Conjunctive behavioral therapy
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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Cognitive behavioral therapy - InformedHealth.org
Created: August 7, 2013; Last Update: September 8, 2016; Next update: 2022.
Cognitive behavioral therapy (CBT) is one of the most common and best studied forms of psychotherapy. It is a combination of two therapeutic approaches, known as cognitive therapy and behavioral therapy.
Which methods of treatment are applied depends on the illness or problem to be treated. The basic principle behind therapy is however always the same: What we think, how we feel and how we behave are all closely connected – and all of these factors have a decisive influence on our well-being.
What is cognitive therapy?
The term cognitive comes from the Latin "cognoscere", meaning "to recognize.
" The point of cognitive therapy is to form a clear idea of your own thoughts, attitudes and expectations. The goal is to reveal and change false and distressing beliefs, because it is often not only the things and situations themselves that cause problems, but the importance that we attach to them too.
For example, a dangerous thought pattern might be when somebody immediately draws negative conclusions from an occurrence, generalizes them and applies them to similar situations. In psychology, this generalized way of thinking is called “over-generalizing.” Another distressing error in reasoning is “catastrophizing”: If something disturbing happens, people immediately draw exaggerated conclusions about the scope of the supposed disaster ahead.
Such thought patterns can sometimes develop into self-fulfilling prophecies and make life difficult for the people affected. Cognitive therapy helps people learn to replace these thought patterns with more realistic and less harmful thoughts.
It also helps people to think more clearly and to control their own thoughts better.
How does behavioral therapy work?
Behavioral therapy has its origins in American “behaviorism.” This theory assumes that human behavior is learned and can therefore be unlearned or learned anew. Behavioral therapy aims to find out whether certain behavioral patterns make your life difficult or intensify your problems. In the second step you work on changing these behavioral habits.
For example, people who have developed depressive thoughts often tend to withdraw and give up their hobbies. As a result, they feel even more unhappy and isolated. Cognitive therapy helps to identify this mechanism and find ways to become more active again.
In anxiety disorders, behavioral therapy often includes learning methods to help you calm down. For example, you can learn to reduce anxiety by consciously breathing in and out deeply so that your body and breathing can relax. When doing this you concentrate on your breathing instead of what is bringing on your anxiety.
These kinds of techniques can help you to calm down instead of getting all worked up with anxiety.
By the way, in Germany, most psychotherapists who are trained in cognitive behavioral therapy call themselves behavioral therapists.
Which thought and behavioral patterns are harmful, which are not?
Harmful thoughts or behavioral habits can make people feel bad about themselves. For example: You see somebody you know on the street and say hello, but they do not say hello back. Your own reaction to that very much depends on how you assess the situation:
| Reaction | Harmful | Neutral |
|---|---|---|
| Thoughts | “He ignored me – he doesn’t like me anymore.” | “He didn't notice me – maybe he doesn’t feel well. I should give him a call and find out how he is doing.” |
| Feelings | Someone who thinks like this feels down, sad and rejected. | These thought patterns do not cause any negative feelings. |
| Behavior | The consequence of this thought is to avoid this person in the future, although the assumption could be completely false. | This thought is a prompt to get back in touch with the person to find out if everything is all right. |
How is cognitive behavioral therapy different from other psychotherapies?
Cognitive behavioral therapy is a problem-oriented strategy. It focuses on current problems and finding solutions for them.
Unlike psychoanalysis, for example, it does not deal primarily with the past. Cognitive behavioral therapy is much more concerned with dealing with current problems. The most important thing is helping people to help themselves: They should be able to cope with their lives again without therapy as soon as possible. This does not mean that cognitive behavioral therapy completely ignores the influence of past events. But it mainly deals with identifying and changing current distressing thought and behavioral patterns.
Analytic psychotherapy, which has its origin in classic Freudian psychoanalysis, uses different methods. Here the therapist tries to help the patient discover and understand problems and their deeper causes.
When is cognitive behavioral therapy an option?
Cognitive behavioral therapy is used to treat conditions such as depression, anxiety and obsessive-compulsive disorders, and addictions. But it is also an option for treating physical conditions such as chronic pain, tinnitus and rheumatism.
It can help to relieve the symptoms.
Cognitive behavioral therapy requires the patient's commitment and own initiative. Therapy can only be successful if the patient actively takes part in the treatment and also works on their problems between sessions. This can be a considerable challenge, especially with severe conditions such as depression or anxiety disorders. That is why medication is sometimes used at first to quickly relieve the worst symptoms so that psychotherapy can be started.
