Dr. Anna Charbonneau

Therapy for people living with stress, depression, and medical conditions

What is cognitive behavior therapy?

by Dr. Anna Charbonneau | Tags: therapy

What makes CBT unique? Could CBT help you? Understanding the different kinds of therapy available will enable you to find the right kind of therapy for you. This focus of this post is on Cognitive Behavior Therapy, also known as CBT. What is it about? How does it work? Let's take a look.

How did I build my expertise in Cognitive Behavioral Therapy?

In my second year of graduate school, I had to face down that monster called "oral comprehensives." Oral comps, we called it, for short. Oral comps is a two-hour exam. You sit in front of three faculty members and present two cases from two different psychological theories or perspective. Graduate students are given one hour to prepare their analysis and treatment plan for both. During the presentation, the faculty slam you with questions. That exam was the second most stressful event in my life (second only to my encounter with a grizzly bear in the wilderness of Montana, but that is a whole other story).

It is a grueling process, but a few good things out came out of it for me. To prepare for this exam, I studied each major psychological orientation (CBT, Interpersonal, Family Systems, Psychodynamic, etc) fanatically for months. Out of all of the psychological orientiations, I fell in love with CBT. I've used CBT in my practice since that time. I find it to be a great fit for my personality and the way I prefer to practice. CBT is very active and solution-focused, and both the therapist and the client shape the process and flow of therapy.

Somewhere along the way, I heard the advice that if you can't sum something up in two sentences or less, you don't really understand it. So that summary is what I'm giving you today.

So What Is CBT?

The heart of cognitive behavior therapy can be summed up in two sentences. Thanks to my fanatical studying and how much I love CBT, this phrase feels pretty much encoded into my DNA. So what is CBT? Here it is:

Cognitive Behavior Therapy is a short term intervention that examines underlying maladaptive patterns of thoughts and behaviors that lead to distress. The focus of CBT is on shifting these maladaptive patterns to relieve distress and restore health.

Okay, I admit, it's a mouthful. I only had two sentences, so I had to cram some heavy words in there. Let's unpack it.

Identifying Maladaptive Thoughts

The first major focus of CBT is identifying maladaptive thoughts. We all have patterns of thinking or talking to ourselves, called self-talk for short. These patterns are different from person to person. Usually these styles of self-talk are shaped by a number of factors. Factors like how our parents talked to us when we were small, how our friends and teachers thought and talked to us when we were adolescents, and what we have told ourselves about major events in our lives all shape our personal style of self-talk.

Self-talk can either be helpful or not helpful. When something is unhelpful, psychologists call that "maladaptive." Maladaptive means a quality that is unhelpful or outright harmful to your ability to adapt and thrive in your life.

It's not the events that happen to us that determine how we feel, it's how we respond to them.

Want to change your emotions? Change your self-talk. It's our self-talk that determines our feelings. How we interpret the events around us. What we say to ourselves when bad or good things happen. Self-talk is the key to managing our emotions.

An Example of Maladaptive Thoughts

CBT was first used to treat depression, so let's start with that. There are some common patterns of unhelpful self-talk that lead to depression. In CBT, maladaptive thoughts are often referred to as cognitive distortions.

Anyone who fails a test is going to have some thoughts around that. What thoughts might you have if you failed a major test? What might you say to yourself?

Someone who is depressed might say something like

  • "I knew I was going to fail."
  • "I can't do anything right."
  • "I am never going to succeed at anything"

The problem with this type of self-talk is that it's probably not true and keeps someone stuck. Let's take a look at some healthier responses someone might say to themselves if they fail a test. Responses like:

  • "I wonder if everyone else failed too; was this just a bad test?"
  • "Did I study enough? I need to focus on what I can do to prepare better next time."
  • "This is just one test. I'm going to learn what I can from it and do my best next time. I know I can do better."

The patterns of negative self-talk are different for each emotional problem and usually unique to each person, although of course there is some overlap. Good CBT therapy can help you identify your unique patterns. And once you figure out your own patterns, you learn to recognize them, you learn to change them, and you learn you have the power to help yourself feel better.

