Cognitive behavioral therapy (CBT) is a form of psychotherapy treatment which focuses on changing one’s negative thinking and/or behavioral patterns that lie behind their difficulties. These may be sleep or relationship difficulties, issues with drug abuse, alcohol dependence, or anxiety and depression. It works by first helping an individual to identify, understand, and then change their harmful attitudes and behavior; the patient ultimately adapts new, more effective ways of dealing with their hardships.
A distinguishing factor and advantage of cognitive behavioral therapy is that it is typically short-term—it usually takes around 5 to 10 months for most emotional problems to resolve or improve substantially, with patients attending just one 50-minute session weekly. In these sessions, the patient and therapist work together to identify underlying problems and come up with new ways to approach them; here, the therapist is on the same level as the patient, which takes pressure off of the individual and creates a comfortable, mutual relationship.
The History Behind Cognitive Behavioral Therapy
Cognitive behavioral therapy came about in the 1960s, after psychiatrist Aaron Beck discovered his depressed patients to have internal dialogue—it was like they were having a conversation in their head, but they only revealed part of this conversation or thought process to him. This led Beck to realize that the link between thoughts and feelings is extremely significant and to create the term “automatic thoughts,” which describes emotional thoughts that exist in one’s mind. He found that while we aren’t always aware of these thoughts, we could be coached into identifying them. This discovery then led to his groundbreaking finding that targeting negative thoughts is crucial to his patients successfully overcoming their difficulties—hence the backbone of cognitive behavioral therapy.
To communicate the importance of thinking in its very name, Beck called his creation cognitive therapy. Today it is known as cognitive behavioral therapy because there is now a focus on behavioral change and techniques as well. This balance between cognitive and behavioral foundations differs across the realm of CBT types, but the importance of both elements is stressed.
The Role of Cognitive Distortions
Cognitive behavioral therapy is based on the ideation that negative thinking or cognitive distortion is at the root of our issues—it’s not about the events themselves, but how we look at them. Take for example: An overly anxious individual named Jill hasn’t heard from her friend in a week. Instead of considering that maybe her friend has simply been caught up at work, Jill jumps to the conclusion that he is angry with her and worries nonstop until she hears from him. This is an example of jumping to conclusions, a type of cognitive distortion or example of negative thinking. In cognitive behavioral therapy, Jill’s therapist would help her realize this negative thinking pattern and develop a better way to approach the problem at hand. Perhaps she could be proactive and call him at the onset of her worry, instead of waiting anxiously for him to call and expecting the worst.
In addition to jumping to conclusions, there are many other forms of cognitive distortion that reinforce our negativity and are confronted in cognitive behavioral therapy. These include:
- Polarized thinking, or “black and white thinking,” whereas we think in extremes; something is either horrible or fantastic, perfect or worthless
- Filtering, in which we place a heavy focus on the negatives and ignore the positives of any given situation
- Blaming, whereas we simply place blame on ourselves or others for every bad thing that happens
- Overgeneralization, as characterized by one’s assumptions and conclusions based on small factors or events
- Catastrophizing, also known as “magnifying or minimizing,” is summed up as someone expecting the worst
- Emotional reasoning, in which we assume our feelings must be true, despite a lack of facts or evidence
- Control fallacies, whereas we feel either externally controlled (e.g., by fate or luck) or internally controlled (directly responsible)
- Fairness fallacy, as demonstrated by those who measure every situation on their scale of fairness, which often leads to their disappointment and/or objection
- Personalization, in which individuals take everything personally; they assume that others’ actions are direct reflections of their feelings toward them
The Three-Column Technique: A Strategy of CBT
In order to diminish their patients’ cognitive distortions and teach them to think more positively, cognitive behavioral therapists often utilize something called the three-column technique. The patient first folds a piece of paper vertically into three different columns. They’re then instructed to write down their negative thoughts in the first column; for example, one may write “I’m a total failure” after missing a deadline at work. Then, they must identify their irrational thinking or cognitive distortion in the second column, which in this case would be polarized thinking. And in the third column, they are to correct their thinking based on facts, not negativity or pessimism. So, this patient may write something like, “I missed a deadline, but it’s okay; nobody’s perfect and I will make up the work.”