Choosing a certain kind of psychotherapy also depends on the goals. If you feel the need for deep insight into the causes of your problems, cognitive behavioral therapy is probably not the right choice. It is particularly useful if you are mainly interested in tackling specific problems and are only secondarily concerned with the “why.”
How does cognitive behavioral therapy work and how long does it take?
It is important that you and your psychotherapist have a close and trusting working relationship.
It can sometimes take a while to find the right therapist.
In the first session, you will briefly explain your current problems and outline your expectations. That forms the basis for discussing the goals of therapy and the therapy plan. The plan can be adjusted if your personal goals change over the course of therapy.
Therapy often includes recording your own thoughts in a journal over a certain period of time. The therapist will then check the following things with you: Do I perceive things appropriately and realistically? What happens if I behave differently than I normally do in a certain situation? You will regularly discuss any problems you may have and progress that you have made.
Cognitive behavioral therapy also uses relaxation exercises, stress and pain relief methods, and certain problem-solving strategies.
Compared to analytical psychotherapy approaches, cognitive behavioral therapy is a short-term treatment. But there is also no standard length of cognitive behavioral therapy.
Some people already feel much better after a few sessions, while others need treatment for several months. This depends on the kind and severity of the problems, among other things. An individual session lasts about an hour. Sessions usually take place once a week. Cognitive behavioral therapy is offered in psychotherapy practices, hospitals and rehabilitation clinics. It is sometimes also offered as group therapy.
Can cognitive behavioral therapy also have side effects?
Side effects resulting from psychotherapy cannot be ruled out. Being directly confronted with your problems or anxieties may be very stressful at first, and relationships might also suffer as a result. It is crucial to speak openly with your psychotherapist if any difficulties come up during therapy.
Hardly any research has been done on possible side effects of psychotherapy.
Who covers the costs?
In Germany, statutory health insurance pays for cognitive behavioral therapy to treat mental illnesses such as depression, anxiety or obsessive-compulsive disorders as well as addictions.
The costs of cognitive behavioral therapy can also be covered for the treatment of severe symptoms that result from a chronic illness. It can however sometimes take several weeks or months until you can see a therapist or until the insurance company approves therapy.
In Germany, a psychotherapy practice can bill the statutory health insurance company directly for up to five trial sessions. This way you can get to know the psychotherapist, find out what the problems are and whether therapy is worthwhile. After the trial sessions, you and your psychotherapist have to prepare an application explaining why therapy is needed. You have to submit this application to your health insurance company before therapy can begin. Besides this application, your health insurance company also requires a medical report from your doctor stating that the symptoms are not caused by a physical problem, and that there are no medical reasons against psychotherapy. The statutory health insurance company decides whether to approve therapy based on an evaluation.
Sources
Robert Koch Institute (RKI). Psychotherapeutic healthcare. Berlin: RKI; 2008. (Federal Health Reporting, Booklet 41).
IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.
Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.
Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.
Cognitive behavioral therapy (CBT) what is it?
Psychotherapist Seregin Dmitry Alekseevich told about what cognitive-behavioral therapy is, how one can prepare for it and what can be done to achieve good results in therapy.
What is Cognitive Behavioral Therapy?
Cognitive Behavioral Therapy (CBT) helps people identify and change ineffective habits related to thinking, behavior, relationships with others and replace them with more beneficial ones. CBT works well in the treatment of anxiety and depression, for example, by helping you recognize and address negative thoughts and behaviors that make depression worse and stop them.
Benefits of CBT:
- Cognitive therapy is one of the few forms of psychotherapy that has been found effective in hundreds of clinical trials for a wide variety of disorders.
- CBT, unlike other forms of psychotherapy, is more specific, focused not on past traumas, but on current problems and ways to solve them. The patient is practicing new skills in real situations that he is facing right now.
- The skills that the patient learns during the sessions, he can subsequently use on his own so that the condition does not recur.
- CBT is a faster method than others. Sometimes 6-8 meetings are enough for the state to change for the better.
What is CBT based on?
It is based on a cognitive model that our emotions are influenced not only by the situation itself, but also to a large extent by how we perceive it. Often a negative way of perceiving reality becomes habitual, stereotyped. A person, experiencing another trouble, automatically thinks something like: “I never succeed,” and this, like a vicious circle, strengthens negative emotions, makes the mood even worse and reduces the ability to approach the situation constructively.
In fact, “it never works out” is not a reality, but a harmful cognitive distortion, a generalization.
Cognitive therapy helps to assess how realistic we think, identify distortions and learn how to correct them. When thinking becomes more realistic, the patient feels better, and it becomes easier for him to change his behavior and actively solve problems.
How to prepare for the first session of psychotherapy?
