Cbt therapy overview
Overview - Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) is a talking therapy that can help you manage your problems by changing the way you think and behave.
It's most commonly used to treat anxiety and depression, but can be useful for other mental and physical health problems.
How CBT works
CBT is based on the concept that your thoughts, feelings, physical sensations and actions are interconnected, and that negative thoughts and feelings can trap you in a vicious cycle.
CBT aims to help you deal with overwhelming problems in a more positive way by breaking them down into smaller parts.
You're shown how to change these negative patterns to improve the way you feel.
Unlike some other talking treatments, CBT deals with your current problems, rather than focusing on issues from your past.
It looks for practical ways to improve your state of mind on a daily basis.
Uses for CBT
CBT has been shown to be an effective way of treating a number of different mental health conditions.
In addition to depression or anxiety disorders, CBT can also help people with:
- bipolar disorder
- borderline personality disorder
- eating disorders – such as anorexia and bulimia
- obsessive compulsive disorder (OCD)
- panic disorder
- phobias
- post-traumatic stress disorder (PTSD)
- psychosis
- schizophrenia
- sleep problems – such as insomnia
- problems related to alcohol misuse
CBT is also sometimes used to treat people with long-term health conditions, such as:
- irritable bowel syndrome (IBS)
- chronic fatigue syndrome (CFS)
- fibromyalgia
Although CBT cannot cure the physical symptoms of these conditions, it can help people cope better with their symptoms.
What happens during CBT sessions
If CBT is recommended, you'll usually have a session with a therapist once a week or once every 2 weeks.
The course of treatment usually lasts for between 5 and 20 sessions, with each session lasting 30 to 60 minutes.
During the sessions, you'll work with your therapist to break down your problems into their separate parts, such as your thoughts, physical feelings and actions.
You and your therapist will analyse these areas to work out if they're unrealistic or unhelpful, and to determine the effect they have on each other and on you.
Your therapist will then be able to help you work out how to change unhelpful thoughts and behaviours.
After working out what you can change, your therapist will ask you to practise these changes in your daily life and you'll discuss how you got on during the next session.
The eventual aim of therapy is to teach you to apply the skills you have learnt during treatment to your daily life.
This should help you manage your problems and stop them having a negative impact on your life, even after your course of treatment finishes.
Pros and cons of CBT
Cognitive behavioural therapy (CBT) can be as effective as medicine in treating some mental health problems, but it may not be successful or suitable for everyone.
Some of the advantages of CBT include:
- it may be helpful in cases where medicine alone has not worked
- it can be completed in a relatively short period of time compared with other talking therapies
- the highly structured nature of CBT means it can be provided in different formats, including in groups, self-help books and online
- it teaches you useful and practical strategies that can be used in everyday life, even after the treatment has finished
Some of the disadvantages of CBT to consider include:
- you need to commit yourself to the process to get the most from it – a therapist can help and advise you, but they need your co-operation
- attending regular CBT sessions and carrying out any extra work between sessions can take up a lot of your time
- it may not be suitable for people with more complex mental health needs or learning difficulties, as it requires structured sessions
- it involves confronting your emotions and anxieties – you may experience initial periods where you're anxious or emotionally uncomfortable
- it focuses on the person's capacity to change themselves (their thoughts, feelings and behaviours) – this does not address any wider problems in systems or families that often have a significant impact on someone's health and wellbeing
Some critics also argue that because CBT only addresses current problems and focuses on specific issues, it does not address the possible underlying causes of mental health conditions, such as an unhappy childhood.
How to find a CBT therapist
You can get psychological therapies, including CBT, on the NHS.
You can refer yourself directly to an NHS psychological therapies service (IAPT) without a referral from a GP.
Or your GP can refer you if you prefer.
If you can afford it, you can choose to pay for your therapy privately. The cost of private therapy sessions varies, but it's usually £40 to £100 per session.
The British Association for Behavioural & Cognitive Psychotherapies (BABCP) keeps a register of all accredited therapists in the UK and The British Psychological Society (BPS) has a directory of chartered psychologists, some of whom specialise in CBT.
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Animated video explaining self-referral to psychological therapies services for stress, anxiety or depression.
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Cognitive behavioral therapy - Mayo Clinic
Overview
Cognitive behavioral therapy (CBT) is a common type of talk therapy (psychotherapy). You work with a mental health counselor (psychotherapist or therapist) in a structured way, attending a limited number of sessions. CBT helps you become aware of inaccurate or negative thinking so you can view challenging situations more clearly and respond to them in a more effective way.
CBT can be a very helpful tool ― either alone or in combination with other therapies ― in treating mental health disorders, such as depression, post-traumatic stress disorder (PTSD) or an eating disorder. But not everyone who benefits from CBT has a mental health condition. CBT can be an effective tool to help anyone learn how to better manage stressful life situations.
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Why it's done
Cognitive behavioral therapy is used to treat a wide range of issues.
It's often the preferred type of psychotherapy because it can quickly help you identify and cope with specific challenges. It generally requires fewer sessions than other types of therapy and is done in a structured way.
