A Guide to Cognitive Behavioral Therapy
Generally considered to be the gold standard of therapeutic counseling methods, cognitive behavioral therapy (CBT) aims to help clients cope with many of life’s hurdles in real time. CBT is well-known for offering clients coping strategies that work well outside of the therapy room.
Based on the observation that our feelings and emotions are attached to our thoughts, CBT works primarily through a comprehensive (yet intuitive) process known as thought replacement. This involves the identification, evaluation, and replacement of negative thoughts—thoughts that produce the unpleasant feelings that may have ultimately driven the client to seek counseling in the first place.
What Is Cognitive Behavioral Therapy (CBT)?
Cognitive behavioral therapy (CBT) is a psychotherapeutic treatment that helps clients learn how to identify, question, and replace their negative thoughts and behaviors as they arise. Therapists employ this method to help individuals learn to better manage their experiences, interactions, and inner dialogue as they face personal obstacles outside of therapy. Common challenges that CBT can help to improve include:
- Dysfunctional romantic relationships
- Family issues
- Oppositional defiant disorder
- Drug and alcohol abuse or addiction
- Eating disorders
- Anxiety disorders
- And many other mental health conditions or situations
What Is the Main Goal of CBT?
The primary goal of CBT is to provide clients with the tools they need to alter their behavior through learning to recognize and replace their harmful thought patterns. Additionally, CBT techniques can help clients learn to remain aware of the detrimental effects caused by negative thoughts. Through CBT, clients can learn to:
- Identify harmful thoughts and negative emotions when they arise
- Challenge the accuracy and usefulness of these negative headspaces
- Replace these negative feelings and thoughts with positive ones
- Helps clients practice putting “therapy in motion”
The foundation of CBT is built on the principle that, while we aren’t always aware of the impact of our thoughts, we can be coached into identifying them and replacing them when they aren’t psychologically beneficial, or negative.
Who Benefits the Most from CBT?
Anyone can benefit from seeking CBT. However, it may be most helpful to those who have specific problems they would like and need to address. Some of the specific problems that CBT can help clients manage include:
- Depression: Among many other elements, depression is primarily characterized by down moods and negative thought patterns. CBT works by targeting this negativity and introducing new coping strategies that help the individual deal with everyday challenges.
- Anxiety: There are a variety of anxiety disorders including generalized anxiety disorder, social anxiety disorder, and post-traumatic stress disorder. Nerves and uneasiness are at the center of each of these disorders. And distorted thoughts—or those cognitive distortions we talked about earlier—can make them even worse. CBT, 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 great risk of relapsing. CBT focuses on improving the client’s life in many ways in addition to just getting sober. This will further motivate them to stay away from the substance and lead a healthy, happy life.
Sometimes, a combination of CBT and interpersonal therapy, or another form of treatment proves to be most effective.
CBT creates real and lasting change. It can significantly reduce the symptoms of emotional disorders, as proven through clinical trials. And it can prove just as effective as medication in individuals struggling with anxiety or depression. Furthermore, its benefits carry on even after the individual finishes therapy.
What Does a CBT Session Look Like?
In CBT sessions, a therapist will generally work with their client to first help them identify, understand, and change their harmful attitudes and behaviors, which they may not be fully aware of.
As the therapeutic process progresses, clients will begin to adopt new and more effective ways of coping with situations and relationships outside of sessions. By the end of the therapy process, a client will hopefully have learned the coping skills needed to better manage their mental health conditions or other challenges.
One distinguishing factor of CBT is that it’s typically a short-term commitment in comparison to other methods such as psychodynamic therapy. While everyone’s mental health needs are different, generally CBT may last up to 5 to 10 months, the point at which some clients’ emotional problems may begin to resolve or improve substantially.
