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Cognitive Behavioral Therapy

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Cognitive Behavioral Therapy

Cognitive behavioral therapy, often shortened to CBT, is a type of psychotherapy that has been found to be beneficial for a wide range of conditions. Cognitive-behavioral therapy is a goal-directed form of therapy that emphasizes changing patterns of behavior and thinking. Patients work to systematically alter their reactions to life situations, their beliefs, and their attitudes. 

During the course of therapy, patients not only reflect how their thought patterns affect their behavior, they actively work to develop new habits that are more beneficial to their lives. While undergoing sessions of cognitive-behavioral therapy, individuals improve their ability to cope with their emotions, engage in a positive manner with other people, and become more fulfilled in their lives. For these reasons, cognitive-behavioral therapy is effective for a wide range of life challenges, including addictions and mental health disorders.

What is Cognitive-Behavioral Therapy?

Cognitive-behavioral therapy, or CBT, is often the treatment of choice for most major mental health conditions, but what is CBT? Cognitive-behavioral therapy is unique among talk therapy methods because it emphasizes the present circumstances of the patient. 

Unlike psychodynamic therapy or psychoanalysis, which involve reflecting on the ways a patient’s history has influenced their current state, cognitive-behavioral therapy is strongly rooted in present concerns. Rather than trying to answer the question of “why” a patient feels a certain way or suffers from a certain mental health condition, cognitive-behavioral therapy works to provide them with actionable tools to help them cope with their situation. As such, cognitive-behavioral therapy tends to be a very goal-directed form of talk therapy.

After an initial evaluation and assessment, individuals engaged in cognitive-behavioral therapy work with a clinical psychologist to set specific concrete goals for treatment. Cognitive-behavioral therapy treatment is often finite, with a clearly delineated beginning and end to treatment. When the goals set by the client and clinician are met, treatment either ends or new goals are devised.

The basic concept behind cognitive-behavioral therapy is that mental processes have a direct impact on behavior. By helping a patient develop healthier and more realistic thinking habits, a cognitive-behavioral therapist can help improve their behavior as well. During treatment, clinicians work with clients to identify problematic thinking patterns and behaviors. Over time, clients work to develop healthier alternatives that aid rather than hinder them in living their lives.

Over the last few decades, cognitive-behavioral therapy has come to be accepted as one of the most effective evidence-based treatment modalities. It is effective for a wide range of mental health disorders and addictions. Given that many mental illnesses emerge from specific behaviors and ways of thinking, CBT is ideally suited to addressing them. Not only does cognitive-behavioral therapy alleviate the symptoms associated with these disorders, it also provides effective tools for people to cope with ongoing symptoms and function normally in their lives.

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Origins and History of Cognitive-Behavioral Therapy

The history of cognitive-behavioral therapy arguably goes back thousands of years. Its philosophical underpinnings can be discovered in the thought of the ancient Stoics. Stoicism was a school of Hellenistic philosophy. Stoic philosophers like Epictetus, who was born a slave, argued that suffering arises when people try to control aspects of life that they cannot possibly control. 

The only aspect of life that people can really control, argued Epictetus, is their own thinking. Stoic philosophers encouraged people to identify and discard erroneous or illogical beliefs that cause destructive emotions.

Modern cognitive-behavioral therapy emerged from two strains of therapy: behavioral therapy and cognitive therapy.

Behavioral Therapy

Behavioral therapy was developed in the early 20th century by a variety of psychologists and medical professionals, such as Ivan Pavlov and B.F. Skinner, who worked to understand the principles behind behavior. Systematic approaches to changing behavior patterns included classical conditioning and operant conditioning, both of which were based on the idea that behaviors can become reinforced by specific triggers and circumstances. These techniques were effective at helping people deal with phobias, anxiety disorders, and problematic behaviors.

Cognitive Therapy

The first therapists to address cognitive processes were Alfred Adler and Albert Ellis. Alfred Adler developed the notion of “basic mistakes,” which are thinking patterns that create challenges for individuals. Examples of Adler’s basic mistakes include overgeneralization and unrealistic goals. Albert Ellis, who was influenced by Adler, developed a systematic approach to cognitive therapy known as rational emotive behavior therapy (REBT). REBT was designed to help people lead happier and more fulfilling lives by changing erroneous beliefs. Albert Ellis, Alfred Adler, and other early cognitive therapists believed that changing these beliefs alone would lead to improved mental health.

Modern Cognitive-Behavioral Therapy

Even though behavioral therapy was effective for a wide range of conditions, major conditions like depression didn’t seem to respond to it. For a period of time, cognitive therapy and behavioral therapy were widely seen as two separate approaches. By the 1980s and 1980s, however, a high number of clinicians were implementing both approaches. To understand behavior, they thought, it was necessary to examine its cognitive underpinnings. Many also began to understand that cognitive processes are also shaped by behavior patterns. 

