Cognitive Behavioral Therapy – What Is It?

Cognitive Behavioral Therapy (CBT) is a type of mental health counseling or psychotherapy in which clients work with a counselor or therapist in a limited number of structured sessions in order to become more self-aware of one’s thoughts and feelings. [1] By becoming more aware of one’s negative thoughts, one is able to relate to those thoughts in different ways to view stressful and difficult situations more accurately and respond accordingly.

Through the various techniques of CBT, clients develop what is called an “observing mind” by which one is able to de-fuse from a thought in order to see new possibilities for relating to that thought. This entails “making a distinction between thought and external reality.” [2]

Certain habits of thinking and relating to our own thoughts can be formed in order to understand that thoughts do not necessarily correspond to reality nor do they have to be taken as such, which generally makes one incapable of acting or moving beyond the thought to the living of the values we hold.

As a blend of cognitive therapy and behavior therapy, CBT is designed to be problem-oriented as well as action-oriented; it aims to address a particular set of problems the client has and develop strategies to cope with those problems.

At The Center for Success and Independence, CBT is for symptom reduction when a client’s current coping skills are maladaptive. An example of this might include helping children and adolescents recognize their automatic thoughts, the feelings associated with a situation and what action was taken—whether adaptive or maladaptive. Bringing to light each factor and how they interact can raise awareness of self and support change. By differentiating between the three, clients can see how negative automatic thoughts can turn into cognitive distortions, or unhelpful thinking patterns. By raising awareness of each, one can then learn to interrupt these patterns, replacing them with more adaptive and healthy thoughts.

Another example of CBT usage might be helping a child or adolescent in the case of substance use and addiction. One might identify situations which trigger cravings. Clients can list situations in which they might be compelled to use. From that point, clients and therapists can work to plan ahead how the teen will react to or deal with the triggering situations.

History of CBT
The major texts and therapies of CBT emerged in the 1970s and 1980s, followed by rapid proliferation of various clinical techniques. There are three main assumptions in CBT that hold all of these approaches together: (1) Cognitive activity affects behavior, (2) Cognitive activity may be monitored and altered, and (3) Desired behavior change may be effected through cognitive change. [3]

CBT’s principles are rooted in ancient philosophical traditions, particularly Greco-Roman Stoicism. [4] In addition, behavior therapy was pioneered in the 1920s, based on research into learning, conditioning, desensitization, and behavior modification. Cognitive therapy grew out of psychoanalytic practice, and was developed first by Aaron T. Beck to help clients with depression, because behavior therapy alone was not successful in treating them.

Cognitive and behavior therapy fully merged in the 1980s and 1990s for treatment of panic disorders. [5]

Uses and Effectiveness
The applications of CBT are numerous. Here are just some of the mental disorders and emotional challenges CBT is designed to deal with:
• Manage symptoms of mental illness in concert with or separate from medications
• Coping with stressful life situations, such as familial stress, school stress, or post-traumatic stress
• Help identify ways to manage emotions, such as anger
• Develop communication skills in order to resolve conflicts
• Overcoming trauma, abuse, and violence

In addition, the following is a list of mental illnesses CBT may help alleviate, especially when combined with other treatment options:
• Sleep disorders
• Sexual disorders
• Depression
• Bipolar disorders
• Anxiety disorders
• Phobias
• Obsessive-compulsive disorder (OCD)
• Eating disorders
• Substance use disorders
• Personality disorders
• Schizophrenia
• Post-traumatic stress disorder (PTSD) [6]

CBT has been shown to be even somewhat more effective in the treatment depression than anti-depressants, and as effective as other forms of behavior therapy in treating OCD and depression. [7]

Teens and Parents
For children and adolescents, CBT aims to improve the child’s maladaptive emotional, cognitive, and behavioral responses to his or her environment. The therapist helps the client recognize the thoughts and feelings that influence and mediate behaviors. While this approach is often explicitly explained to adult clients engaging in CBT, children are often taught through other means, such as shared experiences and exposure tasks, often focusing on social skills and interactions. [8]
CBT can be adapted for both group and individual therapy. Group-based CBT at The Center for Success and Independence takes into account interpersonal dynamics. In groups, clients are able to relate to peers, allowing for normalization of symptoms and past experiences, letting the client know that he or she is not alone. Teens are also able to learn from each other’s experiences, gaining feedback from and offering feedback to others. The skills learned are then further reinforced in individual therapy sessions.

Family Therapy and CBT
An emphasis on interpersonal dynamics is also present in family therapy sessions using CBT. CBT in family therapy usually focuses on helping families identify areas of conflict and distorted thinking in order to help members with decision making as well as more adaptive and healthy patterns of thinking and behavior. Each client has an individual therapist and a family therapist who collaborate to use CBT techniques that will help the client and family as a whole unit, building hope for each member.

“One of the difficulties that anxious and depressed persons must face is the feeling of constriction of such sources of hopeful opportunity [of new possibilities of action, and]…cognitive therapy can step in and offer the hope that a flourishing existence remains possible.” [9]

[2] Aaron T. Beck, “Cognitive Therapy: Nature and Relation to Behavior Therapy,” Journal of Psychotherapy Practice and Research 2 (1993): 349.
[3] Keith S. Dobson, ed., Handbook of Cognitive-Behavioral Therapies, Third Edition, 3-38.
[4] Donald Robertson, The Philosophy of Cognitive-Behavioural Therapy: Stoicism as Rational and Cognitive Psychotherapy (2010).
[5] Rachman, S (1997). “The evolution of cognitive behaviour therapy”. In Clark, D, Fairburn, CG & Gelder, MG. Science and practice of cognitive behaviour therapy. Oxford: Oxford University Press. pp. 1–26; Aaron T. Beck, “Cognitive Therapy: Nature and Relation to Behavior Therapy,” Journal of Psychotherapy Practice and Research 2 (1993): 349.
[7] Andrew C. Butler, et al., “The empirical status of cognitive behavioral therapy: A review of meta-analyses,” Clinical Psychology Review 26 (2006): 17-31.
[8] Amy L. Krain and Philip C. Kendall, “Cognitive-Behavioral Therapy” in Handbook of Psychotherapies with Children and Families, edited by Sandra W. Russ and Thomas H. Ollendick (1999), 121-135.
[9] McInerny, “Poised Strength,” 208.

Hayes, Steven C., Kirk D. Strosahl, and Kelly G. Wilson, Acceptance and commitment therapy: An experiential approach to behavior change (Guilford Press, 1999).

Hayes, Steven C., Jason B. Luoma, Frank W. Bond, Akihiko Masuda, and Jason Lillis, “Acceptance and commitment therapy: Model, processes and outcomes,” Behaviour research and therapy 44 (2006): 1-25.

Hayes, Steven C, “Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies,” Behavior therapy 35 (2004): 639-665.

Aaron T. Beck, “Cognitive Therapy: Nature and Relation to Behavior Therapy,” Journal of Psychotherapy Practice and Research 2 (1993): 349.