CBT is a useful tool to address emotional challenges. For example, it may help you:
- Manage symptoms of mental illness
- Prevent a relapse of mental illness symptoms
- Treat a mental illness when medications aren't a good option
- Learn techniques for coping with stressful life situations
- Identify ways to manage emotions
- Resolve relationship conflicts and learn better ways to communicate
- Cope with grief or loss
- Overcome emotional trauma related to abuse or violence
- Cope with a medical illness
- Manage chronic physical symptoms
Mental health disorders that may improve with CBT include:
- Depression
- Anxiety disorders
- Phobias
- PTSD
- Sleep disorders
- Eating disorders
- Obsessive-compulsive disorder (OCD)
- Substance use disorders
- Bipolar disorders
- Schizophrenia
- Sexual disorders
In some cases, CBT is most effective when it's combined with other treatments, such as antidepressants or other medications.
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Risks
In general, there's little risk in getting cognitive behavioral therapy. But you may feel emotionally uncomfortable at times. This is because CBT can cause you to explore painful feelings, emotions and experiences. You may cry, get upset or feel angry during a challenging session. You may also feel physically drained.
Some forms of CBT, such as exposure therapy, may require you to confront situations you'd rather avoid — such as airplanes if you have a fear of flying. This can lead to temporary stress or anxiety.
However, working with a skilled therapist will minimize any risks. The coping skills you learn can help you manage and conquer negative feelings and fears.
How you prepare
You might decide on your own that you want to try cognitive behavioral therapy. Or a doctor or someone else may suggest therapy to you.
Here's how to get started:
- Find a therapist. You can get a referral from a doctor, health insurance plan, friend or other trusted source. Many employers offer counseling services or referrals through employee assistance programs (EAPs). Or you can find a therapist on your own — for instance, through a local or state psychological association or by searching the internet.
- Understand the costs. If you have health insurance, find out what coverage it offers for psychotherapy. Some health plans cover only a certain number of therapy sessions a year. Also, talk to your therapist about fees and payment options.
- Review your concerns. Before your first appointment, think about what issues you'd like to work on. While you can also sort this out with your therapist, having some sense in advance may provide a starting point.
Check qualifications
Psychotherapist is a general term, rather than a job title or indication of education, training or licensure.
Examples of psychotherapists include psychiatrists, psychologists, licensed professional counselors, licensed social workers, licensed marriage and family therapists, psychiatric nurses, or other licensed professionals with mental health training.
Before seeing a psychotherapist, check his or her:
- Background and education. Trained psychotherapists can have a number of different job titles, depending on their education and role. Most have a master's or doctoral degree with specific training in psychological counseling. Medical doctors who specialize in mental health (psychiatrists) can prescribe medications as well as provide psychotherapy.
- Certification and licensing. Make sure that the therapist you choose meets state certification and licensing requirements for his or her particular discipline.
- Area of expertise. Ask whether the therapist has expertise and experience treating your symptoms or your area of concern, such as eating disorders or PTSD.
The key is to find a skilled therapist who can match the type and intensity of therapy with your needs.
What you can expect
Cognitive behavioral therapy may be done one-on-one or in groups with family members or with people who have similar issues. Online resources are available that may make participating in CBT possible, especially if you live in an area with few local mental health resources.
CBT often includes:
- Learning about your mental health condition
- Learning and practicing techniques such as relaxation, coping, resilience, stress management and assertiveness
Your first therapy session
At your first session, your therapist will typically gather information about you and ask what concerns you'd like to work on. The therapist will likely ask you about your current and past physical and emotional health to gain a deeper understanding of your situation. Your therapist may discuss whether you might benefit from other treatment as well, such as medications.
The first session is also an opportunity for you to interview your therapist to see if he or she will be a good match for you. Make sure you understand:
- His or her approach
- What type of therapy is appropriate for you
- The goals of your treatment
- The length of each session
- How many therapy sessions you may need
It might take a few sessions for your therapist to fully understand your situation and concerns, and to determine the best course of action. If you don't feel comfortable with the first therapist you see, try someone else. Having a good "fit" with your therapist can help you get the most benefit from CBT.
During CBT
Your therapist will encourage you to talk about your thoughts and feelings and what's troubling you. Don't worry if you find it hard to open up about your feelings. Your therapist can help you gain more confidence and comfort.
CBT generally focuses on specific problems, using a goal-oriented approach.
As you go through the therapy process, your therapist may ask you to do homework — activities, reading or practices that build on what you learn during your regular therapy sessions — and encourage you to apply what you're learning in your daily life.
Your therapist's approach will depend on your particular situation and preferences. Your therapist may combine CBT with another therapeutic approach — for example, interpersonal therapy, which focuses on your relationships with other people.
Steps in CBT
CBT typically includes these steps:
- Identify troubling situations or conditions in your life. These may include such issues as a medical condition, divorce, grief, anger or symptoms of a mental health disorder. You and your therapist may spend some time deciding what problems and goals you want to focus on.
- Become aware of your thoughts, emotions and beliefs about these problems. Once you've identified the problems to work on, your therapist will encourage you to share your thoughts about them.
This may include observing what you tell yourself about an experience (self-talk), your interpretation of the meaning of a situation, and your beliefs about yourself, other people and events. Your therapist may suggest that you keep a journal of your thoughts. - Identify negative or inaccurate thinking. To help you recognize patterns of thinking and behavior that may be contributing to your problem, your therapist may ask you to pay attention to your physical, emotional and behavioral responses in different situations.
