The Complete Guide to CBT

Cognitive-behavioral therapy is a highly effective treatment for emotional and psychological disorders.

What is CBT?

Cognitive-behavioral therapy, or CBT for short, is a fascinating therapeutic technique that seeks to solve various mental and emotional disorders by identifying and changing underlying thought patterns. CBT assumes that destructive thought patterns and learned behavior play a major, and sometimes primary role in a wide variety of conditions.

Modern CBT therapy includes a wide range of highly effective cognitive-behavioral therapy techniques that seek to identify, challenge, eliminate and replace these negative cognitive elements. In this article, we will guide you through each aspect of CPT and introduce you to some exciting, highly effective therapeutic techniques that yield incredible results. Today, CBT is one of the most popular and effective therapeutic treatments for many disorders. Let’s take a look at where this began and the common usage today.

CBT (Cognitive-Behavioral Therapy)

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The History of Cognitive-Behavioral Therapy

The 1950s

Modern CPT is rooted in the 1950s when psychologists and psychiatrists from South Africa, England, and the United States started using psychotherapeutic interventions based on principles of learning theory. 1

Early 1960s

During the 1950s, behavior therapy became integrated in established forms of treatment, and this continued into the early 1960s, where it appeared in several industry publications. Other terms began emerging based on behavior therapy, including behavior modification and the practice gained momentum, which showed positive results.. 1

First Journal and Association

In 1963, the first scientific journal dedicated to behavior therapy, titled Behavior Research and Therapy, was published. In 1966, the Association for Advancement of Behavior Therapy (AABT) was established.  1

Behavior Therapy & Cognitive Treatments

During the 1960s and 1970s, psychologists combined behavior therapy with cognitive treatments, which gave birth to the modern version of CBT as we know it today. Although many people played a role in this development, two men named Aaron Beck and Albert Ellis played a significant role in the development of these treatments.  2

How Commonly Used is CBT?

CBT therapy is largely considered as the gold standard in psychological treatment. Although this is often debated and argued, there are solid reasons for this consideration.

CBT vs. DBT

DBT, or dialectical behavior therapy, is a type of CBT therapy for complex mental disorders. It helps to alter harmful behavior patterns like self-harm, suicidal tendencies, and substance abuse. DBT evolved from CBT when certain DBT can assist in cases where CBT cannot. These cases include extreme personality disorders, self-harm, and substance abuse, and as such, DBT places an even stronger emphasis on the psychosocial aspects of treatment. 4

How Does Cognitive-Behavioral Therapy Work?

What Does a CBT Session Look Like?

CBT sessions might seem daunting to those who have never been to one. However, the reality is that they are very safe spaces where a cognitive therapist will try to identify, address, and change negative thought processes. So, let’s take a closer look at some of the basic techniques used during CBT therapy sessions.

The following are common elements in a cognitive therapy session.

Coping With Negative Thoughts

Learning to cope with negative thoughts is one of the priorities of a therapy session, which starts with identifying negative thought processes. The cognitive-behavioral model suggests that three layers of unhelpful thinking exist in people struggling with psychosocial difficulties:

Automatic Thoughts

The immediate instinctive thoughts you have about any situation or occurrence are known as automatic thoughts. These thoughts happen so quickly that we don’t often pay much attention to them, which is part of the problem. Automatic thoughts can help in dealing with situations and making appropriate choices. Still, when they are associated with symptoms of psychopathology, such as social isolation, depression, or anxiety, which could negatively impact your life.5

Intermediate Beliefs

Intermediate beliefs are usually pervasive across most situations known as intermediate beliefs. The big difference between automatic thoughts and intermediate beliefs is that the former are reactive and situational, whereas the latter is usually held for most situations. These intermediate beliefs can change over time, but negative beliefs have become entrenched and are causing problems. 5

Core Beliefs

The deeply entrenched beliefs and affect both automatic and intermediate thought are known as core beliefs. They are often developed in childhood and are very difficult to isolate and change successfully. They are rigid and pervasive, meaning that positive types are beneficial and harmful ones are incredibly damaging. Therefore, a significant goal of CPT therapy is to address negative core beliefs, as these tend to guide the other thoughts and beliefs. 5

CPT therapy sessions will help patients differentiate between these three types of thoughts and beliefs. Automatic thoughts are usually addressed first because they are the least entrenched and offer a glimpse into the deeper issues that influence them.

The goal of this part of the session is to identify the following regarding the patient’s thoughts: 

  • Is the thought or belief secondary to another thought or belief?
  • How much does the patient believe the thought or belief?
  • Does the thought or belief negatively affect the patient’s life?
  • Is the patient prepared to tackle it now, or should they handle it later?

New Skills

Once the thoughts have been identified and categorized, the patient should be introduced to new skills and reintroduced to pleasant activities. This is usually in the form of behavioral activation. It includes a set of procedures and techniques to encourage patient activities that improve their mood and general functioning.

