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CBT
Cognitive-Behavioral Therapy
In the 1960s, American psychiatrist Aaron Beck developed a method of psychotherapy which was then called “cognitive therapy”. Today it is referred to by most of the practitioners as cognitive-behavioral therapy.
It was designed for patients suffering from depression. Since then, it has been adapted to the needs of patients with various diagnoses and problems, of various ages, origins and levels of education.
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Cognitive-Behavioral Therapy
What is CBT therapy?
Both cognitive and behavioral therapies assume that “it is the learning processes that determine our behavior (behavioral therapy), the way we acquire and perpetuate our beliefs and how we perceive the world (cognitive therapies)” (Popiel and Pragłowska, 2008). In practice, the cognitive therapy techniques are applied together with the ones of behavioral therapy. Therefore, in most offices we will come across the term “cognitive-behavioral psychotherapy”. The abbreviation “CBT” is also commonly used – from English for “cognitive-behavioral therapy”.
Today there are many forms of cognitive-behavioral therapies that share some common features (the most important of which is the use of cognitive and behavioral therapy techniques) and yet differ from one another in terms of conceptualization, focus on selected elements of the disorder model or the used techniques. Beck’s cognitive theory integrates different types of psychotherapy and is open to its new forms.
The cognitive model which underlies the cognitive-behavioral therapy assumes that dysfunctional thinking – distorted automatic thoughts and rigid beliefs – is the common feature of all mental disorders. Non-adaptable cognitive schemes and beliefs are created as a result of our experiences, often the ones from our early childhood. In the course of our lives, we “learn” a certain style of thinking which then strengthens and becomes a filter through which we interpret our subsequent experiences. The way we think affects the kind of emotions we experience and how we behave. Because cognitive schemes are “saturated” with emotions and are sometimes quite rigid, sometimes we need specialist help in order to change them.
Dobson and Dozois (2001) indicate the following principles of cognitive therapy:
- Cognitive activity affects our behavior.
- Cognitive content and processes can be monitored and changed.
- Behavioral and emotional change can be prompted by a cognitive change.
Treatment in cognitive behavioral therapy is based on conceptualization, i.e. individual formulation of a patient’s problem. The therapy aims at changing the patient’s cognition in order to cause an emotional and behavioral (behavior) change. By a cognitive change we mean a change in our thought content (beliefs, opinions, assumptions, expectations) and cognitive processes (cognitive distortions, deductions, cognitive strategies). In order to achieve a lasting improvement in mood and behavior, the therapy affects our deeper cognitive content, i.e. beliefs. After changing to more functional thinking, patients may feel better, deal better with their problems and take actions that are beneficial for them.
Nowadays, not only are the theoretical principles and techniques of cognitive-behavioral therapy used in psychotherapy itself, but also in counselling, social welfare and education.
Science about CBT
Cognitive Behavioral Psychotherapy uses evidence-based methods. What it means is that the effectiveness of the used techniques is assessed in empirical research. In their practice, therapists choose cognitive models and techniques that have already proven to be effective in treating a given disorder. The effectiveness of cognitive-behavioral therapy has been demonstrated in over several hundred studies on various mental disorders and problems.
These disorders include i.a.:
- depression, suffered also by the elderly people
- anxiety disorders and phobias
- post-traumatic stress disorder and other stress disorders
- obsessive-compulsive disorders
- behavioral disorders
- eating disorders
- dysmorphophobia
- ADHD
- personality disorders
- bipolar-affective disorder (alongside pharmacology)
- schizophrenia (alongside pharmacology)
Cognitive behavioral psychotherapy is an effective method of intervention in case of problems such as:
- relationship problems
- difficulties in dealing with emotions (e.g. anger, jealousy)
- prolonged mourning
- behavioral addictions (e.g. gambling)
Scientific research has shown that cognitive-behavioral psychotherapy helps patients suffering from somatic diseases with a mental disorder component, which include: irritable bowel syndrome, insomnia, pain in cancer, rheumatic pain, migraine, fibromyalgia, obesity, and sexual disorders.
Cognitive behavioral psychotherapy is also effective in preventing the recurrence of the disorders. Research into the effectiveness of cognitive behavioral therapies is ongoing and covers its various forms and aspects, such as, for example, therapy using modern technologies, different age groups of patients, and neurobiological changes taking place in the brain.