- Reshape negative or inaccurate thinking. Your therapist will likely encourage you to ask yourself whether your view of a situation is based on fact or on an inaccurate perception of what's going on. This step can be difficult. You may have long-standing ways of thinking about your life and yourself. With practice, helpful thinking and behavior patterns will become a habit and won't take as much effort.
Length of therapy
CBT is generally considered short-term therapy — ranging from about five to 20 sessions.
You and your therapist can discuss how many sessions may be right for you. Factors to consider include:
- Type of disorder or situation
- Severity of your symptoms
- How long you've had your symptoms or have been dealing with your situation
- How quickly you make progress
- How much stress you're experiencing
- How much support you receive from family members and other people
Confidentiality
Except in very specific circumstances, conversations with your therapist are confidential. However, a therapist may break confidentiality if there is an immediate threat to safety or when required by state or federal law to report concerns to authorities. These situations include:
- Threatening to immediately or soon (imminently) harm yourself or take your own life
- Threatening to imminently harm or take the life of another person
- Abusing a child or a vulnerable adult ― someone over age 18 who is hospitalized or made vulnerable by a disability
- Being unable to safely care for yourself
Results
Cognitive behavioral therapy may not cure your condition or make an unpleasant situation go away.
But it can give you the power to cope with your situation in a healthy way and to feel better about yourself and your life.
Getting the most out of CBT
CBT isn't effective for everyone. But you can take steps to get the most out of your therapy and help make it a success.
- Approach therapy as a partnership. Therapy is most effective when you're an active participant and share in decision-making. Make sure you and your therapist agree about the major issues and how to tackle them. Together, you can set goals and assess progress over time.
- Be open and honest. Success with therapy depends on your willingness to share your thoughts, feelings and experiences, and on being open to new insights and ways of doing things. If you're reluctant to talk about certain things because of painful emotions, embarrassment or fears about your therapist's reaction, let your therapist know about your reservations.
- Stick to your treatment plan.
If you feel down or lack motivation, it may be tempting to skip therapy sessions. Doing so can disrupt your progress. Attend all sessions and give some thought to what you want to discuss. - Don't expect instant results. Working on emotional issues can be painful and often requires hard work. It's not uncommon to feel worse during the initial part of therapy as you begin to confront past and current conflicts. You may need several sessions before you begin to see improvement.
- Do your homework between sessions. If your therapist asks you to read, keep a journal or do other activities outside of your regular therapy sessions, follow through. Doing these homework assignments will help you apply what you've learned in the therapy sessions.
- If therapy isn't helping, talk to your therapist. If you don't feel that you're benefiting from CBT after several sessions, talk to your therapist about it. You and your therapist may decide to make some changes or try a different approach.
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DIRECTION GUIDE
Contents
Behaviorism and cognitivism
Basic concepts
Techniques and exercises
When will CBT help?
Course duration
Evidence-based medicine and CBT
Medical therapy and CBT
Case studies
What to read
What is CBT?
Cognitive Behavioral Therapy (or CBT) is a technique that highlights a person's unconscious motivations, transfers them to a conscious level, helps to change beliefs and behavior that cause neurotic and other pathological conditions.
From the name it is clear that CBT combines two scientific psychological approaches: cognitive and behavioral (behavioristic). The first states that psychological problems and neuropsychiatric disorders are caused by thoughts and beliefs, stereotypes of thinking acquired during life. The second argues that human (as well as animal) behavior can be changed by encouraging desirable forms of action and not reinforcing undesirable behavior.
Behaviorism and cognitivism
The theory of behaviorism (from the English behavior - behavior) was developed in the early twentieth century. It considers behavior as a set of reactions (reflexes) to environmental stimuli. One of the basic concepts of behaviorism is positive and negative reinforcement. Positive reinforcement, or encouragement, is applied when the individual has done the right thing, and helps to reinforce the desired form of behavior. Negative reinforcement implies a negative reaction to the undesirable behavior of the trainee.
As a rule, the first form of reinforcement is used in CBT: it works faster, clearly indicates what needs to be achieved.
Cognitivism is a scientific movement that originated in the 1960s. It focuses on mental processes: how people perceive, think, remember, learn, solve problems, where they direct their attention. Cognitions are any thoughts and ideas that become the fruits of our thinking. According to the cognitive approach, it is inefficient to work only with a person’s behavior to solve his psychological problems: first, you need to identify beliefs, ideas and thoughts that make him act destructively or feel discomfort, get rid of them, and only then work on the behavioral aspect.
“Cognitions are basically all mental processes, both adequate and dysfunctional. When children are born, they don't know anything about the world yet. Over time, they begin to encounter people and their ideas about the environment. Parents and society help them formulate both adequate and dysfunctional beliefs.
Dysfunctional and maladaptive views make it difficult to adequately assess life situations. Fears, complexes are formed, the child has a feeling that he is doing something wrong. It is this feeling that in the future leads to neurotic and other psychological problems.
Anastasia Afanasyeva, Psychotherapist KPT:
Historically, the development of KPT is divided into 4 waves:
The first wave
(1910s-1950s)
Behavioral therapy
Second wave
(1960s)
Classical approach of CBT and rational-emotive psychotherapy
Third wave
(1990s)
Development of new currents within CBT: dialectical-behavioral psychotherapy, schema therapy, mindfulness therapy, acceptance and obligation therapy (ACT)
The fourth wave
(2010s)
The emerging stage associated with the use of modern technologies in therapy: augmented reality gadgets and software applications
In 1913, the American psychologist John Watson publishes the first articles on behaviorism.
