is Cognitive-Behavioral Therapy?
As the name implies, Cognitive-Behavioral
Therapy is comprised of both cognitive and behavioral techniques.
The premise underlying a cognitive-behavioral orientation
is that difficulties in living, relationships, general health,
etc., have their origin in (and are maintained by) both cognitive
and behavioral factors.
cognitive strategies of Cognitive-Behavioral Therapy aim to
uncover the irrational and problematic thinking styles that
often accompany psychological distress. These strategies believe
that one's feelings are a direct extension of one's thoughts
i.e, how you think determines how you feel. Thus, the aim
of cognitive interventions is to challenge, and change, maladaptive,
The Behavioral techniques are also
central to Cognitive-Behavioral Therapy. These techniques
follow from the premise that maladaptive behaviors are learned,
and therefore be unlearned as well. Among the behavioral techniques
employed are training in both assertiveness and relaxation,
and gradual desensitization to feared objects. Behavioral
interventions have been demonstrated to be highly successful
in the treatment of a broad range of specific problems including
habits (nail-biting, hand- wringing, etc.), and bed-wetting,
as well as more non-specific generalized complaints such as
anxiety and/or depression.
together, the cognitive and behavioral strategies create a
balanced approach to understanding and treating common life-problems.
the case of a child reared in a family in which any kind of
conflict regularly resulted in physical punishmentadministered
by a parent. On the basis of this formative experience, the
individual in later life, perhaps in the context of a love
relationship, may react with undue fear and distress in the
face of minor conflicts. The reaction in this case may serve
as an obstacle to the development of a healthy fulfilling
relationship. By helping an individual to see this situation
and develop more effective coping techniques and communications
skills, the patient learns through experience that some conflict
can be tolerated in the context of a relationship without
extremely unpleasant consequences. It is a popular but false
notion that cognitive-behavior therapists are unconcerned
with an individual's life history. Historical events and relationships
oftentimes represent essential information in understanding
therapy essentially involves helping an individual think in
more effective ways.
opposed to more psychodynamic or psychoanalytic theories in
which feelings are viewed as primary and borne of formative
experiences, cognitive therapy holds that our feelings can
be modified by examining and changing our automatic thoughts
therapy (CBT) has become the preferred treatment for most
emotional and behavioral problems.
for which CBT should be the treatment of choice
> Depression and mood swings
> Shyness and social anxiety
> Panic attacks and phobias
> Obsessions and compulsions
> Chronic anxiety or worry
> Difficulty establishing or staying in relationships
> Problems with marriage or other relationships
you're already in
> Job, career or school difficulties
> Feeling "stressed out"
> Insufficient self-esteem (accepting or respecting
> Inadequate coping skills, or ill-chosen methods
> Shyness, passivity, procrastination and "passive
> Substance abuse, co-dependency and "enabling"
> Trouble keeping feelings such as anger, sadness,
fear, guilt, shame,
etc., within bounds
> Over-inhibition of feelings or expression
what is CBT? How does it work?
therapy helps you break the connections between troublesome
situations and your habitual reactions to them. Reactions
such as fear, depression or rage, and self-defeating or self-damaging
behavior. It also teaches you how to calm your mind and body,
so you can feel better, think more clearly, and make better
therapy teaches you how certain thinking patterns are causing
your symptoms - by giving you a distorted picture of what's
going on in your life, and making you feel anxious, depressed
or angry for no good reason, or provoking you into ill-chosen
combined into CBT, behavior therapy and cognitive therapy
provide you with very powerful tools for stopping your symptoms
and getting your life on a more satisfying track.
is active therapy
CBT, your therapist takes an active part in solving your problems.
He or she doesn't settle for just nodding wisely while you
carry the burden of finding the answers you came to therapy
will receive a thorough diagnostic workup at the beginning
of treatment - to make sure your needs and problems have been
pinpointed as well as possible.
many ways CBT resembles education, coaching or tutoring. Under
expert guidance, as a CBT client you will share in setting
treatment goals and in deciding which techniques work best
for you personally.
provides clear structure and focus to treatment. Unlike therapies
that easily drift off into interesting but unproductive side
trips, CBT sticks to the point and changes course only when
there are sound reasons for doing so.
a CBT client, you will take on valuable "homework"
assignments to speed your progress. These tasks - which are
developed as much as possible with your own active participation
- extend and multiply the results of the work done in your
else is different about CBT?
people coming for therapy need to change something in their
lives - whether it's the way they feel, the way they act,
or how other people treat them. CBT focuses on finding out
just what needs to be changed and what doesn't - and then
works for those targeted changes.
exploration of people's life histories is necessary and desirable
- if their current problems are closely tied to "unfinished
emotional business" from the past.
vs. present and future
on the past (and on dreams) can at times help explain a person's
difficulties. But these activities all too often do little
to actually overcome them. Instead, in CBT we aim at rapid
improvement in your feelings and moods, and early changes
in any self-defeating behavior you may be caught up in. As
you can see, CBT is more present-centered and forward-looking
than traditional therapies.
The most clinically-proven therapy
has been very thoroughly researched. In study after study,
it has been shown to be as effective as drugs n treating both
depression and anxiety.
particular, CBT has been shown to be better than drugs in
avoiding treatment failures and in preventing relapse after
the end of treatment. If you are concerned about your ability
to complete treatment and maintain your gains thereafter,
keep this in mind.
other type of psychotherapy has this kind of clinically-proven
about drug treatment?
is usually employed by itself, without psychiatric drugs.