Sessions often average 50 minutes and may occur weekly, or on a bi-weekly basis. In CBT sessions:
- The client and their therapist work together to identify the underlying problems and solutions
- The therapist creates a comfortable, mutual relationship that’s built on trust and shared understanding
- A client and their therapist will set goals to achieve together; these goals may include achieving healthier communication in a relationship
What Are Cognitive Distortions?
CBT is based on the idea that negative thinking, or cognitive distortions, are at the root of our mental health challenges and personal issues. It’s not about the events or thoughts themselves—it’s about how we look at them.
For example, an anxious client who hasn’t heard from her friend in a week may automatically assume that her friend is angry at her. She might worry nonstop until she hears from him or her. This is an example of overgeneralization, a type of cognitive distortion that can be addressed and resolved through CBT.
In CBT sessions, a therapist can help a client who’s overgeneralizing to recognize her negative thinking and develop a better approach to her problem. For example, she could be proactive and call him at the onset of her worry, instead of waiting anxiously for him to call.
In addition to overgeneralizing and jumping to conclusions, many other forms of cognitive distortion reinforce our negativity. These include:
- Polarized thinking: “black and white thinking,” whereas we think in extremes. A person, event, or situation is either horrible or fantastic; perfect, or entirely worthless.
- Filtering: This happens when we place a heavy focus on the negatives and ignore the positives.
- Blaming: Occurs when we simply place blame on ourselves or others for every bad thing that happens.
- Catastrophizing: Also known as “magnifying or minimizing,”. This cognitive distortion 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: in which we measure every situation on a scale of fairness, which often leads to disappointment or objection.
- Personalization: in which individuals take everything personally; they assume that others’ actions are direct reflections of their feelings toward them.
Correcting these cognitive distortions can help with day-to-day problem-solving. It is also an important part of CBT, which — as we said earlier — can effectively treat many conditions including anxiety and depression.
What’s the Difference Between Dialectal Behavioral Therapy (DBT) and CBT?
Dialectal behavioral therapy (DBT) is a separate therapeutic method that employs certain CBT techniques to help clients experience personal growth. DBT is:
- The preferred treatment method for those with borderline personality disorder
- Focused on distress tolerance, building a client’s resiliency to negative situations or difficult people
- DBT focuses primarily on helping clients to talk through their issues, as opposed to controlling their inner dialogue
3 Common CBT Techniques
CBT techniques help clients to recognize their irrational thinking and correct it. Over time, these individuals will start to notice a pattern in their negative thinking. They will begin to reframe it to reflect reality instead of their false distortions.
- The Three-Column Technique: The client 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. Second, they must identify their 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. This client may write something like, “I missed a deadline, but it’s okay. Nobody’s perfect and I will make up the work.”
- Journal or diary work: A therapist may assign his or her client the task of keeping a journal. The entries to come may reveal a vital part of the healing process for the client. Then, later in treatment, a therapist may assign other exercises or tasks related to coping and changing behavior based on insights gained from these entries.
- Five-step problem-solving: Clients will encounter real-life scenarios that will test what they’ve learned in CBT. Being able to actively work through obstacles is crucial to long-term success after ending CBT. Five-step problem-solving involves the client: 1) Recognizing the issue—perhaps an argument, for example. 2) Creating a list of possible solutions (Walking away to cool off, withholding inflammatory words, recognizing the other person’s perspective). 3) Determining which possible remedy fits best. 4) Choosing a solution. 5) Putting that solution into practice.
How Does CBT Work?
When discussing the subject of therapy, one may picture an individual talking and a therapist exclusively listening. But that is not the case in CBT, a mutual and equal relationship is established. The individual 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 work on:
- Tackling these issues
- Exploring possible fixes
- Identifying effective coping skills
- Creating healthy thinking/behavioral patterns
The therapeutic process doesn’t stop with these sessions. The client is often assigned homework between sessions, which will aid the two in identifying triggers or negative patterns. It can also help them determine effective ways for handling them. This structure is crucial to the success of CBT. The steady progress makes for lasting effects, allowing the individual to continue the efforts alone, outside of therapy.