What is CBT?

Referred to as “CBT”, cognitive behavioral therapy is a short-term talk and behavioral psychotherapy for the treatment of depressive and anxiety disorders. It educates patients that psychological disorders are often the result of a dysfunction in the brain’s information-processing system. What this means for depressed patients is that their thoughts become negative. Therefore they are likely to experience themselves, the world, and the future through a negative prism; while anxious patients conclude that there is more danger in their lives, loss of control, and that they are inadequate to deal with it.

How does it work?

Treatment consists of examining thoughts and conclusions linked to painful emotions in order to determine if they are accurate and if there is any evidence to support them. When negative thoughts are corrected and become rational and based on facts, mood changes, as does behavior. The person may become free of painful affect. If however, a depressed woman believes that she is a “bad and inadequate” mother, CBT would help her scrutinize this conclusion by looking at the evidence, pro and con. Therefore, if she can accurately see herself based on looking at the evidence, she may find that she is a perfectly adequate mother. If this is true, her mood should shift from depressed to feeling relieved. If an anxious patient understands that his thoughts are the source of his anxiety and that he can cope in more productive manner, anxiety will gradually decrease and he/she will no longer avoid triggers that might precipitate anxiety. Medication may also compliment CBT.

What role does the patient play?

Therapists provide much education to their patients in order to help them clearly understand their illness and about how therapy will proceed.

Therapists are quite active early in treatment, but as time passes a patient is expected to become more active. At the initial meeting the therapist will ask patients to develop a number of goals. Each session is devoted to working on the goals of treatment, although these may change as therapy proceeds.

What illnesses does CBT treat?

CBT treats OCD, social anxiety, phobias, generalized anxiety disorder, eating disorders, bipolar disorders, and insomnia. It is also used in certain hospital settings. Therapists have used CBT in groups, with children, adolescents, adults and older adults.

What happens if the patient doesn’t improve?

Chronic, resistant psychological disturbances such as: chronic or recurrent depression and anxiety disorders, personality disorders, maladaptive interpersonal behavior, and others require a newer approach that is based on classical CBT. There are more recently developed strategies for chronic disorders. Two such therapies are schema and modal therapy as developed by Jeff Young, Ph.D. These theapeutics are well presented in Dr. Young’s recent book, Schema Therapy. In an earlier work, he lays out his ideas for patients in Re-Inventing Your Life.

Can I read more about CBT?

Two excellent books on CBT are: Feeling Good, by David Burns, MD; and Mind Over Mood, by Christine Padesky, Ph.D. (it includes a workbook for patients and there is a companion therapist’s guide book).

CBT Links

The Beck Institute
Academy of Cognitive Therapy
Cognitive Therapy Center of New York
Schema Therapy