable position. Close your eyes, and take a few deep breaths. Moving from head to toe, focus on tensing a specific group of muscles while you inhale for 3-5 counts. Relax them as you exhale. Repeat.
Guided relaxation is another well-known mindfulness exercise. In this technique, your therapist will read a meditative script to you. You may be asked to imagine different sights or sounds. You may also be asked to reflect on a specific word or phrase.
Guided relaxation can help reduce some of the negative thoughts or feelings you carry with you. It can teach you to bring yourself back to the present moment.
Role-plays can help people practice new social skills. For example, a therapist may use role-play to help someone needing support with setting a boundary. The therapist will pretend to play the other person, so the patient can rehearse what they intend to say.
Role-play exercises can reduce some of the anxiety associated with social interactions. It can also help patients increase mastery of certain social skills.
Exposure therapy can help people struggling with specific anxieties and phobias. In this work, people learn how to confront their fears by taking reasonable steps. You might create a fear hierarchy to identify these steps from easiest to hardest.
For example, you have an immense fear of flying, but you need to take a plane ride in the next few months. A fear hierarchy might include the following steps:
- Research flights online
- Book the reservation
- Pack your luggage
- Travel to the airport
- Check in for your flight
- Head to the departure area
- Board the plane
- Listen to the safety drill
- Take off/ascend
- Experience turbulence
- Experience plane maneuvering
- Begin descent
- Final approach
- Leave the plane
When it’s all written down, this list looks extensive. But it can help you check off each task as you complete it. Mastering each step can help desensitize you to your fears.
Journaling isn’t exclusive to CBT. However, many CBT practitioners recommend journaling as part of their treatment planning.
Many times, people are largely unaware of their thoughts and feelings. They move through the day without recognizing their triggers. As a result, their patterns may seem random and even surprising.
Journaling can help you identify trends and triggers in your daily routine. For example, you may notice that you start feeling the highest levels of stress once you leave work. But rather than decompress, you continue scrolling through your work email once you get home. This leaves you feeling anxious and frustrated. You hold onto thoughts related to, I’m so bad at my job.
By recognizing this pattern, you have the power to now change it. For instance, you might start listening to enjoyable music on your way home. You might make a rule to avoid checking work emails until the next morning. Or, you might practice shifting your thinking away from, I’m so bad at my job to, I’m doing the best I can, and that’s enough.
Is CBT Right For You?
CBT can be a fantastic resource for people struggling with negative thoughts or feelings. It can also be helpful if you want to start making better changes in your life.
CBT isn’t a quick fix. It requires dedication and commitment. Moreover, it is as effective as your willingness to participate. You need to play an active role in creating sustainable change.
It’s important to be honest with your therapist about your struggles. It’s also crucial to complete your homework and continue practicing the skills you’ve learned.
CBT tends to be a short-term therapy model. However, some people stay in therapy for several months or years. Additionally, some people participate in CBT along with other therapies or mental health treatments.
Are There Any Risks Of CBT?
Yes. All mental health treatment has risks and benefits. It’s essential to know these risks ahead of time.
CBT can feel uncomfortable. It’s challenging to confront your thoughts and feelings. It can be even more difficult to share them with another person, like a therapist.
Additionally, change is also scary. Learning new skills and putting them to practice takes work. You may have to confront your fears of failure.
Therapy often feels worse before it feels better. That’s because you’re increasing your awareness of subconscious issues. You’re gaining more insight into your patterns. At first, this insight can feel overwhelming and even discouraging.
However, most people report noting significant improvements if they stick with their treatment. Change does take time. Most people believe the time and effort are worth the positive outcome.
How Can You Find A CBT Therapist?
As mentioned, CBT is one of the most common treatments in mental health. Almost all practitioners know about CBT, and many of them integrate some or all of this theory into their practice.
There are a few ways to begin your therapist search:
- Check to see if your health insurance covers mental health treatment. If so, determine your deductible and any copays.
- Search for therapists online using a directory like Psychology Today or Good Therapy.
- Ask family or friends for a referral.
- See if your doctor has a referral.
Finding the right fit can be a process of trial-and-error. It’s important that you maintain an open mind.
Other Variations Of CBT
Today, CBT encompasses many other approaches. They are all rooted in using cognitive awareness to trigger change.
Acceptance and Commitment Therapy (ACT)
ACT focuses on accepting thoughts and feelings, rather than judging yourself for them. This method combines self-compassion with mindfulness. In being more tolerant of your mental state, you can start to feel better overall.
Dialectical Behavior Therapy (DBT)
DBT and CBT share many similarities. DBT focuses on core principles like mindfulness, emotional regulation, interpersonal skills, and distress tolerance. Rather than act impulsively, people learn how to manage challenging situations in healthier ways. DBT is often used as the first line of treatment for borderline personality disorder.
Rational Emotive Behavior Therapy (REBT)
Like CBT, REBT focuses on identifying self-defeating thoughts and feelings. REBT focuses on understanding how these thoughts cause current emotional distress. Once identifying these thoughts, you can change them into more productive ones.
Schema therapy blends parts of CBT, attachment theory, and psychoanalysis. Schemas refer to the unhelpful patterns people develop due to unmet needs. If untreated, these schemas can profoundly impact your well-being. Schema therapy teaches people how to work through these schemas to essentially reparent oneself.
CBT is an effective, evidence-based mode of psychotherapy that treats a variety of conditions. By learning how to change your thoughts, you can start to feel better about your life.