Many have asked me what is CBT and DBT is. CBT is Cognitive behavioral therapy. I will share more on DBT (Dialectical Behavior Therapy) in another post. So here goes a comprehensive explanation. CBT is a form of psychotherapy. It was originally designed to treat depression, but is now used for a number of mental disorders.
It works to solve current problems and change unhelpful thinking and behavior. The name refers to behavior therapy, cognitive therapy, and therapy based upon a combination of basic behavioral and cognitive principles. Most therapists working with patients dealing with anxiety and depression use a blend of cognitive and behavioral therapy. This technique acknowledges that there may be behaviors that cannot be controlled through rational thought, but rather emerge based on prior conditioning from the environment and other external and/or internal stimuli. CBT is “problem focused” (undertaken for specific problems) and “action oriented” (therapist tries to assist the client in selecting specific strategies to help address those problems),or directive in its therapeutic approach. It is different from the more traditional, psychoanalytical approach, where therapists look for the unconscious meaning behind the behaviors and then diagnose the patient. Instead, behaviorists believe that disorders, such as depression, have to do with the relationship between a feared stimulus and an avoidance response, resulting in a conditioned fear, much like Ivan Pavlov. Cognitive therapists believed that conscious thoughts could influence a person’s behavior all on its own. Ultimately, the two theories were combined to create what is now known as cognitive behavioral therapy.
CBT is effective for a variety of conditions, including mood, anxiety, personality, eating, addiction, dependence, tic, and psychotic disorders. Many CBT treatment programs have been evaluated for symptom-based diagnoses and been favored over approaches such as psychodynamic treatments.
Mainstream cognitive behavioral therapy assumes that changing maladaptive thinking leads to change in affect and behavior, but recent variants emphasize changes in one’s relationship to maladaptive thinking rather than changes in thinking itself. The goal of Cognitive Behavioral Therapy is not to diagnose a person with a particular disease, but to look at them as a whole and decide what needs to be fixed.
The basic steps in a Cognitive-Behavioral Assessment include
Step 1: Identify critical behaviors
Step 2: Determine whether critical behaviors are excesses or deficits
Step 3: Evaluate critical behaviors for frequency, duration, or intensity (obtain a baseline)
Step 4: If excess, attempt to decrease frequency, duration, or intensity of behaviors; if deficits, attempt to increase behaviors.
These steps are based on a system created by Kanfer and Saslow. After identifying the behaviors that need changing, whether they be in excess or deficit, and treatment has occurred, the psychologist must identify whether or not the intervention succeeded. For example, “If the goal was to decrease the behavior, then there should be a decrease relative to the baseline. If the critical behavior remains at or above the baseline, then the intervention has failed.”
Therapists or computer-based programs use CBT techniques to help individuals challenge their patterns and beliefs and replace “errors in thinking such as overgeneralizing, magnifying negatives, minimizing positives and catastrophizing” with “more realistic and effective thoughts, thus decreasing emotional distress and self-defeating behavior.” These errors in thinking are known as cognitive distortions. Cognitive distortions can be either a pseudo- discrimination belief or an over-generalization of something. CBT techniques may also be used to help individuals take a more open, mindful, and aware posture toward them so as to diminish their impact. Mainstream CBT helps individuals replace “maladaptive… coping skills, cognitions, emotions and behaviors with more adaptive ones”, by challenging an individual’s way of thinking and the way that they react to certain habits or behaviors, but there is still controversy about the degree to which these traditional cognitive elements account for the effects seen with CBT over and above the earlier behavioral elements such as exposure and skills training.
Modern forms of CBT include a number of diverse but related techniques such as exposure therapy, stress inoculation training, cognitive processing therapy, cognitive therapy, relaxation training, dialectical behavior therapy, and acceptance and commitment therapy. Some practitioners promote a form of mindful cognitive therapy which includes a greater emphasis on self-awareness as part of the therapeutic process.
CBT has six phases:
- Assessment or psychological assessment;
- Skills acquisition;
- Skills consolidation and application training;
- Generalization and maintenance;
- Post-treatment assessment follow-up.
The reconceptualization phase makes up much of the “cognitive” portion of CBT. A summary of modern CBT approaches is given by Hofmann.
There are different protocols for delivering cognitive behavioral therapy, with important similarities among them. Use of the term CBT may refer to different interventions, including “self-instructions (e.g. distraction, imagery, motivational self-talk), relaxation and/or biofeedback, development of adaptive coping strategies (e.g. minimizing negative or self-defeating thoughts), changing maladaptive beliefs about pain, and goal setting”. Treatment is sometimes manualized, with brief, direct, and time-limited treatments for individual psychological disorders that are specific technique-driven. CBT is used in both individual and group settings, and the techniques are often adapted for self-help applications. Some clinicians and researchers are cognitively oriented (e.g. cognitive restructuring), while others are more behaviorally oriented (e.g. in vivo exposure therapy). Interventions such as imaginal exposure therapy combine both approaches.