Cognitive-behavioral therapy

**Cognitive-behavioral therapy** (**CBT**) is a type of psychotherapy which helps people change unhealthy thoughts and behaviors. Cognitive behavioral therapists teach their patients to use coping skills (healthy ways to deal with problems).  They also show their patients how their thoughts are sometimes not accurate.   These unhealthy thought patterns are called cognitive distortions.  CBT says that these inaccurate thoughts lead to unhealthy feelings and behaviors.  By changing these thoughts, patients can change how they feel and act.  CBT combines parts of cognitive therapy and behavior therapy.  Using this combination of therapies, CBT helps patients to identify problems in their lives and tries to help them feel better.

CBT is a common treatment for mood disorders.  It is popular because it works well, has a clear structure, and is based on common sense. Research shows that CBT works better than any other treatment for people with depression and anxiety. After completing 5 - 15 modules of CBT, 50 - 75% of people with depression and anxiety feel better.  Medication alone also works, but science still does not understand how these medications affect the brain and body over time.  Also, some evidence says that CBT costs less than medication in the long run.  However, when medication and CBT are used together, patients with mental illnesses get the best results.  In particular, antidepressants paired with CBT could prevent people with depression from getting depressed again in the future.

CBT can also treat personality disorders, post traumatic stress disorder and eating disorders.  Therapists can do CBT with a single patient, in a therapy group, or online.

## History

In the early 1900s, Austrian psychotherapist Alfred Adler suggested that therapists should pay attention to their patients’ cognitions (the way they think).  He talked about how making basic mistakes can make people feel bad.

Adler’s work inspired American psychologist Albert Ellis to develop rational emotive behaviour therapy in the 1950s.  This was one of the earliest forms of cognitive therapy.

In the 1950s and 1960s, American psychiatrist Aaron T. Beck developed a cognitive model of mental illness, which would later become a part of CBT.  This cognitive model says that people feel bad because of the way they think about an event, not the actual event itself.  While doing psychoanalysis, Beck noticed that his depressed patients had a lot of negative thoughts about themselves, the world, and the future.  They seemed like they were ‘talking’ to themselves in their thoughts.  However, they only shared some of these thoughts with Beck.  For example, a person might have thought to themselves, “The therapist is being very quiet today; I wonder if he’s mad at me?” and then began to feel anxious as a result.

In the 1960s, researchers did a number of scientific experiment<nowiki/>s to study how thoughts affect behaviours and emotions.  This period in the history of psychotherapy is called “the cognitive revolution,” or the “second wave” of CBT.

## How it works

CBT targets unhealthy thoughts and develops them into positive thinking patterns. CBT is scientific because irrational beliefs are thought of as theories which are tested to see if they are true. CBT is structured in that it uses an ABC format. A represents the activating event which triggers B, the beliefs. This is followed by C, the consequences, which are the actions. Beliefs are composed of different types of thinking. They include catastrophising where small problems are blown out of proportion and all-or-nothing thinking which involves thinking in extremes. When creating solutions, the therapist and patient need to come to an agreement on possible goals. They follow  criteria which are SMART: specific, measurable, achievable, realistic and time-limited. Specific and measurable highlight the science behind CBT as the goals are used to test the "hypothesis". Achievable, realistic and time-limited ensure that the patient makes progress.

## Techniques

One of the key reasons why CBT is so effective is because of its interactive nature. This is known as collaborative empiricism; the patient and therapist work together in targeting problems and changing negative mindsets.  This means that patients play an active role in improving their mental health which is different from other treatments. Therapists encourage patients to be active by setting them tasks. This may be noting down positive moments throughout their day or producing a list of things to complete. CBT combines cognitive and behavioural methods to maximise its effect. Therapists often set their patients homework which challenge their irrational beliefs. When patients feel down because of these beliefs, the therapist can produce this as evidence. An example of a behavioural method is that therapists help their patients to collect evidence that challenges the use of their avoidance behaviours.  The techniques aim to prepare people with the skills they need to target their problems independently in the future.

## Uses

Cognitive-behavior therapy can be effectively used as a short-term treatment centered on helping people with very specific problems and teaching them to focus on present thoughts and beliefs.

- Addictions
- Anger issues
- Anxiety
- Bipolar disorder
- Depression
- Eating disorders
- Panic attacks
- Personality disorders
- Phobias
- Problems with stress

## Why it's effective

CBT is  recommended because it is successful in changing the patient's way of thinking. It's effective because patients participate in improving their mental health. They are encouraged to be proactive by acting as their own therapist. Once the sessions are over, patients are left with the skills they need to manage their problems. It works because the patient and therapist develop a healthy relationship. It is built upon understanding, cooperation and empathy.  Therapists show patience when patients struggle to identify their negative thoughts or when adopting new coping mechanisms. Compromise is also a key element in this relationship, if a strategy is not working, they are willing to work together to find a better solution.  CBT focuses mainly on the present. It does not dive into the patient's past because CBT aims to improve the patient's current state of mind.

## Criticisms

Even though it is  popular, CBT has faced criticism.  CBT focuses on a patient’s thoughts and the problems they are having in their lives.  Critics say CBT does not look at the patient as a whole.  It ignores the patient’s past experiences.  Because they ignore the patient's past, therapists might not understand how the patient first developed negative thought patterns.  Ignoring the causes of these thought patterns can make it difficult to identify solutions.

CBT is an interactive therapy.  This can make it difficult for patients with mood disorders than can cause low energy, like depression.  Some of these patients might not have enough energy to do all the work required by CBT.

## Revisions

Since  CBT began several revisions and models have been made. One example is the Five Areas model. This was created because traditional CBT tends to use complex terms which may be unsuitable for some patients or colleagues who do not specialise in CBT. The Five Areas model aims to use language that can easily be understood. It is not a new approach. It is a revision of standard CBT. The Five Areas model specifically focuses on five key elements, hence the name. These are life situation, altered thinking, altered emotions, altered physical feelings and altered behaviour.

## Other websites

- Cognitive Therapy Today
- An Introduction to Cognitive Therapy & CBT
- CBT Podcasts (The Jove Institute)
- The Royal College of Psychiatrists' cognitive therapy leaflet
- REBT Network