It is always easier to start if the patient has previously defined the goals of therapy. Think:
- What is your goal, what would you like to change at work, in your personal life, relationships?
- What symptoms, bad habits do you want to eliminate?
- What useful habits, skills would you like to acquire?
At the first session, the psychotherapist will help you evaluate and clarify these goals, set priorities.
Before the session, the therapist may ask you to take experimental psychological tests to assess your mood. Test results will help you and your therapist objectively evaluate your progress.
Collaboration will then begin, which combines discussing and solving the issues you have on the agenda together and assessing the accuracy of your thoughts and beliefs about them. In the future, in the course of psychotherapy, the patient learns new skills. At each session, we check together how you feel compared to the previous weeks.
How long does a psychotherapy course last?
As a rule, it becomes clear in 1-2 sessions. The decision is made jointly depending on the patient's condition and the tasks set. Some patients stay in psychotherapy for only a short time, six to eight sessions. Others may wish to continue therapy for several months.
How often do you need to come?
Patients in acute crisis come twice a week, the usual frequency is once a week. Towards the end of the course, when the patient feels better, we arrange more rare meetings - there is a "narrowing" of sessions, when the patient comes every two, and then every three weeks. This "narrowing" allows you to practice the acquired skills, occasionally checking them with a psychotherapist.
How can I prepare for therapy sessions?
You can supplement psychotherapy by reading books on cognitive therapy that I can recommend, doing tasks in workbooks, brochures.
You can also reflect on what you learned in the previous session, write down everything you would like to discuss in the next session.
It is better to use the acquired skills in practice and analyze the difficulties encountered, and then discuss this with the therapist.
"When will I get better?"
This usually happens by 3-4 sessions if you visit them and follow the recommended appointments. You will notice an improvement both subjectively and in the tests we will run.
Cognitive behavioral therapy | PSYCHOLOGIES
On November 1, 2021, Aaron Temkin Beck, an American psychotherapist, professor of psychiatry, who went down in history as the creator of the cognitive-behavioral direction in psychotherapy, died.
"The key to understanding and solving psychological problems lies in the patient's mind," said the psychotherapist. His groundbreaking approach to working with depression, phobias and anxiety disorders has shown good results in therapy with clients and has become popular with professionals around the world.
What is it?
This method of psychotherapy appeals to consciousness and helps to get rid of stereotypes and preconceived ideas that deprive us of freedom of choice and push us to act according to a pattern.
The method allows, if necessary, to correct the unconscious, "automatic" conclusions of the patient. He perceives them as truth, but in reality they can greatly distort real events. These thoughts often become the source of painful emotions, inappropriate behavior, depression, anxiety disorders, and other illnesses.
How it works
Therapy is based on the joint work of the therapist and the patient. The therapist does not teach the patient how to think correctly, but together with him understands whether the habitual type of thinking helps him or hinders him. The key to success is the active participation of the patient, who will not only work in sessions, but also do homework.
If in the beginning the therapy focuses only on the symptoms and complaints of the patient, then gradually it begins to affect the unconscious areas of thinking - core beliefs, as well as childhood events that influenced their formation. The principle of feedback is important - the therapist constantly checks how the patient understands what is happening in therapy, and discusses possible errors with him.
Progress of work
The patient and the psychotherapist find out under what circumstances the problem manifests itself: how “automatic thoughts” arise and how they affect his ideas, experiences and behavior. In the first session, the therapist only listens carefully to the patient, and in the next they discuss in detail the patient's thoughts and behavior in numerous everyday situations: what does he think about when he wakes up? What about breakfast? The goal is to make a list of moments and situations that cause anxiety.
The therapist and patient then plan a program of work. It includes tasks to complete in places or circumstances that cause anxiety - take the elevator, eat dinner in a public place ... These exercises allow you to consolidate new skills and gradually change behavior. A person learns to be less rigid and categorical, to see different facets of a problem situation.
The therapist constantly asks questions and explains points that will help the patient understand the problem.
Each session is different from the previous one, because each time the patient moves forward a little and gets used to living without the support of the therapist in accordance with new, more flexible views.
Instead of "reading" other people's thoughts, a person learns to distinguish his own, begins to behave differently, and as a result, his emotional state also changes. He calms down, feels more alive and free. He begins to be friends with himself and stops judging himself and other people.
When is it needed?
Cognitive therapy is effective in dealing with depression, panic attacks, social anxiety, obsessive-compulsive disorder and eating disorders. This method is also used to treat alcoholism, drug addiction and even schizophrenia (as a supportive method). At the same time, cognitive therapy is also suitable for dealing with low self-esteem, relationship difficulties, perfectionism, and procrastination.
It can be used both in individual work and in work with families.
