Cognitive Behavioral Therapy (CBT)

What is CBT?

Cognitive Behavioral Therapy (CBT) is the most researched form of psychotherapy and has shown to be effective for many mental health issues such as anxiety, panic, depression, substance use, OCD, and many other disorders.

The general premise of CBT is that we all have reactions to situations in life that can be experienced positively or negatively, but that the reaction is more likely related to the meaning that we attach to the situation than the situation itself. To be more specific, our thoughts (cognitions) and beliefs about the situation impact how we react to it.

For example, we may be having a fun day with friends and be thinking: “This is awesome…My friends are the best.” This results in an emotional reaction of excitement or joy. But our thoughts can also be connected to distressing situations. For example, we might have an argument with our spouse and think: “They never listen to me…It’s never going to get better.” This then triggers a reaction of tension, loneliness, and hopelessness. For most people, they’re keenly aware of the distressing emotions but less aware of the thoughts that are connected to them.

The primary problem with this connection between our thoughts and our reactions is that the thoughts are often inaccurate or simply unhelpful. What CBT helps people do is bring those negative thoughts into our awareness so we can respond to them in ways that are more helpful and accurate, so our reactions are less distressing. With practice, this more open and flexible approach can become automatic.

CBT also works on behavior since there are often things that we do that contribute to our suffering. Depending upon what the person hopes to accomplish, this could include learning new skills, practicing relaxation strategies, increasing pleasurable or social activity, eliminating unhelpful coping strategies, or engaging in behavioral experiments that help the person step outside of their comfort zone.

CBT’s Effectiveness is Well-Documented

In contrast to more traditional approaches, CBT is a more structured and action-oriented form of psychotherapy that focuses primarily on present-day problem-solving. This logical and skills-based approach will help you learn concrete strategies for responding to negative thoughts and unhelpful behaviors so that you can practice them on your own.

CBT is evidence-based and considered the most researched form of psychotherapy (Fordham et al. 2021), often referred to as the gold standard therapy model (David et al. 2018). It has been demonstrated in thousands of studies to be an effective treatment for a variety of psychiatric disorders (Beck 2020) and is especially effective in the treatment of anxiety and depression.

How Does CBT Work?

The treatment process begins with a comprehensive assessment to understand the issues that brought the person to therapy, their symptoms, coping strategies, strengths, and anything in their history or childhood that’s relevant to our work together.

Next, we collaborate on the development of an individualized treatment plan that identifies their hopes and dreams for tomorrow and the roadmap for moving along in that journey. This includes small steps of progress and strategies that we’ll employ to empower them to reach those milestones.

While CBT encompasses many strategies that are individualized based on the person’s goals for therapy, there are primary areas where treatment will typically focus:

Core Components of CBT

• Investigating and Reframing Automatic Thoughts: Because much of the connection between our thoughts and reactions occurs outside of our awareness, therapy often begins by teaching the person how to recognize the dynamic that unfolds when they become distressed.

  For example, a person who experiences work-related anxiety, might be worried about an upcoming performance review, fearing that it will go poorly. We’ll help them identify their worry thoughts and guide them through a simple investigation to assess the accuracy of their worries and their capacity to cope with potential negative outcomes.

  The guiding concept of CBT is that we are not our thoughts; we are the reaction to our thoughts, and we can take steps to shape that reaction. So, this first skill involves teaching people how to identify and respond to their negative thoughts in ways that help them both problem-solve and cope with whatever challenges they face.

• Identifying and Forming Adaptive Belief Systems: Once the person becomes practiced at identifying and responding to their unhelpful thought patterns, CBT might also involve exploring and reshaping more deeply held beliefs the person has about themselves, their future, and the world around them.

  For example, someone may have had a childhood that lacked emotional validation and formed the following belief about themselves: “I’m unlovable.” Or someone else may have experienced trauma in their past and formed a corresponding belief such as: “The world is unsafe.”

  These beliefs can then color everything about the person’s experience of the world including how they think, feel, and behave. CBT helps them explore the origins of those beliefs, loosen the grip they hold over them, and form healthier more adaptative beliefs that better align with their value system.

