Cognitive behavioral therapy (CBT)

Cognitive-behavioural therapy (CBT) is a scientifically-backed talk therapy in which the psychologist helps a patient identify their unhelpful thoughts, thinking styles and behaviours, and uses treatment strategies to help patients change these.

According to an article published in Advances in Psychiatric Treatment, some unhelpful thinking styles that are addressed during CBT sessions are:

• Being biased against yourself: Where you overlook or downplay your strengths and achievements and focus on your weaknesses.
• Applying a negative mental filter: A tendency to focus on what's wrong rather than right in any situation
• Thinking that the future is bleak and expecting the worst-case scenario to come true (catastrophising).
• Thinking that other people have a largely negative view about you (mind-reading)
• Taking undue responsibility (blame) for things
• Using extreme statements and words like "always" and "never" to describe or summarise things, or use must and should for things you have to do

Anyone can benefit from a CBT session, and not just someone with a diagnosis of mental illness. For example, in 2001, psychologists Christine A. Padesky and Kathleen A. Mooney developed a CBT plan for building resilience. We all have problems from time to time and sometimes those problems can seem overwhelming. It is a good idea to seek help whenever we feel stuck or unhappy or unable to get out of a situation.

Core philosophy

CBT is centred on the idea that we each have a core set of beliefs. These core beliefs impact how we think, behave and feel about ourselves, our future and about other people around us. Simultaneously, our experiences, thoughts and feelings affect our core beliefs. If we surround ourselves with negativity and constantly worry or expect the worst, it can eventually affect our core.

CBT tries to break this chain of negative thoughts, by challenging what it describes as unhelpful thoughts (like this person didn’t say hello, he/she hates me) that can add up to unhealthy behaviours (like I am not going to meet new people because I am unlikeable).

When used to treat mental health conditions like depression, anxiety, psychosis, eating disorders, hypochondria, and many others, CBT may be done on its own or along with medications.

CBT is based on the idea that our life situations, experiences, relationships and problems can affect the way we think, feel (in terms of emotions and physically) and act.

• Life situations such as financial setbacks, relationship problems, a death in the family are some examples of events that can sometimes alter our thinking, to make it more negative.
• This altered thinking can alter the emotions (we may experience feelings of sadness or low mood, being cut-off or numb so we feel no pain or pleasure, anxiety or worry, guilt, anger or shame).
• This altered mood, in turn, can manifest as altered physical signs like not being able to sleep or sleeping too much; not being able to eat or eating too much (bingeing), reduced libido, restlessness, constipation or the feeling that our heart is racing, etc.
• Finally, the altered mood and physical symptoms can push people to alter their behaviours to avoid the thing or people or situations that set off this negative thinking.

In CBT, the psychotherapist typically starts by making this five-area assessment. 

What happens in CBT sessions?

During CBT sessions, the psychologist tries to change the thinking styles that he or she feels might be hurting the patient. Some of the strategies available to the therapist to do this are:

• Helping the patient to recognize the thinking errors (“extreme and unhelpful thoughts” that come automatically) that are causing problems in their lives, and then equipping them to reevaluate their thoughts and feelings based on this new understanding.
• Where thinking errors make it difficult for patients to understand the motivation and behaviours of others, therapists can help them gain more perspective. For example, if you see someone you know in a market but that person doesn’t say hello, it doesn’t necessarily mean that the person is avoiding you or doesn’t like you. They may not have seen you, or they might be preoccupied or in a hurry.
• A huge part of CBT is teaching patients “problem-solving skills to cope with difficult situations” (according to the American Psychological Association). This is a five-part process:
  • Identify the problem
  • Come up with a list of possible solutions
  • Test the strengths and weaknesses of each
  • Choose the best solution
  • Implement the solution. Check to see if it solved the problem or if you need another solution
• Helping patients to have greater confidence in their abilities

Changing negative behaviour patterns

CBT has two components: thinking (cognitive) and behaviour. CBT treatment also tries to change negative behaviour patterns using strategies such as:

• Encouraging patients to face their fears instead of avoiding them
• Preparing them for difficult situations by role-playing
• Teaching patients how to stay calm and relax when they start having difficult thoughts or feelings of being overwhelmed

Naturally, psychotherapists apply only those strategies that can be useful to the patient and not everything in their arsenal. Another thing that is very important in CBT is that therapists and patients need to work together—the patient has to be willing to listen and change some things in order to come out of negative thoughts and behaviours.

One of the things that psychotherapists trained in CBT use is worksheets. For instance, they can help the patient draw up a detailed “thought investigation” worksheet in which the patient starts by stating the life situation that bothered them, puts down what “automatic negative thoughts” they had about it, comes up with alternative explanations for what happened. But unless the patient is willing to recognise certain thoughts and feelings as unhelpful, and to change them, there is little that the therapist can do.

You might have heard about cognitive behaviour therapy or CBT in the context of depression and anxiety.

Now, psychologists are also using this psychosocial talk therapy for treating psychosis, sexual dysfunctions, chronic fatigue, eating disorders, drug overuse and unexplained physiological problems. There is also CBT for ADHD or attention-deficit hyperactivity disorder in children.

Additionally, psychotherapists say that CBT can help people learn some life skills to build resilience and be happy.

That said, some of the conditions for which CBT is used are: 

• Depression
• Anxiety
• Bipolar disorder
• Eating disorders like anorexia and bulimia
• Obsessive-compulsive disorder (OCD)
• Panic disorder
• Alcohol use
• Drug abuse
• Phobias
• Chronic fatigue syndrome
• Fibromyalgia
• Irritable bowel syndrome
• Tinnitus (ringing in ears)

Finally, CBT requires commitment from patients—you need to go for regular sessions to be successful. Your therapist will advise how often you should schedule sessions, but it can be once a week or once a fortnight for 5-20 sessions.