This technique is so important and effective because it forces the patient to recognize their irrational thinking and correct it. Over time, these individuals will start to notice a pattern in their negative thinking and begin to reframe it to reflect reality instead of their distortions.
The Therapist-Client Relationship
When discussing the subject of therapy, one may picture a patient talking and a therapist exclusively listening. But that is not the case in cognitive behavioral therapy; again, a mutual and equal relationship is established. So, the patient first explains what kind of problems they are having and what they would like to see improve; these then become the outline for discussions during each session. Each week, they will make more and more progress as they collectively tackle these issues, possible fixes, and healthy thinking/behavioral patterns.
The therapeutic process doesn’t stop with these sessions—the patient is often assigned homework between two sessions, which will aid the two in identifying triggers or negative patterns (thinking or behavioral), as well as determine ways to better handle them. For example, a therapist may assign his or her patient the task of keeping a diary. The entries to come may reveal a vital part to the healing process for the patient. Then, later in treatment, a therapist may assign other exercises or tasks related to coping and changing behavior.
This structure is crucial to the success of cognitive behavioral therapy: the steady progress makes for lasting effects and the mutual relationship allows the patient to eventually continue the efforts alone, once the sessions have concluded.
Who Can Benefit from Cognitive Behavioral Therapy?
Just about anybody could benefit from cognitive behavioral therapy, but it may be most helpful to those who have specific problems they would like and need to address. It may be more difficult for those with vague feelings of unhappiness or discontent because there is such a heavy focus on targeting particular thoughts and behaviors. Here’s a short list of problems cognitive behavioral therapy can help and how it does so:
Among many other elements, depression is primarily characterized by down moods and negative thought patterns. Cognitive behavioral therapy, therefore, works by targeting this negativity and introducing new coping strategies that help an individual deal with everyday issues. Their mood changes as correlated with different activities, may also be recorded, which helps the patient understand what events they find enjoyable and what they don’t; they can then start to prioritize the beneficial activities and decrease the frequency of unpleasant ones.
There are a variety of anxiety disorders, from general anxiety disorder to social anxiety disorder to post-traumatic disorder, all of which have nerves and uneasiness at the center. And distorted thoughts—or those cognitive distortions we talked about earlier—can make them even worse. Cognitive behavioral therapy, however, can remedy the effects by targeting negative thoughts and teaching clients new, healthier patterns.
Alcohol Abuse and Addiction
Alcohol abuse and addiction are tricky issues, as sufferers are at a great risk of relapsing (such that they improve and then worsen). Cognitive behavioral therapy, therefore, focuses on improving the patient’s life in a multitude of ways in addition to just getting sober, as this will further motivate them to stay away from the substance and lead a healthy, happy life.
In addition to depression, anxiety, and addiction, cognitive behavioral therapy has also proven to treat and alleviate anger management, mood swings, obsessive-compulsive disorder (OCD), relationship issues, and so many more. It creates real and lasting change for its patients; it can significantly reduce the symptoms of emotional disorders, as proven through clinical trials; and it can provide just as effective results as medication in individuals struggling with anxiety or depression. Furthermore, its benefits carry on even after the patient finishes therapy.
Begin Cognitive Behavioral Therapy Today at Thriveworks
Sometimes we need a little extra help and guidance in life. If you think you could benefit from professional mental health help, and you’re interested in giving cognitive behavioral therapy a go, reach out to Thriveworks. We will help you find healing through cognitive behavioral therapy, or another form of counseling you’re interested in exploring. Remember: you can thrive, and we can help. Click here to see a counselor or coach this week, if not within 24 hours. Additionally, check out our online counseling opportunities—you may find that this is the right approach to counseling for you.