Cognitive-behavioral psychotherapy is recommended as the primary form of treatment and reimbursed by insurers in many countries around the world.
What is the
Third wave of therapy
Significant progress has been made in cognitive behavioral therapy since its beginnings in the 1950s. Further scientific research and therapeutic practice have given rise to new theories, approaches and methods, which allows us to speak of “therapies” rather than one cognitive-behavioral “therapy”. The development process of cognitive behavioral therapies is often referred to as the “three waves”.
The “first wave” of behavioral therapies is considered to include the methods based on classical and instrumental conditioning research of behaviorists such as Watson, Skinner and Pavlov. The methods were especially helpful for people suffering from post-traumatic stress. The achievements of this stage are still used by contemporary therapists.
The achievements founded by the “second wave” of cognitive-behavioral therapies include i.a. cognitive models of mental disorders. Such models integrated thoughts, beliefs in our understanding of the world, changes in behaviors and emotional experience. It was Aaron Beck and Albert Ellis who pioneered such changes.
The “third wave” evolved from the traditional approach applied in cognitive therapies, adding to them the elements such as mindfulness, focus on cognitive processes, emphasis on therapeutic relationship, values and spirituality. The new methods have been developed in response to the need of more effective techniques in treating complex problems, as well as the need for patients’ personal development. This is what makes them extremely helpful in treating personality disorders and recurrent disorders.
The “third wave” includes i.a. Dialectical Behavioral Therapy (DBT), Metacognitive Therapy (MCT), Acceptance and Commitment Therapy (ACT), Mindfulness-Based Cognitive Therapy (MBCT) and Schema Therapy.
In our work we use the techniques of both the “classical” approach and the achievements of the “third wave”.
Additional information
Glossary
Psychotherapy – a treatment of disorders with the use of psychological methods. “Conscious and intended use of clinical methods and interpersonal attitudes derived from the recognized principles of psychology which helps people modify their behavior, cognitive processes, emotions and other personal traits to go towards the desired direction” (Norcross, 1990; after; Prochaska and Norcross, 2006).
Cognitive-behavioral psychotherapy – a method of treating mental disorders, problematic behavior and emotional difficulties. It is based on the premise that our thoughts determine the way we feel and behave. In therapy we strive to change the unfavourable, often habitual, automatic thoughts and dysfunctional beliefs. To do that, cognitive-behavioral psychotherapy uses methods of scientifically proven effectiveness.
CBT – abbreviation standing for “cognitive-behavioral therapy”.
Conceptualization – individual, cognitive formulation of a patient’s problem. Such formulation lays the ground for the treatment plan. The plan then may be changed and improved during the therapy.
Socratic dialogue – a therapeutic method; a dialogue involving both sides, it encourages you to question the existing way of thinking. By using it in the cognitive-behavioral psychotherapy, we assume that patients are aware of their beliefs and it is possible for them to access information about themselves by answering relevant questions from the therapist.
Beliefs (schemes) – a cognitive structure that selects, codes and evaluates the stimuli affecting our bodies (Popiel and Pragłowska, 2008). Beliefs constitute a coherent and consolidated knowledge of an individual, formulated on the basis of previous experiences and reactions (Segal, 1988).
References
Beck, J. S. (2012). Terapia poznawczo-behawioralna. Podstawy i zagadnienia szczegółowe. Wydawnictwo Uniwersytetu Jagiellońskiego, Kraków.
Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clinical psychology review, 26(1), 17-31.
Chambless, D. L., & Ollendick, T. H. (2001). Empirically supported psychological interventions: Controversies and evidence. Annual review of psychology, 52(1), 685-716.
Popiel, A., & Pragłowska, E. Psychoterapia poznawczo-behawioralna, P. E. (2008). Teoria i praktyka. Paradygmat, Warszawa.
Prochaska, J. O., & Norcross, J. C. (2006). Systemy psychoterapeutyczne. Analiza transteoretyczna.
Segal, Z. V. (1988). Appraisal of the self-schema construct in cognitive models of depression. Psychological bulletin, 103(2), 147.
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