What is CBT – Cognitive Behavior Therapy?
Cognitive Behaviour Therapy is a type of short-term, result-oriented psychotherapy treatment module which focuses on changing faulty and inaccurate cognitive patterns of an individual to promote improved mental health. It is categorized as a psycho-social intervention since it takes into account the surrounding social factors into the picture when providing psychological help to the individual.
The core premise of CBT is that at times a person’s own distorted self-image, low self-esteem, pessimistic thinking etc could be fuelling chronic dissatisfaction and mental agony and gradually causing the person to become anxious or depressed. CBT aims to challenge these faulty behavioral and emotional patterns and help an individual develop healthy coping strategies.
CBT derives its principles from both behavioral psychology and cognitive psychology. Much different from its predecessor, psychoanalysis, CBT is more action and result-oriented approach. Instead of trying to delve deeper and deeper into the unconscious mind to find the root cause of any psychological disorder, as is done in psychoanalysis, CBT relies on treating specific symptoms associated with a particular mental disorder.
CBT has gained immense popularity in the domain of mental healthcare as it is more practical, clear, and realistic compared to other treatment modalities. The factor of common-sense associated with CBT is the biggest appeal of this therapy. Most psychotherapists out there practice CBT as the first and main method of treating and helping patients. Not to mention a plethora of self-help books out there have the guiding principles of CBT at the crux.
How does CBT work?
Cognitive behavioral therapy was founded by psychiatrist Aaron T. Beck during the 1960s. During that time, Beck was an instructor at the University of Pennsylvania where after years of study, he realized that intervening and addressing a patient’s distorted thinking patterns made the patient more aware of how their maladaptive thought patterns affected their behavior. After these negative thoughts were thoroughly evaluated and deemed faulty and inaccurate, the patient usually went on to make significant changes in their behavior.
CBT initially started as a synergistic combination of cognitive and behavioral therapy with the assumption that changes in maladaptive thinking patterns will lead to better behavioral and emotional response.
However, in recent times CBT has evolved to become a psychotherapy protocol that emphasizes more on changing one’s relationship to the faulty line of thinking rather than changing the maladaptive thought-process itself. Instead of pinpointing the mental disorder(s) a person suffers from, CBT is more about treating the person as a holistic being and understanding what particular areas of mental health can be improved.
These are the key guiding principles followed in CBT:
- Faulty or unhelpful thought-process is at least partly responsible for psychological issues
- These psychological issues can also be due to learned patterns of maladaptive behavior
- Individual with such psychological issues can learn better thinking patterns and improve their mental wellbeing manifold.
The main strategies used in CBT treatment sessions are:
- A patient can be made to realize his faulty thinking pattern and this will in turn help him/her re-evaluate them in realistic terms to understand the gap between the reality and his/her own distorted thinking.
- Provide in-depth understanding of positive behaviour and motivation of others
- Whenever there is a difficult or unfavourable situation, applying practical problem-solving skills to eliminate them.
- Having a greater sense of confidence and self-esteem in oneself and building a more optimistic thought process instead of getting surrounded by maladaptive thinking.
With the help of CBT, individuals can:
- Face one’s fears and apprehensions rather than being in denial or avoiding them
- Be prepared for any future potentially problematic interactions with people
- Learn healthy ways of calming one’s mind and coping with stress/anxiety.
What are the steps followed in CBT?
Though the exact approach might differ from patient to patient and also as per the therapist,but broadly-speaking these are the 6 basic steps followed in CBT:
– Complete psychological assessment of the patient
– Reconceptualization of the issue
– Acquirement of new skills
– Consolidation of skills and applying these in stressful situations
– Maintenance of the newly acquired coping skills
– Post CBT follow-up sessions and extended care
This framework, provided by Kanfer and Saslow, takes into account the problematic behaviour and thought patterns associated with it and what treatment/correction method would be required to mitigate these issues.
Reconceptualization of the issue refers to looking at the issues from a completely different perspective. This stage sheds new light on the same event that triggered stress/anxiety or any other mental agony and tries to re-approach the same issue with a more optimistic point-of-view. This change in perspective often helps the patient see things in new light and initiates a chain reaction of better outlook, improved confidence levels, and positive attitude.
These changes at the grassroot level in the psyche of the individual and how he/she views a particular problem or life in general is significant in treating the overall mental health condition, as per CBT.
CBT therapists also ensure that once an individual has identified the key maladaptive behavior or perspective, he/she is able to learn better coping mechanisms to handle them. And also, that the patient is able to apply this newly learned set of positive strategies across every problem faced by him/her.
Beyond that, CBT therapists also have the responsibility of post CBT treatment assessment of the patients and providing extended psychiatric help if required.
What are the different types of CBT?
Based on the demands of the situation and the level of urgency, there are different sub-modules of CBT practiced today:
BCBT or Brief Cognitive Behavior Therapy which is generally sought in cases where the urgency factor is high and there is no time for detailed sessions unlike classic CBT. It takes place over a couple of sessions and was initially designed to help curb the risk of suicide among mental health patients. Prevention of relapse of the initial suicidal behavior is the main aim in BCBT.
Cognitive Emotional Behavioral Therapy was initially developed for patients with eating disorders such as anorexia and bulimia but is now used in case of a wider scope psychiatric conditions such as anxiety and PTSD. This therapy primarily focuses on abnormal emotional responses to stressful conditions such as rage issues or distorted body-image (and thus a negative emotion towards eating). Patients are taught how to regulate these toxic emotional responses and deal with them better.
