Understanding CBT

Cognitive Behavior Therapy, commonly referred to as CBT, is a therapeutic approach that highlights the connection between our thoughts, emotions, and behaviors. In CBT, sessions may include emphasizing the present, concrete goal setting, and understanding the interaction that our thoughts, feelings, and experiences have on our own behavior. Part of the framework of CBT involves recognizing that our thoughts are not always accurate or helpful, and that we often run into trouble when we act as though all of our thoughts are true. Our thoughts can influence behaviors and emotions; and likewise, our behavior can powerfully affect how we think and feel. 

The CBT Model can look something like this:

Some iterations of CBT place a greater emphasis on the role of thoughts in affecting feelings and behavior, while others focus more on how our experiences; the events that occur in our lives, impact our thoughts, feelings, and internal dialogue. Based on the client’s specific needs and the expertise of the clinician, there are myriad interventions that might be used in CBT sessions. Cognitive Behavior Therapy can be used as a short-term treatment to help people overcome specific challenges in their life, and it can also be used as a more general framework to help clients make wide reaching changes in how they navigate their world. CBT is used for a breadth of diagnoses and conditions, including: 

  • Attention Deficit Hyperactivity Disorder (ADHD)
  • Anger Management
  • Anxiety Disorders
  • Panic Attacks/ Panic Disorder
  • Bipolar Disorder
  • Child Behavior Problems
  • Obsessions and Compulsions (OCD)
  • Depression
  • Grief
  • Eating Disorders
  • Insomnia
  • Phobias
  • Chronic Stress
  • Procrastination
  • Substance Misuse or Substance Use Disorders
  • Trauma or Post Traumatic Stress Disorder (PTSD)

Although Cognitive Behavior Therapy is often characterized as short-term, this is likely in comparison to traditional psychoanalytic approaches, which can involve weekly sessions for a number of years, and focus more intensely on the client’s past experiences and family history.

A key piece of “the work” in Cognitive Behavior Therapy involves the client and therapist working together to identify and refute cognitive distortions. Cognitive distortions are often false beliefs and narratives that people tell themselves which inadvertently propel their negative symptoms. Cognitive distortions can involve one’s self, the world, and the future. Cognitive distortions might look like catastrophizing, black & white thinking, labeling, overgeneralization, fortune telling, jumping to conclusions, and “should” statements. This type of thinking can (and often does) lead to negative self-talk, self-doubt, and a lack of effective coping strategies. 

There is no “one size fits all” approach to CBT. Therapy will look very different depending on the client and their own personal preferences and challenges. The therapist’s goal is to build rapport with the client and through this relationship, determine together what strategies may work best. Cognitive Behavior Therapy is comprised of several interventions,  some of which are:  

  • Psychoeducation
  • Somatic Management
  • Modeling & Guided Participation
  • Role Plays
  • Cognitive Restructuring
  • Homework

Sometimes, CBT will involve “homework” or experiments that the client is tasked with completing between sessions. The purpose of homework is to facilitate small changes from week to week in hopes of identifying an activity, skill or strategy that resonates with the client. Once the effective coping strategy is pinpointed, it becomes part of the healing process. 

For example, if my client is experiencing unwanted intrusive thoughts, it may be difficult for them to successfully navigate throughout their day without becoming upset, anxious, or distracted. In the therapy session, we would work together to identify the intrusive thoughts and when they tend to interfere in the client’s mind. Through talk therapy, we would highlight strategies for disrupting or interrupting this unwanted intrusive thought, and come up with responses for the client to practice when these thoughts come into consciousness throughout their week. This exercise becomes the “homework” and the effectiveness is discussed in the next session. This is just one case, however this framework has worked for many clients with a range of challenges.

All therapeutic approaches have their own scope and sequence which usually involves rapport building, information gathering, identifying strengths and resources, and ultimately problem solving. Typically in CBT, treatment will follow a STEPS approach to collaborative problem solving. This approach is summarized below: 

S– Summarize the issues or challenges you are facing 

T– Think of solutions 

E– Evaluate the solutions 

P– Pick the best one 

S– See how it works

This process is repeated until the client feels comfortable with the strategies and finds them effective and seamless to integrate into their daily lives. The goal of Cognitive Behavior Therapy is for clients to build up a strategy “toolbox” to manage challenges independently. Of course, ongoing support is provided based on the needs and desires of the client. 

How do I know if CBT is for me? 

The best way to determine if Cognitive Behavior Therapy is an approach that would work well for you is to schedule a consultation with a mental health professional. Consultations are usually complementary 15 minute phone calls where a provider can answer questions you may have about beginning therapy. If you have any demographic preferences for your therapist, such as race or gender, this would be a good time to share that information with the clinician. The therapist will consider your symptoms, treatment history, and goals you share for therapy, and recommend the best next steps. This is also a good way to determine if you think the clinician that you are speaking with might be a good match for you.

Are you familiar with CBT? Click here to set up a complementary consultation call to determine if CBT could be effective for you!