CBT Cognitive Behavioral Therapy

Understanding CBT

What is cognitive behavioural therapy?

A talking therapy that is sometimes referred to as an intervention, cognitive behavioural therapy is based on several psycho-social theories. Sometimes referred to as CBT for short, cognitive behavioural therapy aims to challenge people in their thoughts, especially ones that have become cognitively distorted in some way, either through habit, belief systems or erroneous attitudes. By talking about such thoughts and challenging them in a secure environment, therapists try to alter the way patients think which can often include attitudes to themselves. Cognitive behavioural therapy was first developed to help people suffering from chronic depression. Still, it has since been adapted to treat people with other mental health conditions, such as anxiety and even psychosis and bipolar disorder.

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 How does cognitive behavioural therapy work?

CBT works by making use of the principles that lie behind behavioural psychology and cognitive psychology, bringing both strands together. Although CBT therapists talk with their patients in confidence, the process of cognitive behavioural therapy differs quite a bit from psychoanalysis and psychotherapy because hidden meanings and deep interpretations are not sought during the sessions. Instead, the aim of a CBT therapist is to fix the patient's problems and take a more proactive approach by using evidence-based strategies based on the already diagnosed conditions. As such, this type of therapy is not used as a diagnostic tool but rather as a means of improving the mental health of patients.

Who developed cognitive behavioural therapy?

To some, the philosophical underpinning of cognitive behavioural therapy goes back to the stoic traditions of ancient Greece and Rome, with the beliefs that we could use logic to deal with any destructive beliefs and feelings. That being said, CBT started to really take off as an alternative to the already commonly used psychotherapies in the 1960s when the theoretical conditioning work of John B Watson and Rosalie Rayner, dating back to the 1920s, began to be read more widely. Early pioneers of CBT were Joseph Wolpe, who is considered one of the most influential people in the development of behavioural therapy, Julian Rotter and B. F. Skinner.

Where do cognitive behavioural therapists work?

You will find cognitive behavioural therapy being offered to patients in many of the mainstream healthcare situations nowadays. CBT has gone from being viewed as an alternative to psychotherapy to actually being one of the first types of treatment that professional clinicians will turn to when treating someone. As such, many hospitals these days will often have their own CBT therapists on-call working in-house. Others may be associated with doctors surgeries and clinics, moving from one to the next for their appointments. Private CBT therapists can work from any location they see fit so long as it offers privacy. Some have private treatment rooms or even work from their own home to provide consultations to their patients.

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Can cognitive behavioural therapy help with grief?

As previously mentioned, cognitive behavioural therapy is first and foremost used to help people with a range of psychological disorders and mental health problems. Numerous psychologists agree that CBT is also a powerful tool in helping people to get through the very complex process of grief. Although it does not claim to 'cure' grief as such, it can help people to cope with the way that it feels in the aftermath of a bereavement. Some people find that by attending cognitive behavioural therapy they feel more empowered in dealing with their loss, and notice that the therapy enhance their feeling of resilience, which can be powerful when grieving. Grief is a very personal journey and we all go through it in different ways, so it is important to find the right kind of support for you.

Where does CBT take place?

Cognitive behavioural therapy is primarily delivered as a psychotherapeutic service which means that your initial sessions will usually take place in a professional setting, such as a counsellor's or a therapist's room. Some people have a room in their home where they deliver such services, but it is more common in most Western countries for this to occur in a professionally rented space where a range of different services might be offered. In most cases, something in the region of ten sessions will be offered for a course of CBT – which is short by the standards of psychotherapy. However, people undergoing this sort of therapy will also be assigned so-called homework. In this sense, CBT takes place frequently between the formal sessions. These occur in the home of the person being treated as they apply the techniques they have learned in domestic situations, thereby reinforcing them.

How does cognitive behavioural therapy compare to dialectical behavioural therapy?

Dialectical behavioural therapy, or DBT as it is known, is based on cognitive behavioural therapy. However, whereas CBT is primarily focussed on changing the thought processes that underpin certain types of undesirable behaviour, DBT delves a little deeper insofar as it will also factor in emotional and social aspects of human behaviour. DBT was developed to help patients who have extreme emotional reactions to stimuli, perhaps because of extreme social behaviours they may have been exposed to and accepted as normal, and to put coping strategies in place. DBT will often take a longer time to be effective compared to CBT which is designed to offer a short-term solution. Furthermore, DBT tends to involve more group therapy compared to CBT which is primarily one-on-one and solo in its approach. DBT often seeks similar outcomes to CBT, but it deals with emotional management more than cognitive management.

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How does CBT help anxiety?

