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Types of Psychotherapy: Cognitive Behavioral Therapy

Updated on June 18, 2013

Cognitive Behavioral Therapy (usually abbreviated CBT) is one of the best-researched, most widely applicable types of psychotherapy available for many types of mental illness. Variations on cognitive behavioral therapy have been used for depressive disorders, anxiety disorders including PTSD, insomnia, pain management, personality disorders and even schizophrenia with beneficial effects. So, how does it work?

Imagine this situation with me. We are both taking a math class in college together. It is a challenging class and we have both studied long and hard. We are both hoping to continue our college educations with the goal of obtaining a master’s degree in accounting and eventually earning our CPA. Both of us receive a B+ on the end of semester final exam.

You react to this B+ with the following thoughts: “Hooray! I did it! That’s a really good grade! I know that will help me get into the master’s program I am interested in. I’m really proud of my hard work. I’m taking myself and my out for a nice dinner to celebrate!” You go home, tell your spouse and children about your good grade, and you all go out to dinner and have a great time. How do you imagine that you are feeling?

I react to this B+ with the following thoughts: “I can’t believe this! This is terrible. This is so unfair. I studied so hard and the test was completely out of line with the material. Now I’ll be rejected from the master’s program I am interested in, they’ll never think this grade is good enough. I’m probably not good enough to do this anyway.” I go home in a funk, don’t tell my spouse and children what happened but instead yell at them about how messy the house is. I go to bed with a terrible headache. How do you imagine I am feeling?

What’s interesting is that in this imaginary example, we are in exactly the same situation. What makes the difference in how we feel is our thoughts (our cognitions) and our behaviors. Many people believe that they could not possibly feel better unless they are in a different situation. CBT teaches that by recognizing, examining and if necessary correcting our habitual cognitions and behaviors we can begin to feel better no matter what our circumstances.

Of course, it isn’t as easy to do as it is to say. Most of the time our thoughts aren’t so “loud” and obvious as the thoughts I used in my example. Our thoughts tend to be similar to a movie soundtrack that is playing all the time in the back of our minds. Music in the movies is usually playing in the background, driving your emotional reaction to a scene but only sometimes grabbing your full attention in and of itself. Our thoughts (called automatic thoughts in cognitive behavioral therapy) are usually snippets of thoughts and images and memory associations that only occasionally rise to the level of full awareness, but like that movie soundtrack they powerfully affect our emotions in any given “scene” in our lives.

Just like our thoughts, our behaviors are often running on an automatic, semi-aware level. Many people don’t believe this about themselves, but it is true for almost everyone. We tend not to think too hard about how we are responding to a situation; we just react. This makes sense. If we have to think carefully about every little thing we are doing we will accomplish things only very slowly, if at all. Doing things on autopilot speeds us up and most of the time works very well. Our “autopilot responses” are built from multiple examples and experiences from childhood onward and are compiled of what has worked in the past. The difficulty comes in when this autopilot doesn’t match up well with our present circumstances. It can be like trying to drive your old route to work when you’ve moved to a new house – you’re just not going to get where you wanted to be.

CBT isn’t magic. It’s a skill and it requires an investment of time and effort. Like any skill, it requires practice, practice, practice. During CBT a patient works with a trained therapist first to learn to recognize the “soundtrack” of their thoughts and the “autopilot” of their behavior and bring these things into full awareness. Then the therapist and patient work together to make changes. They alter the soundtrack by evaluating the automatic thoughts in terms of how realistic and helpful they are and suggesting alternate, more accurate thoughts to use as substitutes when the soundtrack thoughts aren’t functioning well. They alter the autopilot by suggesting new behaviors to start and some old ones to stop. As you can probably guess, CBT is a form of therapy that involves significant homework in between therapy sessions.

Many people have benefited from CBT for many different mental health complaints. It does take a significant commitment of time and effort from the person doing the therapy, but it's track record and effectiveness are outstanding. If this kind of treatment sounds like something you would benefit from and are willing to do the work for, consider finding a qualified therapist


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