He urges his colleagues to focus exclusively on the study of human behavior, the study of the connection "external stimulus - external reaction (behavior)". Instead of analyzing the structural components of consciousness, behaviorists looked for reproducible connections between observed events, in particular between stimuli (environment) and responses (observed and measured reactions of people or animals to stimuli). Learning theories were the main model in the psychology of that time. Behaviorists have tried to formulate an explanation for how an organism establishes new connections between stimulus and response. Despite its early and sustained success, the behavioral approach placed many limitations on the therapy process.
In 1955, the founder of rational-emotional psychotherapy, Albert Ellis, announced the influence of our thoughts and ideas (cognitions) on mental processes. His colleague Aaron Beck begins to study the field of knowledge. After evaluating the results of various methods of therapy, he comes to the conclusion that our emotions and behavior depend on the way we think.
Despite attempts by behavioral therapists to maintain their position in the late 1950s and early 1960s, the ideas of cognitivism became increasingly influential. Publication of the book by A.T. Beck on Cognitive Therapy for Depression (Beck et al., 1979), as well as studies showing that cognitive therapy treats depression as effectively as antidepressants (Rush, Beck, Kovacs & Hollon, 1977), changed psychotherapy forever. In subsequent years, behavioral and cognitive therapy developed together and influenced each other so strongly that they eventually merged into a single cognitive-behavioral approach.
Historical reference
Basic concepts: automatic thoughts, cognitive distortions
Search and awareness automatic thoughts - the basis of the CBT method. About 20 thousand of such quick thoughts arise in our head per day, which are a response to what is happening to us. They are always appreciated. Evolutionarily automatic thoughts are necessary so that we can quickly respond to changes in the environment.
Most of them we do not have time to realize. These thoughts trigger our emotional response. In order to understand why our state has changed (anxiety, fear appeared, mood fell), it is necessary to identify what kind of thought caused this change. CBT suggests looking for quick thoughts in order to process them and translate your judgments into a rational channel.
“There is always a situation that triggers a state change. For example, a person is walking in the dark and hears something rustling in the bushes. He becomes anxious. Most likely, the thought flashed that there was a danger nearby. In response to this thought and feeling of anxiety, the person decides to leave quickly. However, a quick thought and a reaction to it are not always rational. For example, you are doing a work task and realize that you do not have time to complete it on time. A neurotic person may have automatic thoughts: I am not responsible enough, I will be fired. The emotional response to them is anxiety, fear.
Although if you think rationally, it is unlikely that one missed deadline will negatively affect your entire career.
Anastasia Afanasyeva, psychotherapist CBT:
Cognitive Behavioral Therapy works on cognitive distortions (or errors) that arise from automatic thoughts. Cognitive distortions are erroneous conclusions, irrational ideas that ultimately lead a person to psychological problems. There are over 100 types of cognitive distortions. Here are just a few examples:
Generalization
“I never have relationships”, “I always ruin everything”, “I always have bad luck”. A person carries over the characteristics of a single incident for life.
Catastrophe
“Everything is very bad”, “This is a failure”, “Irreparable happened”. Under the influence of negative judgments and emotions, the feeling of the situation is pumped up to complete hopelessness.
Duty
“I owe”, “They owe me”, “Everything should have turned out this way and not otherwise.
” Social roles and responsibilities become immutable truths, neither the specifics of the situation, nor the state of the person, nor the complexity of relationships are taken into account.
Conformity
“Everyone does/behaves like this. Those who do otherwise are bad/inferior, etc.” Ideas about norms received from outside cause one to stigmatize the slightest deviation in oneself and others.
The task of the CBT therapist is to identify cognitive distortions that negatively affect the client's quality of life and help develop rational, constructive thought patterns in their place.
Techniques and exercises
One of the main techniques of the method is keeping a CBT diary . Usually it is a table in which you need to enter daily events that caused a strong emotional reaction, and analyze them according to the proposed scheme. Further cases are discussed with the therapist at the session.
An example of what columns a CBT diary can contain. Each therapist offers his own diary system.
“After the client has learned to identify his automatic thoughts, he begins to keep a diary for a week. We look at what thoughts most often arise in different situations. This may be the fear that the person will look in someone's eyes as optional (that is, bad), or a feeling that he is not successful, or a feeling that he is vulnerable and will not cope. From the automatic thoughts we recognize, core beliefs begin to emerge. Not quick, superficial thoughts, but the foundation on which the human psyche is based. We are working on changing this array of beliefs in a rational direction.”
Anastasia Afanasyeva, CBT psychotherapist:
Another important technique for CBT is exposure . It is especially useful in all kinds of phobias. Exposure helps the client learn not to avoid disturbing situations, but to experience them.
For example, a person is afraid to enter an elevator. When using the exposure technique, the client and therapist approach the booth, stop, and begin to observe the client's reaction. When the anxiety rises, they do exercises with the therapist to help them cope with the anxiety. If the reaction is managed, the client and therapist move on to the next step: they enter the elevator together. The level of anxiety rises again, the therapist again works out with the client his condition. The intensity of the situation gradually increases until the client receives all the necessary skills in order to be aware and rationally assess his condition, to cope with it.