The merging of cognitive and behavioral therapy was popularized by clinicians David M. Clark and David H. Barlow, who developed successful treatments for panic disorder. Over time, cognitive-behavioral therapy came to be recognized as one of the most effective evidence-based treatments for a wide variety of conditions. Because it is evidence-based, well-researched, and very affordable, CBT has also become the treatment of choice for health insurance companies and many clinicians. Today, cognitive-behavioral therapy is an umbrella term that refers to a diverse set of unique treatment modalities.

Types of Cognitive-Behavioral Therapy

Cognitive-behavioral therapy is a type of therapeutic intervention that includes a wide variety of techniques and treatment philosophies. Certain types of cognitive-behavioral therapy are more suitable to treating specific conditions, such as obsessive-compulsive disorder, post-traumatic stress disorder, and substance use disorder. While all varieties of CBT share an underlying philosophy that harmful behavior and distressing emotions arise from unhealthy thoughts, the techniques that each variety uses are somewhat unique. Common types of cognitive-behavioral  therapy include:

  • Rational Emotive Behavior Therapy (REBT). During REBT, clinicians help their clients alter their irrational thoughts so that their views become healthier. Doing so helps alleviate dysfunctional emotions and behaviors.
  • Multimodal Therapy (MMT). Multimodal therapy theorizes that there are seven distinct sides to a person’s personality: behavior, affect, sensation, imagery, cognition, interpersonal relationships, and biology. By addressing each side, MMT helps people shift their emotions and behaviors.
  • Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). This form of CBT is designed to treat post-traumatic stress disorder specifically. TF-CBT follows a structured program to address traumatic incidents and their aftermath.
  • Mindfulness-Based Cognitive Therapy (MCBT). MCBT combines the principles of CBT with mindfulness philosophy, the latter of which is secular in nature despite originating from Buddhism. MCBT helps clients center themselves in the present and respond deliberately to situations rather than reacting automatically.
  • Acceptance and Commitment Therapy (ACT). Acceptance and Commitment Therapy helps people learn to accept their feelings and thoughts rather than trying to change them. Often the process of accepting ones thoughts ends up making them healthier. 
  • Dialectical Behavioral Therapy (DBT). DBT is often the treatment of choice for people with borderline personality disorder or substance use disorder. Dialectical behavioral therapy helps people face the challenges of everyday life and learn to accept their own feelings without judgment.
  • Eye Movement Desensitization and Reprocessing (EMDR). EMDR is a treatment for post-traumatic stress disorder that is based on the idea that when people are re-experiencing trauma or pain, their eyes movements change. By working directly on these eye movements, clinicians can reduce the subjective distress that clients experience.
  • Reality Therapy (RT). Reality therapy rejects the notion of “mental illness,” prefering to understand clients as individuals whose needs are not met. By focusing on the present rather than the past, this type of therapy works to address these needs.
  • Cognitive Processing Therapy (CPT). CPT, which is often recommended for people with PTSD and related conditions, helps people get past “stuck points” in their emotional processing of traumatic events. By supporting them as they work through their thoughts and feelings, CBT can help individuals make a full recovery.

How Cognitive-Behavioral Therapy Works?

The basic idea behind cognitive-behavioral therapy is that thought processes that are inaccurate or unrealistic can lead to unhealthy behaviors and distressing emotions. Cognitive-behavioral therapists help relieve people’s suffering by gently guiding them through the process of replacing unhealthy thoughts with ways of thinking that will help them live successfully in the world. 

CBT takes an active approach. A clinician practicing cognitive-behavioral therapy will encourage their patient to ask themselves whether a certain thought or point of view is helping or hindering them. If the thought is not productive, client and clinician together will work to replace it with something more adapted to living.

At the beginning of CBT treatment, clinicians start by evaluating their client’s situation and needs. After identifying the major problems and difficulties that the client is facing, the clinician will devise an individualized treatment plan. CBT treatment plans are generally goal-based, with tangible treatment milestones. As such, CBT treatment generally has a finite length, lasting roughly 8 to 16 weeks, depending on the client’s needs.

The treatment plans that CBT utilizes to help people change their cognitive and behavioral patterns vary widely. Examples of goals that a clinician might suggest for a patient include:

  • Improving self-confidence
  • Helping a client learn to advocate for herself
  • Coming to a better understanding of what motivates other people
  • Developing better coping techniques for stressful situations
  • Learning how to respond to triggers without relapsing
  • Learning to accept uncomfortable thoughts and emotions
  • Learning how to accept and live in the face of fear, without letting it dictate ones life
  • Developing strategies for remaining calm in complex or difficult situations

Cognitive-Behavioral Therapy Techniques/Practices

Cognitive-behavioral therapy is designed to help people change their thought and behavioral patterns. To that end, clinicians use a wide variety of techniques that are meant to help people learn coping strategies, alternative ways of thinking, and improve emotional regulation. These techniques include:

