What is Cognitive Behavioral Therapy (CBT)?

CBT: A Short Primer

The Underlying Theory

Cognitive behavioral therapy is partially based on the premise that emotions cannot be changed simply by talking about them. Instead, our emotions are a result of our thought, our behaviors, our biology, and our interaction with our environment (family, friends, co-workers, our jobs, culture, living conditions, etc.). Only by changing the way that we think and act can change the way we feel. Our thoughts have a lot to do with why we act the way we do, as well as how we feel. And our behaviors have a significant impact on both our emotions and our environment (for example, how the people in our lives treat us).

The Method

Cognitive Behavioral Therapy (CBT) is a combination of cognitive therapy and behavior therapy.  The primary goal of cognitive therapy is to change self-defeating thought processes so that they are more accurate and so that they lead to more adaptive behaviors and emotions.  The primary intervention is socratic questioning which is designed to help clients learn to think more logically about the way that they see, for example, themselves, their environment, their future and the actions of others.  Cognitions are viewed as the driving force behind emotions (and many behaviors), which thus makes them, and not emotions, the target of intervention.  

Behavior therapy has two potential focuses, depending on the client: behavior change and conditioning.  Interventions for behavior change include identifying factors that motivate maladaptive behaviors as well as barriers to adaptive behaviors; helping clients actively engage in adaptive behaviors by making them easier, by removing barriers and through detailed education about how those behaviors will likely be helpful.  Conditioning, which is particularly relevant to anxiety (e.g., GAD, Panic) and anxiety-related disorders (e.g., OCD), is typically treated with exposure and by teaching clients adaptive ways to NOT avoid anxiety-inducing stimuli so that they can become habituated to anxiety.   

A scientific approach to therapy

Aside from it’s empirically-derived foundation and the empirical support that it has achieved, CBT is also scientific in the way that it is practiced.  Cognitive behavioral therapist think of therapy as a form of “collaborative empiricism,” in that it involves a series of both thought experiments and real-world behavioral experiments where clients learn to think more accurately and adaptively, as opposed to a common tendency to “catastrophize” (blowing things out of proportion – anxiety) or think in black and white terms (“no one loves me” – depression).  We also work with clients to extinguish conditioned fear responses, including panic, avoidance and reassurance-seeking; and to encourage adaptive behaviors such as exercise, finding employment and making and engaging with friends.  We practice the scientific method by constantly monitoring the effectiveness of our interventions, learning from them, and changing them as needed.

Engineering solutions

Empirically Supported Treatments (ESTs) are more tailored forms of CBT that target specific conditions and are sometimes referred to as “technologies.”  They are based on the premise that specific symptoms or symptom clusters are generated and maintained by a specific set of biological, behavioral, cognitive, social and environmental factors.  If those factors can be explicitly understood, they can each be targeted with a specific set of empirically derived and supported interventions, which are packaged together as “technologies.” Thus, cognitive behavioral therapists can be seen as curious, supportive, empathic engineers.  We figure out what is not working, and we use specific tools to fix it.  It is then the client’s responsibility to carry out that plan between sessions and after terminating therapy.

When clients just want to be listened to, we do that.  When they just need support, we do that as well.  But when they want to see their problems go away, we have very good tools to help, and we can sometimes solve those problems or at least alleviate them to the point that the client can be happy.

Client education

Psychoeducation is the bedrock of cognitive behavioral therapy.  Therapy involves teaching clients how to recognize thoughts and behaviors that maintain or escalate their problems; as well as patterns of thinking and behaving that have the potential to alleviate or solve those problems.  In order for that to happen, clients must not only clearly understand maintaining factors and adaptive responses, but also why and how they work so that they are motivated to use them and so that they can use them flexibly in novel situations. 

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