When will CBT help?
The effectiveness of the CPT is proved for the following states:
All types of phobia
Alarm
Panic disorder and panic attacks
Depression
Occupation and compulsive arrest (OKR)
9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 thoughts, actions, rituals
Psychosomatic disorders
irritable intestine, headaches and another
post -traumatic stress disorder
Eating disorder
Difficulties with communication, building contacts and their maintenance, constancy in the work and family relations
Dependence 9000
Physical and physical mental
Aggressive behavior
CBT in panic attacks
Panic attacks are spontaneous panic attacks that are accompanied by rapid breathing, palpitations, dizziness, tremor, nausea, sweating and other somatic manifestations.
A panic attack may be the result of other psychiatric disorders rather than a single illness. Recurrent panic attacks without other symptoms may be manifestations of panic disorder. Cognitive behavioral therapy is the proven and most effective treatment for it.
“Panic attacks can occur in depressive disorders, generalized anxiety disorder, and hypochondriacal disorders. This is a very non-specific symptom, such as fever. It is found in various diseases. To make an accurate diagnosis, before starting treatment, you need to be diagnosed by a psychiatrist or psychotherapist.
Anastasia Afanasyeva, psychotherapist CBT:
The exposure technique mentioned above is very well the main tool for dealing with panic attacks. The psychotherapist teaches the patient to recognize what is happening to him at the time of the attack, how and to what his body reacts. Gradually, the patient learns to cope with his condition.
“First, there is a stage of psycho-education: we tell what happens in the patient's body at the time of the attack.
We analyze cycles, thoughts, emotions, behavior, we are looking for the reason that starts the process. Further work is based on the fact that in the office we learn to cause symptoms: dizziness, palpitations, hyperventilation. We practice techniques to endure the anxiety that these symptoms cause. Thus, gradually we build tolerance. Anxiety decreases and eventually disappears.
Shortness of breath can be caused by hyperventilation - rapid shallow breathing. Dizziness - spinning in place. Palpitations - squats or running up the stairs. All exercises are performed together with the therapist. We say that it is not dangerous, the person understands this. When during the session I breathe with the patient, he sees that I normally endure this state. In doing so, he observes what happens to his own sensations.
The essence of a panic attack is that it always goes away. The fear that it will start, most often becomes the trigger for its start. It brings other problems as well, such as avoiding certain situations or carefully checking one's condition.
"
Anastasia Afanasyeva, psychotherapist CBT:
Duration of the course
CBT is considered a short-term therapy, but the duration of the course depends on many factors. For a specific request, such as a phobia or difficulty falling asleep, about 10 sessions are needed. However, this format involves solving only one problem. For multiple problems and more complex conditions, the course will last from a few months to a year. Treating personality disorders will require even longer work.
Therapy involves a meeting once a week, at a pre-selected time. The duration of the session is 50 minutes. Outside of sessions, the client does homework.
Each session has a structure: agenda, checking homework, discussing specific requests, working through them, debriefing, receiving homework, feedback.
« Terms are always individual and depend on the severity of the condition.
For panic attacks or depression, this is six months to a year. For complex diseases or personality disorders, therapy can be very long. In addition to the form and severity of the disease, the ability and desire of a person to get involved in work play a role. There are people who are more prone to reflection, it is easier for them to realize their own mental processes. There are people who find it harder.
As with any therapy, one should not expect miracles from CBT. You cannot change in a couple of months, and even in six months. But you can learn to see the relationship between your thoughts, emotions and behavior, and this will allow you to weed out unnecessary thoughts, change reactions, not be led by your beliefs left by your parents and the outside world, and not let anxiety and fear rule your life.
Anastasia Afanasyeva, CBT psychotherapist:
Evidence-based medicine and CBT
Cognitive Behavioral Therapy (CBT) is one of the most researched methods of psychotherapy.
In 2012, a Boston University Department of Psychology Working Group released a seminal systematic review of meta-analyses (1) of various studies, which is the most comprehensive scientific paper on the effectiveness of CBT to date. Based on 269 papers, the researchers concluded that the referral was extremely effective in dealing with anxiety and mood disorders, highly effective in treating phobias, insomnia, and significantly effective in reducing workplace stress. The full text of the review in English can be found here.
1 Meta-analysis is a type of data analysis in which the results of a number of randomized clinical trials are combined and analyzed as a single large study. In evidence-based medicine, meta-analysis is assigned the highest level of evidence (IA).
Medication and CBT
There are a number of conditions that can be treated with non-medicated CBT, such as mild generalized anxiety disorder, panic disorder, mild OCD, mild depression.
However, in a number of conditions, it is recommended to combine psychotherapy with pharmacotherapy. These include moderate depression and severe depression.
« Fear of pharmacotherapy is quite common and I deal with it regularly. I can say that many fears are unfounded. There is a myth that antidepressants are addictive. According to all studies, no antidepressant causes either mental or physical dependence.
If you have a fear of medication, see a qualified doctor who is trained in psychotherapy and pharmacotherapy. He will conduct a medical diagnosis, decide whether it is really necessary to carry out drug therapy, and help work through your fear using CBT techniques.”
