- What is CBT ? What is cognitive behaviour therapy?
- How does CBT work?
- Who benefits from CBT?
- When doesn’t CBT work?
- CBT techniques
- Cognitive behaviour therapy online
- CBT vs. behavioral therapy - what is the difference?
What is CBT ? What is cognitive behaviour therapy?
Cognitive Behavioural Therapy or CBT is a form of treatment that focuses on practical strategies to change unhelpful thought patterns or behaviours. It’s a type of psychotherapy - an approach which looks primarily at your psychological makeup, exploring how your thoughts and emotions impact your life and actions.
How does CBT work?
CBT is a goal-based system where patients take on activities and strategies designed to target their perceptions that are either negative or inaccurate. The aim of CBT is to replace unhelpful thoughts and behaviours with helpful or desirable ones, and to develop skills that promote mental resilience.
Cognitive behavioral therapy operates on the idea that what you think affects what you do. Therefore, by changing thinking, CBT aims to change behaviour as a result. A CBT trained therapist will first look for unhelpful thoughts, then begins the process of replacing them with accurate and positive thoughts through varying strategies. CBT is a great tool for changing the brain!
Who benefits from CBT?
- Anyone can benefit from cognitive therapy who is going through some sort of difficulty in life.
- While CBT is particularly helpful and effective for mental health disorders and phobias, it can also help someone who may be going through a difficult event - like losing a job, a loved one, or even just dealing with regular life stress.
- CBT is also recommended for people who don’t currently have any difficulties, in order to build preventative mental resilience.
When doesn’t CBT work?
Like all treatments, CBT might not work for 100% of people. This is normal and doesn’t mean that someone is a lost cause. CBT might not be as effective if a person doesn’t feel comfortable with their therapist, if their symptoms are too severe, or if they can’t see their therapist regularly enough to make meaningful change.
In these cases, CBT can be supplemented with other activities - like yoga or journaling - or partnered with a digital CBT platform, or with medications. For example, if someone cannot participate in CBT because their depression is too severe, antidepressants may be used to give the person a window of opportunity to change their thought patterns so they can eventually go off of the drugs when their thought patterns have been effectively reframed to avoid depressive feelings and behaviour.
CBT focuses more on ‘how’ rather than ‘why’. For this reason, people who have deep past issues that they want to explore first may not benefit as much from CBT, but should try out psychodynamic therapy, which is focused on an exploration of the past and how it manifests in the subconscious and in the present.
Cognitive behavioural therapy relies on practical, guided strategies to identify and replace unhelpful thought patterns. There are a large variety of techniques to cater for the unique situation of each person.
Techniques may include:
- Cognitive Distortion Examination. This involves exploring any thought patterns which fall under the “distortion” label - things like catastrophizing or jumping to conclusions.
- Journaling. Research shows that journaling is an effective way of identifying and reducing negative emotional responses while tracking solutions.
- Set Goals. By setting specific, measurable, achievable, relevant, time-bound goals, a person can make fast progress in therapy.
- Create Rewards.
- Desensitization. A therapist may slowly expose a person to a fear of theirs - for example, they might start by asking the client to imagine an elevator. Then they might look at pictures of elevators. Then look at one in person. Then stand in it for just ten seconds. Eventually, the aim is to dispel the fear entirely.
- Guided Discussion. CBT is a way for a person to maintain autonomy in their therapy - the therapist may ask guiding questions, but the patient will use the questions to self-examine their thoughts and behaviours.
- Applied Relaxation. Learning emotional control is an important part of cognitive therapy. Being able to relax at will helps take the body out of fight or flight mode, reducing stress, anxiety and depression.
CBT for anxiety
Anxiety can be a helpful emotion to create action. However, sometimes the anxiety people feel causes inaction or persists without reason.
- Studies show that CBT is a highly effective treatment for anxiety.1
- Anxiety is often caused by a person's perception of their ability to meet demands - thus CBT is highly relevant, targeting thought patterns and using practical activities to eliminate stressors.
- For example, consider a person who gets anxious in social situations. Perhaps they perceive that they cannot meet the social demands on them to make good conversation, and think that everything they say is embarrassing. In this scenario, CBT would focus on the perception causing the anxiety - evidence to the contrary, other explanations, accuracy, and thought distortions - and employ strategies to replace unhelpful thoughts (like “Everyone gets bored when I speak”) with helpful ones (i.e. “People always enjoy talking to someone who’s interested in them.” or “Even if they look bored, they may be tired or stressed about other things.”). They may also work on desensitization techniques to become more comfortable in social settings.
