Author: Cassie Jewell

Choosing a therapist is difficult enough, but it becomes perplexing when you see a long list of acronyms following their name. Cognitive behavioral therapy, or CBT, is one of those acronyms.

CBT, founded on the notion that our ideas create our reality and behavior, may be just what you need, whether you’re seeking assistance for mental health concerns or need a little additional support.

Cognitive therapy and behavioral therapy are two distinct therapy modalities combined in CBT. Cognitive therapy focuses on how ideas and beliefs lead to unfavorable feelings and behaviors. Behavioral therapy emphasizes the causes of behavioral patterns and how they can be changed to impact mood positively.

What is CBT?

CBT is a type of psychotherapy that uses solution-based techniques to heal dysfunctional emotions, ideas, and behaviors. It is helpful for various issues, including depression, anxiety disorders, problems with alcohol and other drugs, general stress, managing one’s anger, marital problems, eating disorders, and severe mental disease.

Establishing new, healthy behavior patterns motivates patients to confront unhelpful and misguided thinking. With CBT, it is hoped that harmful behaviors can be modified and rerouted by rewiring cognitive pathways based on the theory that our ideas and perceptions influence human behavior.

It is essential to highlight that improvements in CBT have been made due to clinical and research-based work. A wealth of scientific evidence supports CBT, demonstrating that the techniques used indeed result in change. CBT is distinct from many other types of psychiatric therapy in this way.

How is CBT practiced?

According to Mary Heekin, a therapist at CBT Denver, “CBT is a practical, results-based, evidence-tested approach. It teaches people how thoughts and actions influence mood and other aspects of mental and physical health. People are given strategies to overcome challenges daily. CBT is very flexible and can benefit people with mental health conditions.”

CBT is based on several fundamental theories, such as:

• Psychological issues stem from flawed or harmful ways of thinking.
• Learned undesirable behavioral patterns can evidence psychological problems.
• People with psychological issues can develop more robust coping mechanisms to help them manage their symptoms and improve their effectiveness.

In CBT, efforts are made to alter thought processes, such as:

• Recognizing one’s thinking patterns that are problematic and then reevaluating them in the context of reality
• Improving one’s knowledge of other people’s motivations and behaviors
• Use problem-solving techniques to deal with challenging circumstances
• Increasing one’s self-assurance as one grows in confidence

CBT treatment attempts to alter behavioral patterns. Such strategies include:

• Confronting one’s fears without ignoring
• Using role-playing to get ready for possibly awkward social interactions
• Learning how to relax one’s body and mind

Not all CBT will implement each of these techniques. Instead, a collaborative effort between the psychologist and patient/client is used to analyze the issue and develop a treatment plan.

The goal of CBT is to assist people in becoming therapists. Patients and clients are assisted in developing coping skills to learn to alter their thoughts, disturbing emotions, and behavior through activities done both during and outside of sessions.

Instead of focusing on the circumstances that lead to the client’s problems, CBT therapists highlight what is happening in the present. Although some knowledge of one’s past is necessary, the goal is to move forward in time and create more useful coping mechanisms.

What conditions respond well to CBT?

Many mental ailments such as mood, anxiety, eating disorders, insomnia, and substance use disorders respond well to this therapy. While CBT is beneficial for people with mental health concerns, it can help anyone improve their quality of life.

Here are three common mental health disorders that are treated with CBT:

Bipolar disorder

CBT is helpful for bipolar disorder, seasonal affective disorder, dysthymia, and depression. If you have one of these disorders, it might be beneficial to recognize thought patterns contributing to mood problems and confront them by adopting a more realistic and positive perspective on your environment. In contrast to other treatment modalities, CBT emphasizes collaboration and goal-oriented therapy sessions.