Anastasia Afanasyeva, psychotherapist CBT:
Case reports
“A young man asked for help: after breaking up with a girlfriend, he suffered from depressed mood, anxiety, difficulty falling asleep, obsessive thoughts before going to bed, loss of appetite .
In the course of therapy, we uncovered the hidden beliefs that generated these reactions. He believed that if he could not "keep" the relationship, then this indicates his unreliability, if he failed to choose an "adequate" partner, this indicates weakness. Also, the client could not understand what he needed, he relied on ideas about how "should be".
During three months of work, the client has learned to be aware of his needs, desires, track thoughts and engage in polemics with them. The young man was able to emotionally distance himself from obsessive thoughts, the mood background leveled off. He built his schedule in accordance with his own goals and values, acquired awareness skills.
Anastasia Afanasyeva, psychotherapist CBT:
What to read?
Cognitive Behavioral Therapy for Anxiety, Fear, Worry and Panic. Michelle Skin, Matthew McKay, Patrick Fanning
This book is for those who are already in therapy and want to understand the basics of the method and get the most out of CBT.
The authors dwell on techniques and exercises that help to cope with the manifestations of anxiety and symptoms of panic attacks.
Cognitive Behavioral Therapy for Dummies. Rena Branch, Rob Wilson
A book from practicing therapists that explains CBT principles, concepts and how to deal with various disorders in simple language. In addition to practical advice and exercises, you will find many examples from the practice of the authors in it.
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Cognitive Behavioral Therapy (CBT) or Cognitive Behavioral Psychotherapy (CBT)
FIND A PSYCHOLOGIST
We tell you how one of the most popular psychotherapy techniques works, which allows you to correct thinking and emotional reactions.
alter
DIRECTION GUIDE
Contents
Behaviorism and cognitivism
Basic concepts
Techniques and exercises
When will CBT help?
Course duration
Evidence-based medicine and CBT
Medical therapy and CBT
Case studies
What to read
What is CBT?
Cognitive Behavioral Therapy (or CBT) is a technique that highlights a person's unconscious motivations, transfers them to a conscious level, helps to change beliefs and behavior that cause neurotic and other pathological conditions.
From the name it is clear that CBT combines two scientific psychological approaches: cognitive and behavioral (behavioristic). The first states that psychological problems and neuropsychiatric disorders are caused by thoughts and beliefs, stereotypes of thinking acquired during life. The second argues that human (as well as animal) behavior can be changed by encouraging desirable forms of action and not reinforcing undesirable behavior.
Behaviorism and cognitivism
The theory of behaviorism (from the English behavior - behavior) was developed in the early twentieth century. It considers behavior as a set of reactions (reflexes) to environmental stimuli. One of the basic concepts of behaviorism is positive and negative reinforcement. Positive reinforcement, or encouragement, is applied when the individual has done the right thing, and helps to reinforce the desired form of behavior. Negative reinforcement implies a negative reaction to the undesirable behavior of the trainee.
As a rule, the first form of reinforcement is used in CBT: it works faster, clearly indicates what needs to be achieved.
Cognitivism is a scientific movement that originated in the 1960s. It focuses on mental processes: how people perceive, think, remember, learn, solve problems, where they direct their attention. Cognitions are any thoughts and ideas that become the fruits of our thinking. According to the cognitive approach, it is inefficient to work only with a person’s behavior to solve his psychological problems: first, you need to identify beliefs, ideas and thoughts that make him act destructively or feel discomfort, get rid of them, and only then work on the behavioral aspect.
“Cognitions are basically all mental processes, both adequate and dysfunctional. When children are born, they don't know anything about the world yet. Over time, they begin to encounter people and their ideas about the environment. Parents and society help them formulate both adequate and dysfunctional beliefs.
Dysfunctional and maladaptive views make it difficult to adequately assess life situations. Fears, complexes are formed, the child has a feeling that he is doing something wrong. It is this feeling that in the future leads to neurotic and other psychological problems.
Anastasia Afanasyeva, Psychotherapist KPT:
Historically, the development of KPT is divided into 4 waves:
The first wave
(1910s-1950s)
Behavioral therapy
Second wave
(1960s)
Classical approach of CBT and rational-emotive psychotherapy
Third wave
(1990s)
Development of new currents within CBT: dialectical-behavioral psychotherapy, schema therapy, mindfulness therapy, acceptance and obligation therapy (ACT)
The fourth wave
(2010s)
The emerging stage associated with the use of modern technologies in therapy: augmented reality gadgets and software applications
In 1913, the American psychologist John Watson publishes the first articles on behaviorism.
He urges his colleagues to focus exclusively on the study of human behavior, the study of the connection "external stimulus - external reaction (behavior)". Instead of analyzing the structural components of consciousness, behaviorists looked for reproducible connections between observed events, in particular between stimuli (environment) and responses (observed and measured reactions of people or animals to stimuli). Learning theories were the main model in the psychology of that time. Behaviorists have tried to formulate an explanation for how an organism establishes new connections between stimulus and response. Despite its early and sustained success, the behavioral approach placed many limitations on the therapy process.
In 1955, the founder of rational-emotional psychotherapy, Albert Ellis, announced the influence of our thoughts and ideas (cognitions) on mental processes. His colleague Aaron Beck begins to study the field of knowledge. After evaluating the results of various methods of therapy, he comes to the conclusion that our emotions and behavior depend on the way we think.