Because cognitive behavioural therapy is designed to help people think about the problems they face and to adjust their behaviours accordingly, it can be used successfully in the treatment of anxiety. When people start to feel anxious, it is usually not something that comes out of the blue. Rather, there are stimuli that lead to a certain habituated thought process that, in turn, lead to excessive amounts of worry and concern. The idea is to use the therapy to address the thought processes which have become such an unhelpful habit. Therefore, most therapists will expose their patients to the sort of things they become anxious over while encouraging them to remain mindful of their internal thought processes in reaction to them. In theory, over time, more mental control can be gained, which will dissipate feelings of anxiety. In this way, CBT can be deployed as a way of dealing with both irrational fears. Indeed, it can help people who have suffered severe trauma, which may have resulted in conditions like post-traumatic stress disorder.

When does CBT not work?

Cognitive behavioural therapies are not for everyone. Some people will have psychological disorders that require a more in-depth approach than the quick fix remedy that CBT can offer. For many people, of course, it works well and offers the desirable quick turn around. However, by focussing on thought processes, it will not be able to help people who have certain conditions for which no amount of positive thoughts or new modes of thinking could help. People who suffer from clinical depression because they have a physical imbalance of neuro-chemicals in their brain will not be suited to it, for example. Equally, various scientific research papers have said that it is not always effective in cases of schizophrenia and other serious mental disorders. In some cases, the therapy may not be as effective as patients might like simply because their therapist is insufficiently skilled or, more often, because they have not reinforced their new cognitive processes enough on their own.

Can CBT help with eating disorders?

Yes, it can. Cognitive behavioural therapists have been found to be more successful with a range of different eating disorders than other professionals. Certain studies have claimed that CBT is even more effective in this field than interpersonal psychotherapy sessions. At its heart, this type of therapy does not focus on food or eating but rather helps patients to think about their bodies and their appearance in a more positive manner, focusing on body positivity. Many – but not all – eating disorders have, at their core, a type of body dysmorphia which means people see themselves in a certain way. To account for this, they will adjust their diet, which, in turn, leads to an eating disorder. In the case of CBT, it is the thought processes that go on surrounding this view of oneself that is addressed, thereby leading to a more normalised dietary intake.

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What are the medical uses of CBT?

There are numerous uses of cognitive behavioural therapies in the field of medicine. Although it is not suited to all types of clinical depression, for example, it has certainly helped some people with anxiety and depression disorders. As previously mentioned, the therapy has a high success rate among people with eating disorders. Along with meta-cognitive training, it is often used to help people who are suffering from psychosis, too. In addition, this therapeutic approach has been found to be useful in dealing with unwanted addictive behaviours. Some people have found that it has been successful in helping them to give up smoking, for example. Others have used it to help them control their gambling addiction or to limit their time spent on social media. Recent research also suggests that it may be a useful tool in helping adults with autism spectrum disorder, as well.

What are cognitive distortions in CBT?

There are a few different cognitive distortions that a course of CBT will try to identify. In the main, these can be thought of as erroneous or self-destructive modes of thought. For example, if you receive a letter and think it will contain some terrible news or nasty comment about you even before you open it, then this would be considered a cognitive distortion, especially if it led to an unwanted behaviour, such as drinking excessively or arguing with those around you. Essentially, CBT tries to identify such thought processes and help patients to notice them when they occur so that the same behavioural patterns are avoided. In the main, cognitive distortions come down to being excessively negative, thinking about things in a generalised or prejudicial way or having thoughts that tend towards catastrophic outcomes rather than more realistic ones.

How is cognitive behavioural therapy sometimes criticised?

Some critics of the effectiveness of CBT will state that where it has been shown to be successful is within patient groups who would probably have responded well to any form of treatment. In other words, because it has a short-term, quick intervention model, it necessarily doesn't deal with the tougher cases, thereby artificially boosting its perceived success as a treatment. Furthermore, some people point out that despite its short-term nature, there is a relatively high drop-out rate among patients, something that is markedly different from many other sorts of psychological treatment. Equally, some clinicians have pointed out that its effectiveness is in decline and that outcomes today are not what they used to be when CBT first became popularised. Some also equate it to a kind of management culture that has been pervasive in the West for decades which deals with issues superficially but does not necessarily get to the heart of them.

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Cognitive behavioural therapy in summary

Overall, cognitive behavioural therapy should be seen as an overarching therapeutic approach that is based on multiple psycho-social theoretical models, something that means it is useful in a wide range of treatment applications. Although it is not suited to everyone, nor every kind of behavioural disorder, it has proven itself in many situations, notably in helping people to overcome – at least, in part – their eating disorders.

With CBT, the idea is that a therapist will help a patient to identify their unwelcome thought processes – known as cognitive distortions – and to see them for what they are. Consequently, they should be in a better position to deal with them when they occur in real-life situations outside of the therapy room and, therefore, to not behave in the same way as they have become accustomed to doing.

Although this form of therapy has many supporters – not least because it is quicker than many other approaches and, therefore, usually cheaper – some critics point out its limitations. These include what it cannot be used for as well as what it can. That said, it is highly likely that people will continue to use the treatment as a way of attempting to alter their behaviours. After all, if it is not successful, there are alternative treatment models available to try instead.

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