Structured Cognitive Behavior Training derives much of its principles and core philosophies from CBT but is implemented in a much more stringent and regimented manner. Also, unlike CBT, SCBT is a training period of finite duration and has specific goals assigned for specific duration of time. The main areas of application of this training are addiction treatment, substance abuse management, diabetes management, and even in the field of criminal psychology.
Moral Reconation Therapy is specifically built for training felons overcome traits of antisocial personality disorder and narcissistic behavioral tendencies that will ensure lower repeat offenses. It is widely practiced in correctional facilities.
Stress Inoculation Training is based on utilizing psychotherapy and humanistic training methods to pinpoint the stressors in the individual’s life and help him/her cope with stress and anxiety better. It occurs in 3 phases namely – self-monitoring of the patient, skill acquisition, and application of skills in stressful conditions.
Mindfulness based cognitive hypnotherapy is where the individual is trained to garner higher levels of awareness and reflective thinking by the help of hypnosis. It is designed to pinpoint subconscious tendencies and thoughts that might be at the core of faulty behaviour.
Unified protocol is a treatment approach that can be successfully applied to a wide spectrum of depressive and anxiety disorders. It includes psycho-education, cognitive re-appraisal, emotional regulation, and behavior transformation.
CBT : Medical and psychiatric applications
CBT’s wide-scale popularity is also partly due to its effectiveness in identifying and treating the following highly-prevalent and largely debilitating mental health conditions:
Depression: With more than 300 million reported cases worldwide, depression is one of the most widespread mental health conditions prevalent globally. CBT is a promising treatment modality for clinical depression. This in addition to interpersonal psychotherapy forms a potent combination for addressing issues of depressive disorders. As per CBT, patients of depression tend to acquire a negative schema of the external world and thus tend to develop depressive tendencies. CBT is a critical way of identifying such cognitive distortions that lean towards the negative side and help patients overcome the disorder effectively.
Anxiety Disorders: The way CBT helps anxiety disorder patients is that it exposes an individual to the event/object creating fear and panic, in a safe and controlled environment. As per proponents of CBT, by safe and repeated exposure to the toxic trigger, anxious traits can be unlearned.
Schizophrenia: Several studies have shown that CBT can be a powerful tool when combined with other treatment methods in bringing down the intensity of the symptoms of schizophrenia and also decrease the risk of relapse.
Prevention of mental illness: Patients of anxiety disorders have seen immense improvements in their condition by the help of CBT intervention. And studies have revealed that timely application of CBT can actually curb the risk of anxiety disorders taking other forms such as generalized anxiety disorder. It has been also observed that in 38% of cases CBT helped depressive tendencies from growing into major depressive disorders.
Prevention of gambling : Around 1-3% of the general population engages in gambling. If not controlled timely, the addiction of gambing can render serious repercussions. CBT can help compulsive gamblers develop stronger control over their gambling urges and also prevents the relapse of engaging in gambling activities.
Smoking Cessation: Nicotine addiction is one of the toughest addictions in the world to recover from. From the perspective of CBT, smoking and nicotine addiction are a type of learned behavior. Smokers usually indulge in the habit in order to handle day-to-day stress. CBT has proven ways to help smokers cope with stress and anxiety better and it also has modules that can help people stave off strong cravings upon withdrawal.
Substance abuse disorders: Substance abuse disorders are often an adverse effect of altered or maladaptive cognitive patterns. The cognitive biases that often exist in substance abusers are denial, minimization of harmful effects, and severely self-destructive thought processes. What CBT does here is that it helps patients form a healthier narrative for such maladaptive mentality and when combined with proper medications it can work wonders for rehabilitation of addiction patients.
Eating disorders: In case of eating disorders, CBT is proven to be a more effective treatment than medications and interpersonal psychotherapy alone CBT aims to combat major causes of distress such as negative cognitions surrounding body weight, shape and size. CBT therapists also work with individuals to regulate strong emotions and thoughts that lead to dangerous compensatory behaviors. CBT is the first line of treatment for Bulimia Nervosa, and Eating Disorder Non-Specific
Occupational stress: Work-related stress is a global problem with negative implications for individuals and society. Meta-analyses have found cognitive behavioral therapy (CBT) superior in reducing stress levels and psychological complaints among stressed workers compared to other types of intervention.
Internet Gaming Disorder: Internet Gaming Disorder, a subtype of Internet Addiction, is now classified in Section 3 of the DSM-5. Cognitive behavioral therapy (CBT) has been suggested in treating Internet addiction as this modality has been shown to be an effective treatment for similar impulse control disorders. Given the daily and necessary use of the Internet and technology in general compared to other compulsive syndromes, a specialized form of CBT has been developed called Cognitive-Behavioral Therapy for Internet Addiction (CBT-IA).
CBT : In a nutshell
CBT provides one of the best and most effective ways in empowering an individual with healthy coping mechanisms, the absence of which is believed to be a root cause in several widespread health conditions. CBT involves a therapist and an individual working together to understand the pattern of maladaptive thoughts and then gradually “unlearning” these faulty patterns in order to enhance mental well-being. However, it must be kept in mind that only a professional licensed psychotherapist or psychiatrist can recommend and provide this therapy. This pathbreaking assimilation of cognitive and behavioral psychology has changed the face of modern psychotherapy and helped millions across the globe unlearn maladaptive behaviour.
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