The Complete Guide to Cognitive Behavioural Therapy
Discover the essentials of Cognitive Behavioral Therapy (CBT) in our comprehensive guide. Learn how this evidence-based approach can transform negative thoughts and behaviors, offering support and improvement for a wide range of personal challenges.
What is Cognitive Behavioural Therapy?
Cognitive Behavioral Therapy (CBT) is a widely recognized therapeutic technique designed to assist individuals in altering their thought processes and patterns. This approach focuses on transforming negative, unhelpful or intrusive thoughts, beliefs, attitudes, and behaviours into more positive and constructive ones.
Cognitive behavioural therapy is a very effective and versatile treatment for a wide variety of mental health challenges. This includes but is not limited to anxiety, depression, eating disorders, substance use, and other mental health conditions. CBT explores the connections between cognitive thinking, emotions, and behaviours, helping individuals understand how these elements interact and influence one another.
CBT is based on three core principles:
Psychological issues are partly based on unhelpful ways of thinking:
Our core beliefs and negative ways of thinking are ingrained into us from childhood. They are deeply rooted in how we perceive ourselves, our environment, and the future.
Psychological issues are partly based on learned patterns of behaviour:
As humans, we hold onto learned negative patterns easier than positive ones. These irrational thought patterns disrupt our perceptions of reality.
People living with these issues can learn better ways of coping and managing to help relieve their symptoms:
Using CBT to help change thinking patterns greatly improves the quality of life for those dealing with mental health and other issues.
CBT was first introduced in the 1960s by Dr. Aaron Beck. He found that depressed patients often experienced negative thoughts about themselves, the world, and the future, resulting in negative feelings and behaviours.
Based on the idea that these negative thoughts and feelings were all interconnected, Dr. Beck had the patients identify and evaluate these thoughts, which they learned to recognize were inaccurate. He used a combination of cognitive therapy and behavioural techniques to help his clients identify, understand, and deal with these automatic thoughts. He called this approach Cognitive Therapy, which later became CBT.
What is the goal of CBT?
The goal of CBT is to teach patients that while they cannot control every aspect of the world around them, they can control how they perceive and respond to things in their environment.
Everyone’s experience with CBT is different, and the number of sessions varies. Generally, traditional CBT lasts for about 6 to 20 weeks, with weekly 30 to 60 minute sessions.
How Does CBT Work?
In Cognitive Behavioral Therapy (CBT), the client and therapist collaborate to identify and address current distorted thoughts and beliefs, aiming to alter the way individuals perceive their situations. This therapeutic approach is highly individualized, recognizing that each person has unique needs and coping mechanisms.
CBT supports clients in managing overwhelming thoughts by dissecting them into smaller, more manageable components and modifying negative patterns. This process is designed to help individuals escape the cycle of negative thoughts and feelings that often ensnare them, thereby enhancing their emotional well-being.
The Five Stages to Cognitive Behavioural Therapy:
Stage 1: Assessment and Engagement
The therapist will ask the client questions about their mental health, any specific concerns, and a brief history of their life. They’ll identify negative thought patterns and observe how they think, feel, and process information. This stage mainly focuses on building trust between the client and the therapist.
Stage 2: Formulation
The client and therapist work together to identify specific issues and really understand the client’s past experiences, beliefs, and thoughts about their current struggles. This helps develop a plan that guides the next stages of treatment.
Stage 3: Active Intervention
The therapist works with the client to develop strategies and interventions customized to their needs, like challenging negative thought patterns and practicing coping skills. This is where core CBT takes place, as the client learns to replace negative thoughts and behaviours with more positive ones.
Stage 4: Maintenance and Relapse Prevention
By this stage, progress is being made, and the client will continue to practice and reinforce the skills learned in the previous stages. They’ll recognize potential triggers and signs of regression and learn essential coping strategies.
Stage 5: Termination and Evaluation
In the final stage of formal CBT sessions, the therapist and client review the progress made and address any remaining concerns. This is the stage to celebrate achievements and prepare to use coping mechanisms and healthy behaviours learned in therapy in their everyday life.
The 4 Types of CBT Therapy
CBT is highly personalized for each individual, but the four main types are:
- Mindfulness-Based Cognitive Therapy (MBCT)
MBCT combines cognitive behavioural therapy with meditation. Unlike other forms of CBT, it doesn’t focus on changing thoughts but rather on changing the way someone reacts to these thoughts. This helps foster a non-judgemental, present attitude.
- Dialectical Behaviour Therapy (DBT)
Dialectical Behavioural Therapy focuses on problem-solving and acceptance strategies. It helps those who tend to see things in black and white come to terms with discomfort. It is highly beneficial for those who experience negative, extreme, and unpredictable emotions.