Despite attempts by behavioral therapists to maintain their position in the late 1950s and early 1960s, the ideas of cognitivism became increasingly influential. Publication of the book by A.T. Beck on Cognitive Therapy for Depression (Beck et al., 1979), as well as studies showing that cognitive therapy treats depression as effectively as antidepressants (Rush, Beck, Kovacs & Hollon, 1977), changed psychotherapy forever. In subsequent years, behavioral and cognitive therapy developed together and influenced each other so strongly that they eventually merged into a single cognitive-behavioral approach.
Historical reference
Basic concepts: automatic thoughts, cognitive distortions
Search and awareness automatic thoughts - the basis of the CBT method. About 20 thousand of such quick thoughts arise in our head per day, which are a response to what is happening to us. They are always appreciated. Evolutionarily automatic thoughts are necessary so that we can quickly respond to changes in the environment.
Most of them we do not have time to realize. These thoughts trigger our emotional response. In order to understand why our state has changed (anxiety, fear appeared, mood fell), it is necessary to identify what kind of thought caused this change. CBT suggests looking for quick thoughts in order to process them and translate your judgments into a rational channel.
“There is always a situation that triggers a state change. For example, a person is walking in the dark and hears something rustling in the bushes. He becomes anxious. Most likely, the thought flashed that there was a danger nearby. In response to this thought and feeling of anxiety, the person decides to leave quickly. However, a quick thought and a reaction to it are not always rational. For example, you are doing a work task and realize that you do not have time to complete it on time. A neurotic person may have automatic thoughts: I am not responsible enough, I will be fired. The emotional response to them is anxiety, fear.
Although if you think rationally, it is unlikely that one missed deadline will negatively affect your entire career.
Anastasia Afanasyeva, psychotherapist CBT:
Cognitive Behavioral Therapy works on cognitive distortions (or errors) that arise from automatic thoughts. Cognitive distortions are erroneous conclusions, irrational ideas that ultimately lead a person to psychological problems. There are over 100 types of cognitive distortions. Here are just a few examples:
Generalization
“I never have relationships”, “I always ruin everything”, “I always have bad luck”. A person carries over the characteristics of a single incident for life.
Catastrophe
“Everything is very bad”, “This is a failure”, “Irreparable happened”. Under the influence of negative judgments and emotions, the feeling of the situation is pumped up to complete hopelessness.
Duty
“I owe”, “They owe me”, “Everything should have turned out this way and not otherwise.
” Social roles and responsibilities become immutable truths, neither the specifics of the situation, nor the state of the person, nor the complexity of relationships are taken into account.
Conformity
“Everyone does/behaves like this. Those who do otherwise are bad/inferior, etc.” Ideas about norms received from outside cause one to stigmatize the slightest deviation in oneself and others.
The task of the CBT therapist is to identify cognitive distortions that negatively affect the client's quality of life and help develop rational, constructive thought patterns in their place.
Techniques and exercises
One of the main techniques of the method is keeping a CBT diary . Usually it is a table in which you need to enter daily events that caused a strong emotional reaction, and analyze them according to the proposed scheme. Further cases are discussed with the therapist at the session.
An example of what columns a CBT diary can contain. Each therapist offers his own diary system.
“After the client has learned to identify his automatic thoughts, he begins to keep a diary for a week. We look at what thoughts most often arise in different situations. This may be the fear that the person will look in someone's eyes as optional (that is, bad), or a feeling that he is not successful, or a feeling that he is vulnerable and will not cope. From the automatic thoughts we recognize, core beliefs begin to emerge. Not quick, superficial thoughts, but the foundation on which the human psyche is based. We are working on changing this array of beliefs in a rational direction.”
Anastasia Afanasyeva, CBT psychotherapist:
Another important technique for CBT is exposure . It is especially useful in all kinds of phobias. Exposure helps the client learn not to avoid disturbing situations, but to experience them.
For example, a person is afraid to enter an elevator. When using the exposure technique, the client and therapist approach the booth, stop, and begin to observe the client's reaction. When the anxiety rises, they do exercises with the therapist to help them cope with the anxiety. If the reaction is managed, the client and therapist move on to the next step: they enter the elevator together. The level of anxiety rises again, the therapist again works out with the client his condition. The intensity of the situation gradually increases until the client receives all the necessary skills in order to be aware and rationally assess his condition, to cope with it.
When will CBT help?
The effectiveness of the CPT is proved for the following states:
All types of phobia
Alarm
Panic disorder and panic attacks
Depression
Occupation and compulsive arrest (OKR)
9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 thoughts, actions, rituals
Psychosomatic disorders
irritable intestine, headaches and another
post -traumatic stress disorder
Eating disorder
Difficulties with communication, building contacts and their maintenance, constancy in the work and family relations
Dependence 9000
Physical and physical mental
Aggressive behavior
CBT in panic attacks
Panic attacks are spontaneous panic attacks that are accompanied by rapid breathing, palpitations, dizziness, tremor, nausea, sweating and other somatic manifestations.
A panic attack may be the result of other psychiatric disorders rather than a single illness. Recurrent panic attacks without other symptoms may be manifestations of panic disorder. Cognitive behavioral therapy is the proven and most effective treatment for it.