• Reshaping Behaviors: Everyone engages in helpful and unhelpful coping strategies that they use during challenging times. Sometimes we’re unaware of what we’re doing that’s exacerbating our suffering. Other times we know it’s unhelpful, but we can’t stop.

  CBT helps people investigate the advantages and disadvantages of various coping behaviors and empowers them to build motivation towards engaging in behaviors and activities that make them feel better, not worse.

  One of the most common areas of behavioral intervention in CBT is helping people get outside of their comfort zone. This might include someone with depression who’s lost motivation to engage with the people or activities that bring them pleasure. Or it might include someone who avoids situations because of the anxiety it provokes. Reshaping behaviors involves exploring your fears, identifying and removing obstacles, and slowly building your confidence and motivation to increase your connection to the things in life that are important to you.

While working with thoughts, beliefs, and behaviors are key to effective CBT, there are many other areas that CBT focuses on such as increasing problem-solving skills, implementing relaxation strategies, and helping you manage and tolerate difficult emotional reactions. If you’d like to learn more about CBT for anxiety or depression, refer to my service pages for more information.

Think of CBT as an umbrella therapy that incorporates multiple other approaches into its fold. For example, Acceptance and Commitment Therapy (ACT) is a form of CBT that focuses on values and mindfulness. This form of CBT helps people clarify their value system so they’re able to tolerate life’s challenges with acceptance and flexibility. I incorporate ACT and several other modalities into the work with my client’s, depending upon each person’s interest and therapy goals.

The Unique Benefits of CBT

The primary contrast between CBT and traditional psychotherapy is its problem-solving nature. Traditional psychotherapy is “insight oriented,” which means the focus is on understanding the root of our challenges. This is helpful but doesn’t necessarily impact change in the present. That’s where CBT bridges the gap. CBT not only focuses on insight but also making practical changes in thinking and behavior in the present.

For example, traditional therapy might help someone make the connection between a perfectionistic pattern of overachieving in the workplace with growing up in a critical home environment. It might take weeks, months, or even years of traditional therapy to repair that emotional wound. CBT would do some of this, but the primary focus would be empowering the person to make changes in the present so they’re able to achieve whatever work/life balance they envision for themselves.

Why I Specialize in CBT

CBT is a skills-based therapy that teaches people how to navigate the inevitable ups and downs of life with resilience. In essence, it teaches you how to be your own therapist, so you don’t need to be in therapy forever. As a therapist, this coaching aspect of CBT is incredibly rewarding and is the reason why I practice CBT over more traditional forms of psychotherapy.

CBT is also considered a short-term therapy. Because of its focus on problem-solving challenges in the present, people often experience at least some relief rather quickly as they begin implementing new skills to manage whatever brought them to therapy. For people with relatively minor anxiety or depression, they might achieve their goals within just a few sessions. For more complex issues, or people who’ve been dealing with anxiety or depression for years, therapy can take longer. That means we’ll likely identify both short-term and long-term goals, breaking up problems into manageable pieces so the path forward feels achievable to you.

Let’s Begin Your Journey Today

If this seems like a good fit for you, take the first step and schedule a free 20-minute video consultation.

Beck, J. (2020). Cognitive Behavior Therapy: Basics and Beyond. New York, NY: The Guilford Press.

Fordham, B., Sugavanam, T., Edwards, K., Stallard, P., Howard, R., Das Nair, R., . . . Lamb, S. (2021). The evidence for cognitive behavioural therapy in any condition, population or context: A meta-review of systematic reviews and panoramic meta-analysis. Psychological Medicine, 51(1), 21-29. doi:10.1017/S0033291720005292

David, D., Cristea, I. & Hofmann, S.G. Why Cognitive Behavioral Therapy Is the Current Gold Standard of Psychotherapy. Frontiers in Psychiatry. 2018 Jan 29;9:4. doi: 10.3389/fpsyt.2018.00004. PMID: 29434552; PMCID: PMC5797481.