What is CBT?

Cognitive-behavioral therapy is a present-focused, skills-based approach to understanding and working on problems.  It is designed as a short-term, goal-directed form of therapy.  Treatment involves the use of skills and strategies that have been researched and have proven effective for people who are experiencing similar difficulties.

In most cases, CBT involves psychoeducation, cognitive therapy techniques, and behavioral strategies.  Treatment also emphasizes the importance of positive lifestyle factors such as adequate sleep, a healthy diet, and routine exercise, which are associated with lower levels of negative emotions such as depression and anxiety.

At the start of CBT, the therapist provides information that helps clients to better understand the causes of, nature of, and most up-to-date treatments for their difficulty.  Clients often read recommended books to supplement and reinforce what they learn in sessions.  

Cognitive therapy teaches clients to identify the specific thoughts that are tied to their emotions.  They learn to step back and examine these thoughts more objectively.  Cognitive therapy does not teach clients to always think positively.  Instead, it helps them to be sure they are looking at things accurately, in a way that is consistent with relevant facts or evidence.

Through cognitive therapy, clients learn to:

• identify possible mistakes in their thinking
• separate facts from feelings
• consider the evidence relevant to their thoughts so they can form fact-based conclusions
• generate alternative perspectives or outcomes to negative thoughts or predictions
• identify, examine and sometimes challenge long-standing, underlying negative beliefs regarding self, others, and life that affect emotions, behaviors, and self-esteem.

CBT can include a broad range of behavioral strategies depending on the goals of treatment.  Behavioral strategies may help clients to change negative behaviors such as avoidance, compulsions (e.g., checking,  reassurance seeking), procrastination, overeating, interpersonal conflict or infidelity.  The therapist works with the client to understand what drives these behaviors and to identify barriers to change.  CBT also focuses on developing and strengthening positive behaviors such as effective stress and anxiety management, mood management, problem solving, assertiveness, effective communication and conflict resolution.

With a technique known as exposure, CBT teaches clients who suffer from anxiety to gradually face the situations they fear.  After learning cognitive therapy strategies, clients work through a list of anxiety-provoking tasks that they identify at the start of treatment.  Typically, in routine outpatient settings, clients start by facing the moderately anxiety-provoking situations and build up to those that are more difficult.  Clients do this at a pace that feels comfortable to them with the guidance and support of the therapist.  This process helps clients to gradually reduce their anxiety and to build their comfort and confidence in situations that they previously avoided or endured with great distress.  They learn to make more realistic predictions regarding likely outcomes and to become more aware of their ability to cope if any difficulties should arise.

Clients who suffer from depression often work on getting out from under the weight of low mood to meet their daily goals, engage in pleasurable activities, and to increase a sense of accomplishment in their day.  Treatment often involves helping clients resist the inclination to withdraw and, instead, to engage more regularly in structured activities that provide a sense of pleasure and satisfaction.

Couples who are in distress may learn to examine and understand the patterns in their dynamic, with each partner owning and identifying the changes he/she/they can make to improve the relationship.  They learn communication skills and develop guidelines for managing and working through conflict.  Couples learn to work directly on effective ways of ensuring that both of their needs are met.

In cases of impulsive/compulsive behaviors such as overeating, skin picking, or excessive shopping, clients learn to identify and then eliminate, avoid, or reduce triggers for the behavior in their environment.  They develop positive alternatives to the problem behaviors.

In nearly all cases, clients learn to examine the function of symptoms or negative behaviors.  They gain insight into their behaviors by considering the triggers and the related thoughts, behaviors, and consequences.  An understanding of these patterns is helpful and important for long-term change.

This is only a brief overview of the components of CBT.  The specific elements of treatment vary depending on the nature of the case and the goals of therapy.