Cognitive-behavioral therapy is one of the most popular and well-known types of talk therapy applied in modern-day psychiatry. It is the evolution of decades of psychotherapy and psychoanalysis, with roots dating back over a century. But what is cognitive behavioral therapy, really? And how does it work?
Understanding how CBT can affect patients with different mental health disorders and psychological states can help individuals get a better sense of how therapy can treat psychological disorders, as well as the role of therapy in the long term.
What Is Cognitive Behavioral Therapy?
Cognitive behavioral therapy has two important elements: the cognitive, and the behavioral. Both were developed individually at first and came together over the years through integrative treatment.
On a cognitive level, CBT establishes the idea that a person’s symptoms and problems are based in part on faulty or irrational thinking. It aims to help patients discover, recognize, and understand these irrationalities, and separate them from logical reality.
On a behavioral level, CBT aims to help patients recognize and overcome their own patterns of unhelpful behavior. We each fall into a cycle of self-destructive habits when struggling with mental health problems – recognizing the urge to stick to the formula, and learning to avoid it, is an important part of the healing process.
Put together, CBT aims to help people isolate and identify problematic thoughts and actions, emphasize healthier thinking based on reality, and develop strong coping mechanisms for themselves. It’s important to remember that cognitive behavioral therapy is a greater sum of its two parts, and not just two different therapeutic theories brought together.
A Brief History on CBT
On that note, cognitive behavioral therapy has a long and complex history. It did not spring from nothing but was instead developed as a culmination of decades of work in behavioral analysis and an amalgamation of different therapeutic practices.
The earliest instance of the kind of framework on which today’s cognitive behavioral therapy was built on can be found in the 1960s, when it was predominantly used to analyze and treat behavioral dysfunction in children. It wasn’t until the 70s that behavioral therapies were developed for older, higher functioning clients.
Over the years, cognitive and behavioral theories melded into a framework that centered around self-talk – that is, internal thought processes – as a central mechanism of change for anxiety disorders, then mood disorders, post-traumatic stress, and more.
Today, cognitive-behavioral therapy is one of the most prominent first line treatments in a number of common mental health disorders, playing an important role alongside disorder-specific medication.
How Cognitive Behavioral Therapy Works
Cognitive behavioral therapy takes two parties: the therapist and the patient. Little more is involved, and in many cases, CBT can be applied efficaciously via telehealth and online resources – meaning physical contact isn’t necessary.
A lot of CBT boils down to talking. A therapist will work with a patient to help them identify and understand thought processes that play a vital role in shaping their emotions and behavior yet have little to no foundation in reality. These irrationalities often lay at the center of our anxieties and can help deepen depression.
CBT also often incorporates elements of mindfulness training (breathing exercises, meditation, focus, and more) and utilizes roleplay and imaginative thinking to explore anxieties, identify problems, and come up with healthy solutions.
While CBT may not help someone completely think their way out of a mental disorder, it can lessen their symptoms, lead to powerful coping skills, and can help motivate patients to affect positive changes in their daily lives – creating a positive cycle.
Cognitive behavioral therapy also ultimately helps people become their own therapists by arming them with the tools needed to continue treatment indefinitely. That being said, patients are always encouraged to seek out professional help whenever they need it, no matter what.
Learning Mindfulness with CBT
Mindfulness is an important element of cognitive behavioral therapy because it emphasizes taking a step back to self-analyze and identify problematic thinking in the here and now. The two are intrinsically linked because both require analysis and awareness.
Mindfulness can be better characterized as a healthy self-awareness – one that isn’t overly self-critical but aims to be objective. That means recognizing wanted and unwanted thoughts and acknowledging and separating our biases from reality. Affirmations can play an important but separate role in mindfulness, by shifting our perspective from a negative one, to one focused on gratitude.
For people with depressive and anxious symptoms in particular, making a point of recognizing the present rather than viewing life through a negative lens informed by the past can make a big difference.
This is often the first step towards establishing a healthier mental framework on which to build important coping skills.
CBT for Depression
Mood conditions like major depressive disorder are characterized by a persistent low mood or prevailing sadness that won’t go away. Some cases of depression are also underlined by anhedonia (inability to experience joy) in addition to dysphoria.
Cognitive behavioral therapy helps patients with depressive symptoms develop mental arguments for a more positive, healthier outlook, which can have a marked impact on mood and mental health.
The effects of CBT on any given patient with depression largely depends on the source of their depression, as well. Sometimes, biological factors such as chronic illness or thyroid disease can cause or exacerbate depressive symptoms.
CBT for Anxiety
Anxiety is characterized as an irrational level or kind of fear. Phobias, for example, describe a form of fear that is nearly constant, persisting even when there is no threat.
Conditions like social anxiety disorder can lead to dysfunctional behavior and are debilitating. Generalized anxiety disorder can lead to long-term fatigue and depression, as a person remains on edge and worried in nearly every waking moment. CBT aims to help people with anxiety disorders recognize the irrationality of their thoughts and emotions, and find ways to counter, reject, and overcome them.
CBT and Other Treatment Modalities
CBT is an effective treatment method but is often used in conjunction with other case-specific treatments.
Conditions like bipolar disorder rely on mood stabilizers like lithium to reduce the severity of certain symptoms. Depression in a neurological sense can be an expression of a neurotransmitter dysfunction, so drugs like SSRIs can help combat this dysfunction. Anti-anxiety medication can help reduce the likelihood of panic attacks, and so on.
Aside from psychotherapy and medication, common mental health treatment modalities include lifestyle changes, such as exercise and diet, to improve mood and self-esteem. But in any and all cases, one of the most important elements in mental health treatment is a strong support system.