CBT teaches several essential skills that target the core ways bipolar disorder affects you. These include:

1. Acknowledging the diagnosis. The first step is to understand and admit that your disorder is causing your symptoms. For mental health practitioners, teaching about the condition’s indications, symptoms, causes, and progression is crucial because it may be challenging for individuals with bipolar disorder to accept their diagnosis. Psychoeducation empowers people to receive needed assistance while also realizing they are not alone.
2. Monitoring overall mood. This is frequently accomplished by keeping a worksheet or notebook between sessions, which is then evaluated with your therapist. On a scale of 0 to 10, where 0 equals “depressed,” 5 equals “feeling OK,” and 10 equals “very irritable or heightened mood,” patients are asked to rate their mood daily. The goal is to increase awareness of mood shifts and triggers.
3. Restructuring cognitive processes. A patient can fix incorrect thinking patterns by learning to become more conscious of the impact that thoughts have on their mood, how to recognize problematic thoughts, and how to change or correct them. The therapist shows the patient how to analyze their thoughts, seeing errors like ‘all-or-nothing’ thinking and coming up with more reasonable ideas.
4. Frequently solving problems. This stage teaches you how to recognize a problem, devise potential solutions, choose one, try it out, and assess the results. Problem-solving is typically first introduced in therapy and then practiced in-between sessions. Problems arise in all life areas, including relationships, jobs, and finances. If none of these stressors are addressed, you risk experiencing a lapse more frequently.
5. Improving your social abilities. Some people living with bipolar disorder struggle socially, making them feel like they aren’t in control of aspects of their lives. You may improve how you manage interpersonal relationships by developing skills like assertiveness.
6. Making routine changes. Establishing a rhythm to your day through regular, scheduled activity helps to stabilize your mood. Examples include:
   1. Working out in the early afternoon
   2. Maintaining regular sleep and mealtime routines
   3. Scheduling social activities
   4. Performing household duties

Anxiety disorders

Patients who suffer from anxiety disorders benefit from CBT’s attention to thoughts and behaviors. CBT assists patients in experiencing fewer and less intense symptoms of dread, anxiety, and panic, as well as avoiding being controlled by their fear by identifying habitual thought patterns that result in the sense of danger.

Cognitive behavioral therapy is effective for issues with a physical foundation. It is founded on the idea that our negative thought patterns influence or even drive our behaviors and impulses.

CBT professionals use common techniques to help you manage anxiety and change your behavior.

1. Restructuring or reframing of the mind

Examining negative thought patterns is a necessary step in this process. People may frequently:

• Overgeneralize
• Believe the worst will occur
• Give excessive weight to minute details

This thinking could influence human actions and, in some cases, might become a self-fulfilling prediction. The therapist will inquire about one’s mental processes in certain circumstances so one can spot negative patterns.

Once the patient becomes conscious, they can learn how to change them into more optimistic and useful ones.

2. Thought challenging

By using concrete examples from our daily lives, patients may challenge their thoughts and look at something from multiple aspects. Instead of simply accepting their beliefs as the facts or the truth, thought questioning might help people view things more objectively.

A person can attempt to rectify the unhelpful beliefs with more balanced and factual ones by becoming aware of when a cognitive distortion is present in their thinking after receiving education about them.

People with anxiety may find it difficult to reason through the issues. They may experience anxiety but be unable to pinpoint its source. Or they might fear things like social gatherings but not understand why.

3. Behavioral activation

You can plan an activity if anxiety prevents you from doing it by placing it on your calendar. Doing this lets you set up a strategy and stop worrying about it.

For instance, you might plan a meet-up with a friend in the park if you’re worried about your kids’ safety at the same place. The techniques you practice in CBT will inspire you to take action and deal with the situation.

4. Maintaining journals

You can connect with and become aware of your thoughts and feelings via journaling, also known as a thought recorder. It can also facilitate cognitive organization and clarity.

You may list the negative and uplifting thoughts you can replace them with. Your therapist could encourage you to keep a journal of the new abilities and habits you practice outside of therapy sessions.

5. Behavioral research

These are frequently employed when you have devastating thinking, which is when you predict the worst.

Like in a scientific experiment, we make assumptions about the possible activity results and write down what we believe will occur and what we fear may happen.

Discussing your predictions and whether they came true with your therapist may be a good idea. You’ll eventually realize that your worst-case situation is unlikely to occur.

6. Calming methods

Relaxation methods ease tension and improve your ability to think correctly. These, in turn, can assist you in regaining control of a circumstance. These methods could consist of:

• Activities for deep breathing
• Progressively relaxing the muscles
• Meditation

You may apply these techniques whenever you’re anxious because they don’t take much time, like in the checkout line at the grocery store.

OCD

Patients with obsessive-compulsive disorder use particular compulsions to escape their distressing obsessive thoughts temporarily. The automatic connection between obsessive thinking and ritualistic compulsive conduct is broken through cognitive behavioral therapy. Additionally, CBT teaches patients not to engage in rituals when they are worried.

