Cognitive Behavioral Therapy (CBT)

In the early 1960s, Aaron Beck developed a type of psychotherapy initially called “cognitive therapy”, which is now synonymous with Cognitive Behavioral Therapy (CBT). The cognitive model of CBT states that dysfunctional thinking patterns (which affect a patient’s mood and behavior) are common elements in all psychological disorders. When people learn to assess their thoughts in a more realistic and adaptive way, they experience improvements in their emotional state and behavior. For example, if someone were severely depressed and had neglected some bills, they might have an automatic thought, an idea that crosses their mind, such as, “I can’t do anything right.” This thought could then lead to a specific reaction: they might feel sad (emotion) and lie down in bed (behavior). If they were to examine the validity of this idea, they might conclude that they had engaged in overgeneralization and that, in reality, they had done many things well. Viewing their experience through this lens, they would likely feel better and engage in more functional behavior.

For long-lasting improvement in patients’ mood and behavior, therapists work on a deeper level of their beliefs, the entrenched ideas that patients hold about themselves, the world, and the future. Modifying these dysfunctional beliefs can lead to a stable change. For example, if we repeatedly underestimate our abilities, we may hold a core belief of inadequacy. Changing this general belief (i.e., seeing ourselves in a more realistic light, where we have both strengths and weaknesses) can alter our perception of specific situations. Dysfunctional thoughts that cause emotional distress, like “I can’t do anything right,” would no longer be as prevalent. Instead, in situations where we make mistakes, we might think, “I’m not good at this” (only in that specific task).

CBT is based on understanding the patient’s continuously evolving perception or conceptualization. It requires a strong therapeutic relationship, an alliance between the therapist and the patient. The therapy is goal-oriented and focused on the present. It aims to teach the patient how to become their own therapist and emphasizes relapse prevention.

Research on CBT shows that it has been extensively evaluated. To date, over 500 outcome studies have demonstrated the effectiveness of CBT in a wide range of psychiatric, psychological, and medical problems with psychological factors. CBT has been adapted to be effective for patients of all ages, from school-age children to the elderly.

Some fundamental principles of this therapy are:

• The therapy is based on the patient’s ever-evolving understanding.
• The therapy requires a strong therapeutic relationship, an alliance between the therapist and the patient.
• The therapy is goal-oriented and focused on the present.
• The therapy aims to teach the patient to become their own therapist and places an emphasis on relapse prevention.

There are various types of CBT, including rational-emotive therapy (Ellis), dialectical behavioral therapy (Linehan), acceptance and commitment therapy, exposure therapy, and others.
The common goal of all these therapies is to help patients achieve the desired changes in how they think, feel, and behave.