The behaviors to be encouraged include:

  • Reintroducing previous pleasant activities
  • Introducing new pleasant skills and activities
  • Teach active coping or mastery activities that previously triggered negative feelings
    • Dealing with difficult family members
    • Going to work
    • Cleaning the house

Problem-Solving

Problem-solving is a vital part of cognitive-behavioral therapy where effective means of coping with problems of everyday living are established. It involves analyzing problem areas and then identifying coping mechanisms. Ultimately, a plan is formulated where patients have solutions to the most triggering and challenging scenarios in their lives. Problem-solving techniques should impart skills that aid the patient in feeling increased control over life issues that previously felt overwhelming or unmanageable. As such, problem solving can help with practical resolution and emotion-focused coping. Problem-solving techniques should be practical, meaning the solutions should be realistic and tangible. Additionally, the more specific the problem-solving technique is, the more effective it will likely be. Last but not least, the problem-solving techniques should be simple, as to not be too complex or take too much time to implement.

Self-Monitoring

Self-monitoring is actively encouraged during cognitive-behavioral therapy sessions. The basic concept is explained, and patients are urged to keep a personal diary to assist in their treatment. Thoughts, emotions, physical feelings, and reactions to various stimuli should be included here. Self-monitoring aims to help with clinical evaluation and empower the individual to play a significant role in self-analysis and healing. It puts the patient in control of the process and their feelings and reactions. Self-monitoring doesn’t need to follow a strict format. Instead, it should encourage patients to record everything they feel, react to, and any other forms of expression and emotional feeling they might have.

The Importance of Setting Goals

The importance of setting individual goals for the patient

Another essential part of the cognitive-behavioral therapy sessions is to set individual goals for the patient. These goals should be based on all the information gathered throughout the therapy sessions. They should also be attainable in the patient’s mind and based on the therapist’s professional opinion.

These goals help to make treatment less daunting for patients. It breaks down positive progress into small and manageable pieces. Quite often, patients requiring CBT become overwhelmed with obligations or relatively daunting activities, and as such, these goals shouldn’t contribute to anxiety, depression, or any other disorders already present.6

Let’s look at some practical examples of CBT session goals for patients with various mental and emotional challenges. CBT for insomnia is another use of cognitive-behavioral therapy, but today, we are looking at CBT for patients with behavioral challenges, depression, anxiety, and trauma.

Goals For Patients with Behavioral Challenges

  • Goals for patients with behavioral challenges
    • Keep their hands to themselves without getting physical with anyone.
    • Find constructive ways to deal with rage and anger.
    • Come up with practical outlets instead of fighting and arguing.
    • Don’t get into trouble at school or at home for a month.
    • Commit to expressing your feelings as soon you feel frustration building up.

Goals For Patients with Depression

  • Goals for patients with depression
    • Make a new friend every month.
    • Think of one positive aspect despite everything that makes you feel depressed.
    • Limit time alone in your room or at home to only a few hours per day.
    • Set goals for socializing and going out.
    • Participate in activities that make you excited and happy at least once a day.
    • Exercise for at least an hour every single day to improve your mood.

Goals For Patients with Anxiety

  • Goals for patients using CBT for anxiety
    • Do one thing out of your comfort zone per day.
    • Face a major fear once a month.
    • Make new friends and meet new people.
    • Keep a diary of triggers and bring them to the next session.

Goals For Patients with Trauma

  • Goals for patients with trauma
    • Stop blaming yourself by repeating a mantra every single day.
    • Understand that nightmares are a natural way of dealing with trauma.
    • Look at yourself in the mirror for a set time every day.
    • Go out and connect with friends at least twice a week.

An Example of Goal Setting

What Are Cognitive Distortions?

Cognitive distortions are subjectively biased ways in which we view ourselves and the world around us. They are tendencies or patterns of thinking and are inaccurate. Moreover, they are reinforced over time, and when they are negative, they can be highly damaging both psychologically and emotionally.7 The following are types of cognitive distortions that will be identified and addressed during CBT therapy.

All-Or-Nothing Thinking

Also known as polarized thoughts or black-and-white thinking, this cognitive distortion causes a patient to only view things in extremes, without acknowledging nuance or gray areas.

Overgeneralization

When one or two incidents causes a patient to identify a pattern and make broad assumptions about either themselves or the world, they are overgeneralizing.

Mental Filters

When small yet harmful events are amplified, any good or positive aspects are filtered out and disregarded.

Positive Disqualifications

Positive aspects are acknowledged but they are still dismissed and rejected as being either fictitious or irrelevant.

Jumping To Conclusions

This is an inaccurate belief that makes someone think they know what somebody else is thinking without asking them or clarifying their intentions directly.