The following methods are frequently employed in CBT to assist in treating OCD patients. Along with treatment sessions, calming techniques like deep breathing and progressive muscle relaxation can be used to reduce anxiety.

Here are some CBT techniques that are commonly used to treat OCD:

1. Exposure and Response Prevention Therapy (ERP)

Exposure and response prevention therapy is the most beneficial CBT technique for treating OCD. The patient is exposed to the anxiety-inducing obsessive thought during this procedure, but they are not permitted to engage in the compulsive action. They must deal with their anxiety until it subsides, and they get numb to it by doing this to avoid the brief relief that comes with the compulsion.

Among the elements of ERP are:

• In vivo exposure – Sometimes known as “real-life exposure,” involves regularly exposing a subject to feared stimuli for a long time.
• Imaginal exposure – The mental representation of a feared stimulus and the effects of exposure to the stimuli is known as imaginary exposure.
• Ritual or response prevention – Avoiding ritualistic behavior after exposure to the feared stimuli is known as ritual or response prevention.

2. Exercises for deep breathing

Exercises focusing on breathing are pretty effective at reducing OCD-related anxiety and can be used during ERP. Deep breathing exercises come in various forms, but they all have the same goal of soothing the body by lowering the breath and pulse rate.

3. Progressive relaxation of the muscles

People can physically contract and relieve tension throughout their bodies via progressive muscle relaxation. Our bodies may activate the fight-or-flight reaction when we are under stress or anxiety, which frequently results in muscle tightness throughout the body. You may easily manage your stress by preventing your body from activating this response.

4. CBT and cognitive restructuring

Cognitive restructuring is a method of confronting irrational thoughts or cognitive patterns. This way, patients may replace these patterns with logical, sensible thoughts. The idea is to utilize facts to refute arguments founded on emotional reactions.

By recognizing the beliefs that lead people to turn to food, drugs, or impulsive behavior, these disorders can be treated. CBT teaches patients the skills to recognize the circumstances that could lead to bingeing on substances or acting impulsively, and it also helps to find alternate, healthier ways to cope.

How to find a CBT professional

Finding a competent therapist can be difficult. Though it may seem overwhelming to know where to begin, you can find a counseling practice that is ideal for you. Here are some things to consider when searching for a CBT expert.

Initiate your search

Ask friends and relatives for ideas. Online searches are a further resource for finding a CBT therapist. You can search a database on the Psychology Today website by state. Additionally, you can look through the National Association of Cognitive-Behavioral Therapists‘ directory.

Identify the characteristics you’re looking for in a therapist

Identifying the kind of therapist you would feel at ease with is helpful. Your ability to regain mental health will depend on how well you get along with your therapist. Ask yourself:

• Who are you looking for in a therapist?
• Do you prefer working with a particular gender?
• Do you want an older or younger therapist?
• Do you desire a spiritual component to your therapy?

Don’t compromise

It’s vital that you feel at ease with your therapist. It’s acceptable to look for a better match if they aren’t a good fit. Not everyone will be a good fit, and various therapists can address multiple concerns.

Online or in-person consultation

When you visit a therapist in person, you sit on sofas or chairs in their waiting room or office. However, as more therapists see their patients virtually, clinics now provide a more comprehensive range of possibilities for online therapy. You could discover that virtual counseling is more comfortable for you.

Certain businesses, like Online-Therapy, specialize in CBT. In addition to treatment sessions, they may provide you with additional beneficial materials like workbooks and live sessions.

Group or individual therapy

You may opt for CBT in a group therapy setting or individual counseling. In a group therapy session, a facilitator, typically a mental health professional with a license, works with a small group of persons experiencing related problems. The patient can get a one-to-one consultation with the doctor in an individual counseling session. 

Conclusion

It might be challenging to deal with mental illness, but fortunately, there are actions you can take to get through them. CBT is a means to alter your negative thought patterns so that they have a positive impact on how you react to circumstances.

About the Author: Dr. Joann Mundin is a board-certified psychiatrist who has been in practice since 2003. She is a Diplomate with the American Board of Psychiatry and Neurology and a Fellow with the Royal College of Physicians and Surgeons of Canada. Currently associated with Mindful Values, she provides assessments and treatment for patients with severe mental illness.