“Panic attacks can occur in depressive disorders, generalized anxiety disorder, and hypochondriacal disorders. This is a very non-specific symptom, such as fever. It is found in various diseases. To make an accurate diagnosis, before starting treatment, you need to be diagnosed by a psychiatrist or psychotherapist.
Anastasia Afanasyeva, psychotherapist CBT:
The exposure technique mentioned above is very well the main tool for dealing with panic attacks. The psychotherapist teaches the patient to recognize what is happening to him at the time of the attack, how and to what his body reacts. Gradually, the patient learns to cope with his condition.
“First, there is a stage of psycho-education: we tell what happens in the patient's body at the time of the attack.
We analyze cycles, thoughts, emotions, behavior, we are looking for the reason that starts the process. Further work is based on the fact that in the office we learn to cause symptoms: dizziness, palpitations, hyperventilation. We practice techniques to endure the anxiety that these symptoms cause. Thus, gradually we build tolerance. Anxiety decreases and eventually disappears.
Shortness of breath can be caused by hyperventilation - rapid shallow breathing. Dizziness - spinning in place. Palpitations - squats or running up the stairs. All exercises are performed together with the therapist. We say that it is not dangerous, the person understands this. When during the session I breathe with the patient, he sees that I normally endure this state. In doing so, he observes what happens to his own sensations.
The essence of a panic attack is that it always goes away. The fear that it will start, most often becomes the trigger for its start. It brings other problems as well, such as avoiding certain situations or carefully checking one's condition.
"
Anastasia Afanasyeva, psychotherapist CBT:
Duration of the course
CBT is considered a short-term therapy, but the duration of the course depends on many factors. For a specific request, such as a phobia or difficulty falling asleep, about 10 sessions are needed. However, this format involves solving only one problem. For multiple problems and more complex conditions, the course will last from a few months to a year. Treating personality disorders will require even longer work.
Therapy involves a meeting once a week, at a pre-selected time. The duration of the session is 50 minutes. Outside of sessions, the client does homework.
Each session has a structure: agenda, checking homework, discussing specific requests, working through them, debriefing, receiving homework, feedback.
« Terms are always individual and depend on the severity of the condition.
For panic attacks or depression, this is six months to a year. For complex diseases or personality disorders, therapy can be very long. In addition to the form and severity of the disease, the ability and desire of a person to get involved in work play a role. There are people who are more prone to reflection, it is easier for them to realize their own mental processes. There are people who find it harder.
As with any therapy, one should not expect miracles from CBT. You cannot change in a couple of months, and even in six months. But you can learn to see the relationship between your thoughts, emotions and behavior, and this will allow you to weed out unnecessary thoughts, change reactions, not be led by your beliefs left by your parents and the outside world, and not let anxiety and fear rule your life.
Anastasia Afanasyeva, CBT psychotherapist:
Evidence-based medicine and CBT
Cognitive Behavioral Therapy (CBT) is one of the most researched methods of psychotherapy.
In 2012, a Boston University Department of Psychology Working Group released a seminal systematic review of meta-analyses (1) of various studies, which is the most comprehensive scientific paper on the effectiveness of CBT to date. Based on 269 papers, the researchers concluded that the referral was extremely effective in dealing with anxiety and mood disorders, highly effective in treating phobias, insomnia, and significantly effective in reducing workplace stress. The full text of the review in English can be found here.
1 Meta-analysis is a type of data analysis in which the results of a number of randomized clinical trials are combined and analyzed as a single large study. In evidence-based medicine, meta-analysis is assigned the highest level of evidence (IA).
Medication and CBT
There are a number of conditions that can be treated with non-medicated CBT, such as mild generalized anxiety disorder, panic disorder, mild OCD, mild depression.
However, in a number of conditions, it is recommended to combine psychotherapy with pharmacotherapy. These include moderate depression and severe depression.
« Fear of pharmacotherapy is quite common and I deal with it regularly. I can say that many fears are unfounded. There is a myth that antidepressants are addictive. According to all studies, no antidepressant causes either mental or physical dependence.
If you have a fear of medication, see a qualified doctor who is trained in psychotherapy and pharmacotherapy. He will conduct a medical diagnosis, decide whether it is really necessary to carry out drug therapy, and help work through your fear using CBT techniques.”
Anastasia Afanasyeva, psychotherapist CBT:
Case reports
“A young man asked for help: after breaking up with a girlfriend, he suffered from depressed mood, anxiety, difficulty falling asleep, obsessive thoughts before going to bed, loss of appetite .
In the course of therapy, we uncovered the hidden beliefs that generated these reactions. He believed that if he could not "keep" the relationship, then this indicates his unreliability, if he failed to choose an "adequate" partner, this indicates weakness. Also, the client could not understand what he needed, he relied on ideas about how "should be".
During three months of work, the client has learned to be aware of his needs, desires, track thoughts and engage in polemics with them. The young man was able to emotionally distance himself from obsessive thoughts, the mood background leveled off. He built his schedule in accordance with his own goals and values, acquired awareness skills.
Anastasia Afanasyeva, psychotherapist CBT:
What to read?
Cognitive Behavioral Therapy for Anxiety, Fear, Worry and Panic. Michelle Skin, Matthew McKay, Patrick Fanning
This book is for those who are already in therapy and want to understand the basics of the method and get the most out of CBT.