CBT for depression
Cognitive behavioural therapy is the most studied psychotherapy for depression. One of the main symptoms of depression is repeated negative thoughts, which are treatable through cognitive therapy methods.
- Clinical trials indicate that CBT used in conjunction with antidepressants may be more effective than medication alone.2
- Medication is usually effective only while it’s being taken, with no lasting benefit afterwards. Cognitive behaviour therapy is shown to have long lasting effects. Thus it can be helpful to use both in tandem - antidepressants can press pause on the brain long enough for CBT to properly implemented, at which point antidepressants can be slowly withdrawn.
- However, it’s important for all depression treatments to be tailored to each individual person.
CBT for insomnia
Insomnia has a variety of complex causes. However, insomnia can often be caused by mental issues, instead of physical ones. CBT can apply the same techniques used for mental disorders to help a person overcome insomnia and get a good night’s sleep.
For example, a clinician may look at a person’s sleep habits and beliefs, and recommend behaviours to change negative associations - like making sure the person only goes in their bedroom to sleep, and if they can’t get to sleep, to immediately leave the bedroom. Cognitive behavioural therapy for insomnia is extremely individual, tailored to the needs of each person.
Cognitive behaviour therapy online
For CBT to be effective, it must also be consistent and accessible. This can sometimes make in person CBT a difficult option for people who are isolated, busy, or under financial strain. Fortunately, modern technology is learning to replicate CBT techniques to help people remotely and on their own schedule - making widespread preventative action possible.
Cognitive behavioral therapy online training has become increasingly more popular in recent years, as digital health has begun to alter the therapy landscape. Driven uses CBT techniques tailored to each individual user. These techniques are woven throughout the daily activities, and intensified in the Rewire program, which addresses specific life adversity. Techniques like reappraisal, thought examination, SMART goal setting, and journaling help users identify and replace thought patterns to develop more resilient behaviour. Self-directed therapy based on CBT techniques has proven effective in several studies.
CBT vs. behavioral therapy - what is the difference?
While CBT revolves around thought identification and replacement, behavioural therapy uses a reward system to rewire the brain.
For example, if the therapist wants a client to step into an elevator, they will ask the client to do so, ignoring any negative behaviour or refusal. The therapist will simply ask again. When the client takes a step towards or into the elevator, the therapist will reward them (usually with praise).
Behavioral therapy is a more immediate, intense way to bring about behavioural change, and is usually used in situations where a person has a significant mental disorder preventing them from doing certain actions. For this reason, behavioural therapy is often used for people with autism, OCD, PTSD, or depressive disorder.
While CBT can also be used for these, CBT can also be used for more general circumstances, and allows a person to be in the driver's seat with their training.
Cognitive behavioral model
The cognitive behavioural model is the groundwork of CBT. It revolves around the idea that emotions and beliefs result in lived experience and behaviours. What happens in your head expresses itself through your actions. This is called the perception-action cycle. As Einstein said, “Perception is reality.” The psychologist Beck (1976) argued that it isn’t a particular situation which causes distress to a person, but instead, their perception of the situation. Sometimes a person’s perception can be distorted, causing distress and interfering with their life. CBT aims to align a person’s perception better with reality, to help them make more informed choices.
CBT Australia and worldwide
Cognitive behaviour therapy in Australia is mostly covered by Medicare, but still carries additional up-front costs for therapist sessions. If cost, transport, or accessibility pose an obstacle, you could consider digital platforms, like Driven, that use CBT principles to train people at any time and any place, for a fraction of the cost.
CBT and medication
For some people, cognitive behavioural therapy will be just as effective as medication, while others may need a mix of both. Sometimes medication is used to put the brain ‘on pause’ long enough for CBT to remove the long term negative thinking patterns, reducing the chances of relapse even after the medication window is finished.
1Carpenter, J. K., Andrews, L. A., Witcraft, S. M., Powers, M. B., Smits, J. A., & Hofmann, S. G. (2018). Cognitive behavioral therapy for anxiety and related disorders: A meta‐analysis of randomized placebo‐controlled trials. Depression and anxiety, 35(6), 502-514.
2Steven D. Hollon, Robert J. DeRubeis, Jan Fawcett, Jay D. Amsterdam, Richard C. Shelton, John Zajecka, Paula R. Young, Robert Gallop. Effect of Cognitive Therapy With Antidepressant Medications vs Antidepressants Alone on the Rate of Recovery in Major Depressive Disorder. JAMA Psychiatry, 2014; 71 (10): 1157 DOI: 10.1001/jamapsychiatry.2014.1054