For some people, however, drug treatment is needed to obtain
a partial reduction in symptoms before CBT can be fully effective.
Usually, though not always, it is preferable to try CBT alone
before prescribing medications. This is for several reasons:
addition, research studies have revealed these other facts
about drug treatment for depression:
CBT and well-chosen drugs, when each is used alone, are about
equally effective during the period of active treatment.
> Adding drug treatment to CBT is not likely to get
better results than using CBT alone (except in special cases
such as the one described above).
> Treatment failure is more likely when drugs are
used, typically because of side effects.
> Relapse after the end of treatment is more likely
when only drugs have been used. This is believed to be because
drugs, unlike CBT, do not encourage the development of valuable
coping and emotional management skills.
the research data comparing CBT with drugs in the treatment
of anxiety are somewhat less complete than they are in the
case of depression, the indications so far are that a similar
is usually brief
CBT patients are able to complete their treatment in just
a few weeks or months - even for problems that traditional
therapies often take years to resolve, or aren't able to resolve
for people with complex problems, or who are forced to live
in adverse conditions beyond their control, longer-term treatment
is also available.
often will I be seen?
answer to this question depends on your individual needs,
your insurance plan, and the way your own therapist prefers
a rule, however, most people can expect to begin their treatment
with weekly visits.
few - particularly if they are in crisis - may begin with
two or more sessions a week until their condition is stabilized
enough that they can safely come only once a week.
happens further on in treatment?
the answer depends on how you are progressing, and on your
therapist's and your own preferences. These are among the
options that are often recommended . . .
Individual sessions every other week or monthly, combined
with weekly group therapy meetings.
Individual sessions every other week or monthly, without participation
in group therapy.
A planned break of several weeks, followed by resumption of
weekly individual sessions for a period of time.
A trial termination of therapy - with the option of resuming
if the need develops. Quite often, a follow-up session or
phone contact is scheduled for a future date.
working hypothesis of cognitive therapy is that the best way
to solve emotional problems is to alter the patient's thinking.
This form of psychotherapy concentrates mainly on the way
people perceive the world and how they reason about it in
everyday situations. Various techniques are used to expose
and correct biased attention and recall, misinterpretation
of events and statements, false assumptions, rigid beliefs,
unjustified generalization, inferences based on insufficient
evidence, magnifying and minimizing, thinking in extremes
and absolutes, and other errors.
is still the chief indication for cognitive therapy. According
to the theory, depressed people interpret their experience
by schemes known as the depressive triad: I am worthless,
the world is hostile, and the future is hopeless. They blame
themselves for accidental misfortunes and explain events by
general and pervasive circumstances rather than temporary
and local ones. They believe the world makes unreasonable
demands on them and expect to fail at whatever they undertake.
The resulting loss of confidence and paralysis of will eventually
lead to chronic fatigue and other physical symptoms as well.
purpose of therapy is to make patients aware of their automatic
thoughts, schemes, and reasoning errors, then develop new
ways of thinking, test them, adjust them, and practice them.
Weekly therapeutic sessions are usually held for 3 to 5 months,
and sometimes followed by monthly sessions for as long as
a year. Goals are defined and procedures are established at
the start. A time limit is set to heighten the sense of urgency
and the patient's concentration. In early sessions the patient's
problems are defined and evaluated; in the middle sessions,
attention passes to automatic thoughts and thinking errors;
toward the end, patient and therapist work on schemes and
therapist brings automatic thoughts to light by discussing
situations that provoke anger, fear, guilt, doubt, and sadness.
Through questioning, patients are trained to identify these
thoughts so that their insignificance or unreasonableness
becomes obvious. Unlike obsessive ideas, automatic thoughts
often seem reasonable even if the patient has consciously
decided they are invalid. The patient is educated to ask repeatedly
"What is the evidence? Are you oversimplifying or taking
things out of context? Are there other explanations?"
For example, a depressed person who believes that his supervisor
at work considers him inadequate learns to tell himself that
the supervisor thinks that way about everyone, and that no
one else thinks he is inadequate.
therapist challenges thoughts that kill initiative ("Why
bother?"; "I don't have time"; "It's too
hard"). Patients learn to think in degrees and probabilities
rather than stark opposite alternatives -- not love or hate,
failure or success, but degrees of liking and dislike, achievement
and falling short.
is also used to correct thinking. Patients are asked to induce
images to distance themselves and test the reality of their
perceptions and fears. The imagery can be modified until the
fantasy becomes more realistic and less depressing or frightening.
Aaron T. Beck, A. John Rush, Brian F.
Shaw, and Gary Emery. Cognitive Therapy of Depression. New
York, Guilford Press, 1979.
T. Beck, Gary Emery, and Ruth L. Greenberg. Anxiety Disorders
and Phobias: A Cognitive Perspective. New York, Basic Books,
John Rush and Aaron T.Beck, eds. Cognitive Therapy. In Allen
J. Frances and Robert E. Hales, eds. Review of Psychiatry,
Vol. 7 Washington, D.C., American Psychiatric Press, 1988.