Cognitive-Behavioral Therapy

August 8, 2011

Cognitive-behavioral therapy (CBT) is a family of interventions used to help people recognize and overcome a wide variety of problems. It is based on the theory that how a person thinks about a situation affects how he/she feels about it and ultimately affects how he/she reacts or behaves as a result. The therapist teaches the person to recognize these cognitive distortions (“irrational thoughts”) and their result. Once the distortion is recognized, the person can restructure her/his thoughts and change the emotional and behavioral result.

For example, you are at home waiting for a friend to come over for dinner and he is an hour late. There are several ways you can think, feel, and react to this situation. You can think, “maybe he’s been in an accident.” If you think this, you may feel nervous or scared. As a result, you may bite your nails, pace, call all the hospital emergency rooms and the police to check for accident victims, or maybe ruminate to the point of getting a stomachache. When he does arrive, you may cry, hug him tight, and tell him how worried you were.

You can think “he’s blowing me off, he doesn’t care about me.” If you think this, you may feel angry. As a result, you may pace, call his house or office and leave nasty messages, or maybe tear up his picture or things he has given to you. When he does arrive, you may yell and scream at him, start a physical altercation, or slam the door in his face without giving him the opportunity to explain.

You can think “he’s with another girl, I’m not good enough, smart enough, pretty enough, etc.” If you think this, you may feel worthless or unsure of yourself. As a result, you may cry, make a mental list of all of your “faults,” or maybe even think no one will ever like you or want to be with you. When he does arrive, you may be quiet, distant, or even tell him he could do better.

You can think “he’s late, now I have some extra time to get something done until he gets here.” If you think this, you may feel content or even relieved that you have the extra time. When he does arrive, you may continue with your evening as planned and have a good time.

In each of these scenarios, you had “automatic, irrational thoughts” based only on conjecture and not based on fact.

Some people get confused and think Cognitive-behavioral therapy is trying to have people turn everything into a positive, “look for the silver lining.” Cognitive-behavioral therapy is more sophisticated than that. It teaches people to recognize the result of irrational thoughts and to change the thoughts, emotions, and resultant behaviors. In the above example, if your friend was late because he was inconsiderate and did not care that you were waiting, Cognitive-behavioral therapy may help you to see that this is not a reflection on you and your selfworth but more a function of his attitude and behaviors.

Cognitive-behavioral therapy is not one specific intervention but a family of interventions based on the underlying theory. You and your therapist will discuss your particular problems and tailor the intervention to address those needs. The interventions are geared at identifying the irrational thoughts and resultant problematic feelings and behaviors and then teaching you how to replace those with more healthy coping techniques.

Cognitive-behavioral therapy is short-term, structured therapy that involves active participation on both the therapists’ and the clients’ parts. Depending on the target problem, you may have as few as 2 or 3 sessions or up to 15-20 sessions. In addition, most Cognitive-behavioral therapy requires “homework” between sessions. The homework assignments are geared to practicing the skills learned in therapy by applying them to the “outside” world. The next therapy session will usually address the homework assignment and how it worked or did not work, reshaping the exercises, and trying again.

Cognitive-behavioral therapy has been shown to be effective in helping with a wide variety of problems. Issues such as depression, anxiety, phobias, and eating disorders as well as being nervous in public speaking, resolving issues that come up in adjusting to new situations (job, relocation, marriage, divorce, parenthood), and grief are all problems that can be helped with Cognitive-behavioral therapy interventions.

Cognitive-behavioral therapy has been subjected to the rigors of scientific research. Because of the structured nature of the interventions, it is particularly suited to being delivered consistently across therapists to be able to study its effectiveness. Studies have shown Cognitive-behavioral therapy to be as effective as medications in treating psychological problems and in some cases better than medication. The combination of Cognitive-behavioral therapy and medications is consistently helpful over medications alone.

As with any treatment, it will only work if you follow through on the therapy. Cognitive-behavioral therapy is an effective family of interventions that can make a significant, long-term impact on the lives of those who engage in it.

SEE ALSO: Anxiety disorders, Depression, Mood disorders

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