Magnification or Minimization

Also known as the binocular trick, this cognitive distortion either exaggerates or diminishes the meaning of things, including their importance or their relevance to the current situation. 7

How CBT Changes Cognitive Distortions

There are a few techniques that CBT uses to change cognitive distortions.

  • Cognitive Distortions Recognition: Patients read about cognitive distortions and select the ones they resonate with or feel that they have.
  • Automatic Thought Record: Patients are encouraged to keep records of their automatic thoughts and assumptions.
  • Decatastrophizing: Patients are taught how to deescalate wild and extreme thoughts about people’s situations by journaling and working through them.
  • Discernment Between Facts and Opinions: Various statements are made and written down, and together with the therapist, the patient discerns between what is fact and what is opinion.7

What is Cognitive Behavioral Therapy Used to Treat?

There are a variety of conditions treated by CBT, and these include the following.
  • Depression: CBT techniques can identify unhealthy patterns of thought to determine how they affect your mood, self-belief, and your outlook on life in general.8
  • Anxiety Disorders: CBT is particularly effective for anxiety, which is related mainly to learned reactions and beliefs about people and scenario.
  • ADHD: CBT seeks to alter irrational thought patterns that prevent people from focusing on tasks and being productive.
  • OCD: Exposure and response prevention (ERP) is a form of CBT that is particularly effective for reducing OCD symptoms.
  • PTSD: Post-traumatic stress disorder is directly linked to cognitive memory that affects patients’ lives. As such, CBT can identify and treat these symptoms with great effectiveness.

Dual Diagnosis Treatment

CBT therapy can be highly effective as a CBT for addiction approach for addiction-based disorders.

Dual diagnosis is when there is both an addiction disorder and mental illness. The two are always linked, and either the abuse has caused the mental illness, or in most cases, the mental illness has resulted in self-medication or actively seeking risky and addictive behavior.

CBT techniques are effective at treating both the addiction and mental disorder in the following ways:

  • Isolating the learned behavior and beliefs that trigger drug or alcohol abuse
  • Changing the cognitive reaction to triggers that lead to abuse
  • Developing self-awareness and self-love to better understand reactions and cravings

Integrated cognitive behavioral therapy (ICBT) is particularly effective with dual diagnosis cases. ICBT simply means that CBT principles are used to fit the format needed in any given treatment scenario. It means that the technique for performing ICBT will be different for a patient with PTSD and heroin addiction than for a patient suffering from bipolar disorder and marijuana abuse.9

A Discussion on CBT

How CBT Helps in Addiction Treatment

CBT techniques and CBT for addiction can assist addiction treatment in the following ways.

Explores Harmful Thought Patterns and Behaviors

One of the primary functions of CBT is to explore harmful thought patterns and identify the root causes via talk therapy. In this regard, it is highly effective in identifying the root causes of destructive and addictive behavior, which is the first step to successful treatment.

Allows Alternative Thinking

Once the harmful thought patterns are identified through talk therapy, alternative ways of thinking must be introduced as part of the treatment process. CBT uses a variety of techniques to facilitate new ways of thinking. Patients are taught how to think in new ways and are encouraged to continuously monitor and correct their negative thought processes and replace them with positive ones.

Can Be Done in Group or Individual Settings

Therapy for addiction can be undertaken in both individual and group sessions. There are various benefits for each, including increased honesty and expression in individual sessions and the benefit of camaraderie and support in group sessions. Both are generally accepted as effective and should be left up to the therapist and patient to decide on.10

Incorporates Useful Practices into Everyday Life

One of the most compelling aspects of CBT is the practical and valuable information that patients learn and can apply in their everyday lives. It includes journaling, personal monitoring, and techniques that are applicable both in and away from therapy sessions.

Effectiveness of Cognitive Behavioral Therapy

There have been extensive studies on the effectiveness of CBT vs. other therapies, and the outcomes vary depending on a wide range of factors. Statistics related to CBT are therefore subjective to the sample population and the initiators of the studies.

Other Therapies and Treatments Used Alongside CBT

CBT integrates well with several other therapies and treatments.

Medication-Assisted Treatment

CBT can be successfully integrated with medication-assisted therapies. It is often prescribed as a supplementary therapy for patients who require medication. In most cases, medication-assisted treatment is usually offered as in-person sessions only, but online CBT may be available to you.

Motivational Interviewing

Motivational interviewing is a form of therapy with close ties to CBT, and the two methods are often used in conjunction with one another.

Holistic Treatment

Modern therapeutic methods take a holistic approach to treatment, incorporating various methods to assist patients, including CBT.

Peer Support Groups

Another highly effective treatment method is peer-support groups, which can either be in-person sessions or CBT online as well. CBT can be incorporated into this treatment when participants share their self-analysis and feelings with their peers.