- Acceptance and Commitment Therapy (ACT)
Acceptance and Commitment Therapy aims to change how people react to their inner experiences, like emotions, thoughts, and impulses. It teaches people how to acknowledge deeper feelings and helps them stop denying and avoiding their inner emotions.
- Rational Emotive Behaviour Therapy (REBT)
The goal of REBT is to help individuals identify irrational beliefs, challenge them, and change dysfunctional thought patterns into healthier ones. It was created based on the idea that everyone holds a unique set of assumptions about themselves and the world, which influences their actions and perspectives on certain situations.
Conditions That CBT Can Treat Effectively
Depression
CBT treats depression by helping individuals identify and change negative thought patterns, fostering healthier thinking and behaviors. It also provides tools for developing resilience, building a more positive outlook on life.
Borderline Personality Disorder (BPD)
For BPD, CBT teaches crucial skills for managing emotions, tolerating distress, and improving relationships. It also helps individuals challenge and change distorted thinking patterns, fostering healthier coping mechanisms and greater emotional stability.
Obsessive Compulsive Disorder (OCD)
CBT, especially through Exposure and Response Prevention (ERP), successfully treats OCD by gradually exposing individuals to their fears and preventing compulsive responses.
Impulse Control
CBT aids those with impulse control disorders by identifying triggers and developing strategies to manage impulsive behaviors and enhance self-control, which contribute to long-term behavioral change and improved emotional regulation.
Post Traumatic Stress Disorder (PTSD)
CBT, including Trauma-Focused CBT, assists individuals with PTSD by processing traumatic experiences and reducing distressing symptoms through cognitive restructuring and gradual exposure.
Attention Deficit Hyperactivity Disorder (ADHD)
For ADHD, CBT provides essential skills in organization, time management, and problem-solving, helping individuals enhance focus and reduce impulsivity, allowing for better management of daily challenges and improved overall functioning.
Body Dismorphia
CBT is particularly effective for body dysmorphia, helping individuals challenge distorted beliefs about their appearance and develop a more realistic and positive self-image.
Eating Disorders
CBT effectively addresses eating disorders by challenging unhealthy eating behaviours and distorted body image through targeted cognitive and behavioural interventions.
Schizophrenia
Assessing Cognitive Distortions
Cognitive distortions are irrational thoughts and beliefs about ourselves and the world around us that we unknowingly reinforce over time. They can be harmful because they are subtle, everyday thoughts that are challenging to change. They are false, inaccurate, and can potentially cause psychological damage.
1. Negative Filtering or Discounting the Positives
Patients often focus solely on the negative aspects of a situation, disregarding any positive elements. This type of cognitive distortion is common in individuals with low self-esteem and depression.
2. Polarized Thinking / Black and White Thinking
Individuals with black-and-white thinking perceive situations in extremes, unable to see any middle ground. They often categorize things as entirely good or bad, or right or wrong, which can lead to unrealistic standards and expectations for themselves.
3. Overgeneralization
People who overgeneralize tend to make sweeping negative conclusions based on limited experiences. They often believe negative outcomes will always occur, using words like “never,” “always,” and “everything” to describe situations without thoroughly examining the evidence.
4. Catastrophizing/Magnifying or Minimizing
When something negative occurs in a person’s life, they may exaggerate the situation, perceiving it as far worse or more frightening than it actually is. This tendency, known as catastrophizing, can lead them to believe that the situation is entirely beyond their control, even if the problem is relatively minor.
5. Personalization
Personalization is when a person believes that others’ negative behaviors are directed at them, without considering other possible reasons for those behaviors. They often blame themselves for everything that goes wrong. This pattern is common among individuals who have experienced trauma or abuse.
6. Control Fallacies
Control fallacy involves believing either that one has no control over their life and is helpless in what happens to them, or that they are entirely responsible for everything that occurs around them. Both perspectives are damaging and inaccurate, leading to a distorted view of one’s influence over events.
7. Jumping to Conclusions, AKA Mind Reading
Jumping to conclusions occurs in two ways: when someone assumes they know what another person is thinking or when they predict future events inaccurately. These distortions often lead to negative conclusions, affecting their actions and feelings toward the other person.
8. Fallacy of Fairness
The fallacy of fairness occurs when individuals believe that the world and those around them should always be fair. People who judge every experience based on its perceived fairness are often impacted negatively, feeling anger and hopelessness when they encounter situations that they perceive as unfair.
9. Blaming
Blaming is a cognitive distortion where someone believes that others’ negative behaviors are directed at them, failing to consider other factors that might be influencing the situation. They take full responsibility for others’ actions, often without justification.
10. Should Statements
“Should” statements are damaging cognitive distortions where individuals impose unrealistic expectations on themselves and others, based on what they believe they “should” be doing. These unrealistic standards often lead to feelings of guilt, failure, anger, and resentment when the expectations are not met.
