Cognitive Behaviour Therapy (CBT) is a therapeutic modality based on the work of Aaron T. Beck (Cognitive Therapy) and Albert Ellis (Rational Emotive Behaviour Therapy; REBT) which took root in the 1960’s. CBT is a structured, present focused and relatively short term form of therapy which has been extensively studied through empirical research since the 1970’s. What separates CBT from many other types of therapy is that its effectiveness in treating a wide range of psychological issues has been proven through clinical research. In short, we know that CBT works. In addition, CBT tends to be shorter in duration than many other therapeutic interventions, making it more cost effective.
CBT is based on the premise that distorted or dysfunctional thinking is common to all psychological disturbances. The Cognitive Model proposes that clients’ thinking influences their moods, behaviour and even their physiological responses (e.g., heart rate and blood pressure). The good news is that clients can be taught to modify their thoughts and beliefs and can thereby experience enduring emotional and behavioural change, reduction in distressing symptoms and improvement in general functionality and wellbeing.
How Does CBT Work?
The starting point in CBT is collaboratively conceptualising the client’s problems in cognitive terms to enhance insight and pave the way for therapeutic change. The client’s problems are framed in terms of current thinking and behaviour, precipitating factors (i.e., triggers), and past developmental events and the enduring manner in which these events are interpreted leading to maintenance of current issues.
CBT encourages collaboration and active participation– therapy is viewed as ‘team work’ and sessions are structured. The client and therapist together decide on such things as what to work on in each session, how often to meet, and what to do in between sessions to enhance the therapeutic process.
CBT is goal oriented and problem focused. The therapist assists the client in defining their problems in cognitive and behavioural terms thereby facilitating more manageable problem-solving. If the client lacks effective problem-solving or goal planning skills, the therapist will coach the client in developing these essential life skills.
CBT initially emphasises the present. There is a strong focus on current problems and specific situations that are causing the client distress and this allows early symptom reduction. CBT does address the past when necessary in order to understand the origin of current dysfunctional beliefs and behaviours and how these affect the client in the present.
CBT is educative and empowering - the aim is to teach clients to be their own therapists, with an emphasis on relapse prevention. Clients are taught about the nature and course of their difficulties as well as the process of CBT. In addition, clients are taught to identify, evaluate and respond to their unhelpful thoughts and beliefs and are shown a variety of techniques to change their thinking, mood and behaviour. CBT aims to empower clients with the skills they need to manage their own psychological health and wellbeing.
CBT aims to be time limited. Many clients can be assisted within 6 to 14 sessions and this might be followed by ‘booster’ sessions every 3 months to maintain progress and prevent relapse. In some instances, clients require 1 to 2 years of therapy to adjust very rigid dysfunctional beliefs and patterns of behaviour which underlie their chronic distress.
Advantages of CBT
The effectiveness of CBT has been confirmed in a large number of clinical studies (over 300) comparing CBT with other treatments (including other therapeutic modalities and antidepressants).
Research has shown that the benefits of CBT may last longer than those of medication. For example, studies have shown that clients who receive CBT have lower relapse rates than those who use medication alone.
The National Institute for Health and Clinical Excellence (NICE) in the UK consistently recommends CBT as the most effective treatment in all its guidelines for treatment of emotional disorders.
CBT provides clients with tools, skills and principles to tackle their problems, which they can continue to use after therapy has ended.
CBT tends to be short-term or medium-term, taking three to six months for most emotional problems. It is thus cost-effective.
In CBT there is an equal relationship between client and therapist. The therapist elicits the client's views and reactions, which then shape the way the therapy progresses. There is little danger of the client becoming dependant on the therapist, as the aim is to enable the client to become their own therapist.
CBT makes use of jointly agreed on ‘homework’ tasks between sessions to maximise the efficiency of therapy.
What Kind of Problems Can CBT Help With?
CBT can be an effective therapy for a number of problems, including:
Anxiety and chronic worry
Chronic pain and chronic fatigue management
Coping with medical conditions (e.g., IBS, Fibromyalgia, Cancer)