An Example of Maladaptive Behaviors

Sticking with depression, depressed people usually have a bunch of unhelpful patterns of behaving that keep them stuck in the cycle of depression. When I see someone who is depressed, some of the first things I assess are behaviors. Unlike self-talk, behaviors are easy to see and observe.

Behaviors include things like:

  • Time spent in bed
  • Number of days a week you shower
  • How many times a day you eat
  • How many times a week you speak with another person

When people get depressed, they naturally start to shut down. They bathe less often, the spend more time in bed, they forget to eat, or they end up eating too much. These are symptoms of depression. But they are also behaviors that you can start (slowly) to take back control over. In cognitive behavior therapy, the therapist will usually try to help the client come up with a plan and goals to slowly start shifting these behaviors back to more healthy patterns.

Behaviors can cascade into a downward cycle, with one leading to another. You sleep more with the curtains closed, you get less sunlight, your body feels worse. You feel worse and more depressed, so you shower less, call in sick to work, cancel plans with friends. Now you're isolated and sluggish and maybe stressed about losing your job. You feel worse, so you spend more time sleeping…. That's a classic downward spiral. Small changes cascade into severe distress and dysfunction.

But the good news is that the cascade works in the other direction, too. You stay in bed but decide at least to keep the curtains open. You start making sure you drink at least a bit more water and eat just a bit more often. You sit up more. You decide to talk with a friend for a few minutes. Small changes start to add up, and slowly you can shift your patterns of behavior to a more healthy place.

What is CBT Good For?

The purpose of cognitive behavior therapy is to help you get well again. The first step in CBT is to learn to recognize your unique patterns of thoughts and behaviors. The second step is to practice new ways of thinking and acting.

CBT is very effective for many people with depression, anxiety, eating disorders, addiction problems, and many other problems.

CBT is not great for relationship problems. Cognitive behavior therapy is solely focused on you, as an individual. It can still help you figure out your own stuff, but if you're having major problems in relationships, parenting, or friendships, you and your therapist will probably want to expand the focus of your therapy to include other treatment methods.

How long is CBT treatment?

The process of change can be fast or slow, depending on a few factors. How you are ready for change, how quickly you can recognize your own self-talk, and how severe your problems are will all be factors in how quickly you can expect to improve with CBT.

Most CBT therapists use a short-term model, meaning therapy lasts anywhere from a few weeks to six months. Sometimes you might choose to work with a therapist longer than that, using your sessions to focus on several issues.

I worked with one client with CBT first for anxiety, then to focus on handling work-related problems better, and then finally to improve some health-related behaviors. Our work together was 9 months long, and we spent about 4 months on the first problem, but after she got into the swing of things, it took less time to address her other issues.

If someone comes in with a very specific problem, therapy can be much shorter. Sometimes someone just needs a gentle nudge and someone to point them in the right direction and they can take it from there. Sometimes people need much more support. Everyone is different, and each person's approach is valid.

Do I need a therapist or can I do CBT myself?

Cognitive behavior therapy can be a great form of self-help. The heart of CBT is simple. It's easy to adapt to a manual or workbook form.

Sometimes, though, it can really difficult to recognize your own thoughts and behaviors. Journaling or writing things down can be a good way to get some perspective. One of the major problems with relying on self-help, especially if you're depressed, is what happens if you don't feel better? You risk digging yourself even deeper into negative self-talk "I can't even fix this on my own" "I'm worthless" "This seems to be working for other people, what is wrong with me" are all sneaky damaging thoughts that can creep up on you and make problems worse.

A good therapist using CBT can help you get out of your head and give you some outside perspective. They can help you figure out how to recognize, challenge, and change those unhelpful thoughts and behaviors. Please note, though, that I said a good therapist. With therapy, it's so important to find someone who is qualified AND a good match for you.

Whether you try it on your own or seek out a professional to help you out, there is only one important thing: get the help you need. It's better to get help sooner rather than later. And it is possible to get better.

More info on therapy?

If you've been thinking about therapy, but still have questions about the process, check out this book. In it, I cover everything you need to know about good therapy from start to finish.

If you'd like to do more of your own research on CBT, check out the Beck Institute for good evidence-based information.