Cognitive-Behavioral Therapy
Cognitive Behavioral Therapy (CBT) is an empirically
supported treatment that focuses on patterns of thinking that
are maladaptive and the beliefs that underlie such thinking. For
example, a person who is depressed may have the belief, "I’m
worthless," and a person with a phobia may have the belief, "I
am in danger." While the person in distress likely holds such
beliefs with great conviction, with a therapist’s help, the
individual is encouraged to view such beliefs as hypotheses
rather than facts and to test out such beliefs by running
experiments. Furthermore, those in distress are encouraged to
monitor and log thoughts that pop into their minds (called
"automatic thoughts") in order to enable them to determine what
patterns of biases in thinking may exist and to develop more
adaptive alternatives to their thoughts. People who seek CBT can
expect their therapist to be active, problem-focused, and
goal-directed.
Studies of cognitive behavioral therapy have demonstrated its usefulness for a wide variety of
problems, including mood disorders, anxiety attacks, personality disorders,
eating disorders, substance abuse disorders, and psychotic disorders. While a
full description of the treatment and presenting problems for which it is useful
is beyond the scope of this brief overview, a brief summary of several
treatments will be presented.
CBT has been shown to be as useful as antidepressant medication for
individuals with depression and is superior in preventing relapse. Patients
receiving CBT for depression are encouraged to schedule activities in order to
increase the amount of pleasure they experience. In addition, depressed patients
learn how to restructure negative thought patterns in order to interpret their
environment in a less biased way. CBT for Bipolar Disorder is used as an adjunct
to medication treatment and focuses on psychoeducation about the disorder and
understanding cues and triggers for relapse. Studies indicate that patients who
receive CBT in addition to treatment with medication have better outcomes than
patients who do not receive cognitive behavioral therapy as an adjunctive treatment.
CBT is also a useful treatment for anxiety attacks. Patients who
experience persistent panic attacks are encouraged to test out beliefs they have
related to such attacks, such as specific fears related to bodily sensations,
and to develop realistic responses to such beliefs. This treatment is very
effective for those who experience such problems. Patients who experience
obsessions and compulsions are guided to expose themselves to what they fear and
beliefs surrounding their fears are identified and modified. The same is true
for people with phobias, including phobias of animals or phobias of evaluation
by others (termed Social Phobia). Those in treatment are exposed to what they
fear and beliefs that have served to maintain such fears are targeted for
modification.
Over the past 10 years, CBT for schizophrenia has received considerable
attention in the United Kingdom. While this treatment continues to be in its
infancy in the United States, the results from studies in the United Kingdom
have stimulated considerable interest in therapists in the U.S., and more
therapists are conducting the treatment now than just a few years ago. In this
treatment, patients are encouraged to identify beliefs and their impact and to
engage in experiments to test their beliefs. Treatment focuses on thought
patterns that cause distress and also on developing more adaptive, realistic
interpretations of events. Delusions are treated by developing an understanding
of the kind of evidence the person uses to support the belief and encouraging
the patient to recognize evidence that may have been overlooked that does not
support the belief. Furthermore, the assumed omnipotence of "voices" is tested,
and patients are encouraged to utilize various coping mechanisms to test the
controllability of auditory hallucinations.
While the above summary is certainly not comprehensive, it provides a brief
overview of the principles of CBT and how it applies to various presenting
problems. CBT’s focus on thoughts and beliefs are applicable to a wide array of
issues. Because CBT has excellent empirical support, it has achieved wide
popularity both for therapists and consumers. Those who may receive CBT training
include psychologists, psychiatrists, social workers, and psychiatric nurses.
Those seeking treatment using a CBT approach are encouraged to ask their
therapist what CBT training they have had or to contact a Center for Cognitive
Therapy and request a referral in their geographical location.
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