11. Fallacy of Change
The fallacy of change occurs when someone believes that others will change their behavior if pressured or encouraged enough. This distortion is often accompanied by the belief that one’s own happiness and achievements depend on the actions or changes of others.
12. Always Being Right
This distortion involves the belief that one must always be right. The notion of being wrong is entirely unacceptable, leading the individual to frequently argue and defend their position to prove their correctness.
13. Heaven’s Reward Fallacy
Heaven’s reward fallacy is the belief that one’s suffering, hard work, and struggles will inevitably lead to a significant reward. This thought pattern can be damaging, often leading to disappointment, anger, and frustration when the anticipated reward does not materialize.
CBT Techniques and Tools
CBT offers a variety of techniques tailored to address specific issues. Each individual may find different methods effective, but here are some of the most common CBT techniques and interventions.
Cognitive restructuring: this helps people examine unhelpful thinking patterns and devise new, healthy ways to react to problematic situations.
Exposure: the client gradually exposes themself to something they fear, with the idea that facing their fears will not harm them.
Journaling: this helps clients keep a record of their thoughts, feelings, and emotions and identifies potential harmful patterns in thinking.
Relaxation: techniques such as abdominal breathing and progressive muscle relaxation help reduce stress and anxiety symptoms.
Distraction: this can help distract those who usually engage in harmful behaviour to make a better decision.
CBT Compared to Other Therapy Methods
CBT vs. Talk Therapy
CBT focuses on identifying and changing negative thought patterns and behaviors through structured interventions, whereas Talk therapy (or traditional psychotherapy) typically involves open-ended conversations to explore feelings and past experiences. Talk therapy often relies more on the therapeutic relationship and insight-oriented techniques, while CBT is more directive and goal-oriented.
CBT vs. DBT (Dialectical Behavior Therapy)
CBT aims to change negative thinking patterns and behaviors through cognitive restructuring and behavioral strategies. In contrast, DBT, a form of CBT, incorporates mindfulness and acceptance techniques, focusing on balancing acceptance and change, particularly effective for emotional regulation and interpersonal difficulties.
CBT vs. CPT (Cognitive Processing Therapy)
CBT is a broad approach addressing various psychological issues by altering negative thought patterns and behaviors. CPT, a specific type of CBT, is tailored for treating PTSD, emphasizing understanding and challenging trauma-related thoughts and beliefs to reduce symptoms of distress and improve functioning.
CBT and Mindfulness
CBT and Mindfulness are complementary; CBT focuses on changing negative thought patterns and behaviors, while Mindfulness involves staying present and accepting thoughts and feelings without judgment. Integrating Mindfulness into CBT helps individuals become more aware of their thoughts and feelings, enhancing their ability to apply CBT techniques effectively.
Trauma-Focused CBT
Trauma-Focused CBT (TF-CBT) is a specialized form of CBT designed to help individuals process and overcome trauma-related symptoms. While standard CBT addresses general cognitive and behavioral issues, TF-CBT incorporates specific techniques to address trauma, such as creating a trauma narrative and gradually exposing individuals to trauma-related memories and feelings.
CBT vs. ACT (Acceptance and Commitment Therapy)
CBT focuses on changing negative thoughts and behaviors, emphasizing cognitive restructuring. In contrast, acceptance and commitment therapy encourages accepting thoughts and feelings without trying to change them, focusing on commitment to personal values and actions that align with those values, thereby promoting psychological flexibility and resilience.
Considerations of Cognitive Behavioural Therapy
These six considerations will help you find out if CBT therapy is right for you.
1. CBT is structured
CBT does not delve into underlying issues or unconscious resistance to change. Instead, it is a more structured approach, which may not be suitable for individuals who are uncomfortable with routine and structure.
2. You must be open to change
It can be challenging, but dedicating time to analyzing your thoughts and feelings is crucial. This self-reflection helps you understand how your thinking influences your behavior.
3. Progress is often gradual
CBT is not a quick-fix solution; it requires a commitment to gradual change. Being open to taking incremental steps toward altering behavior is key to making meaningful progress toward your overall goal.
4. You must commit yourself to the process
CBT requires time and commitment, often involving a process that can span months or even years. Weekly therapy sessions are recommended, and consistent collaboration with your therapist is essential to achieving progress.
5. You will have to confront your emotions
During CBT, you may encounter moments where uncomfortable emotions arise, but it’s important to face them. Confronting these feelings is a crucial part of the process and allows you to fully benefit from the therapy.
6. CBT focuses on re-training your thoughts
Simply being aware of unhealthy or irrational thoughts is not sufficient for change. It’s essential to be open to engaging in specific exercises and doing the necessary work between sessions to retrain your thoughts into healthier patterns.
Contact Us For a Free Consultation
You don’t have to navigate your challenges alone. Schedule a free consultation to explore how CBT can provide the support and tools you need for positive change.