  • Problem-solving. Clinicians help their clients figure out practical solutions for problems they face in their daily lives.
  • Skills training. Clinicians help clients develop specific communication and self-advocacy skills so that they are better prepared to handle social situations.
  • Role-playing. The clinician may suggest acting out a distressing situation, after which both parties will discuss what emotions the client experienced. This can be a helpful way of learning new ways of reacting.
  • Exposure therapy. By exposing a person to painful or triggering circumstances in a safe and supported manner, patients with PTSD or strong phobias can learn to handle their emotions.
  • Relaxation. The clinician will likely teach a variety of relaxation exercises, including breathing techniques, visualization, and meditation. Sometimes medication is suggested for this purpose as well.
  • Mindfulness. Mindfulness techniques can help people live in the present and respond to their actual circumstances, rather than reacting automatically based on past experiences that no longer have any bearing.
  • Cognitive restructuring. Cognitive restructuring involves recognizing and challenging maladaptive thoughts and beliefs.
  • Homework. Clinicians sometimes assign CBT worksheets or writing exercises to help reinforce the themes of each CBT therapy session.

Cognitive Distortions

Cognitive-behavioral therapy often involves learning to recognize what CBT refers to as “cognitive distortions.” Cognitive distortions are thoughts, beliefs, and attitudes that do not reflect reality and lead to psychopathological states. The underlying assumption of CBT is that if a person is able to perceive reality more accurately and rationally, the symptoms of their mental health disorder will abate. Cognitive-behavioral therapists work with their clients to replace these cognitive distortions with more rational and adaptive ways of thinking. Examples of cognitive distortions include:

  • Overgeneralizing. Overgeneralizing means reaching a hasty generalization based on insufficient evidence. An example would be an addict who, after a relapse, concludes that they “always will relapse.” The more accurate statement would be that they merely relapsed once.
  • Jumping to conclusions. People sometimes jump to negative thoughts without any evidence. A common example is mind reading, which occurs when a person erroneously believes they know what other people are thinking about them in social situations. Another common example is fortune-telling, when a person erroneously believes they know how a certain event will turn out.
  • Emotional reasoning. During emotional reasoning, people are led to believe that just because they have a strong emotion, their thoughts must be true.
  • Making “must” or “should” statements. People who make “must” or “should” statements are often holding themselves to unrealistic standards.
  • All-or-nothing thinking. All-or-nothing thinking gets in the way for many people. An example could be thinking, “I either need to find the love of my life or never date anyone.” Sometimes avoiding absolutes is the healthiest approach.
  • Magnification and minimization. It is common for people to minimize positive events and give more weight to negative events. Another variation of this is emphasizing the positive qualities of others while dwelling on ones personal deficiencies.
  • Personalization and blaming. Personalization involves making a situation about oneself. An example could be a parent believing that they are a bad parent because their child failed an exam. Blaming is the inverse of personalization. It involves removing the locus of control from oneself, such as blaming a spouse for marital problems.
  • Fallacy of change. People with this cognitive distortion often believe that they need to control others in order to obtain cooperative actions or harmony. In reality, a person’s happiness does not depend on the actions of others.
  • Always being right. It is common for depressed or mentally ill people to believe their way of thinking is right no matter how much contrary evidence is presented to them. Realistic thinking involves recognizing that a person might be wrong.

What to Expect During Cognitive-Behavioral Therapy?

Cognitive-behavioral therapy is a finite, short-term form of treatment that is highly goal-oriented. The beginning of treatment usually involves the therapist identifying the patient’s problem areas. The initial sessions revolve around recognizing dangerous cognitive and behavior patterns. After these are recognized, the clinician will use CBT techniques to help the patient replace these maladaptive thought and behavior patterns with more useful and rational ones.

CBT sessions are generally 60 minutes, though sometimes they can last for 45 minutes. These sessions are often highly structured. They are not meandering conversations, but focused meetings with specific objectives. CBT sessions are most frequently conducted on a one-on-one individualized basis, but group therapy often utilizes the principles and techniques of CBT as well.

During the course of CBT, people should expect to be uncomfortable at times. Cognitive-behavioral therapists make an effort to ensure that treatment feels safe and supportive. Nonetheless, exploring distressing thoughts and emotions is by definition somewhat distressing! 

Clinicians treating people who have had traumatic experiences often use a technique called exposure therapy, that involves gradually exposing a person to their triggers in a way that feels safe. Nonetheless, techniques like this can be very emotionally demanding. Fortunately, a cognitive-behavioral therapist is available to help people work through their complicated thoughts. They may also assign homework and other exercises to help reinforce the topics covered in the session.

Goals and Benefits of Cognitive-Behavioral Therapy

As a goal-based treatment, CBT offers patients a chance to work on difficulties that are unique to their lives. During the course of treatment, patients improve their coping skills, change the underlying thought processes that lead to mental distress, eliminate destructive thoughts, and learn how to better communicate and interact with other people. 

After the completion of treatment, most people feel that they have more control over their problematic behaviors and are able to see their situations more realistically. The goal of cognitive-behavioral therapy, however, is not “insight” — but tangible results. Clinicians work to help their clients become more functional in their everyday lives.

By the end of therapy, patients will experience fewer symptoms of their mental health disorder. Some people even experience complete remission. More importantly, the skills and coping tools learned via CBT are often sufficient to prevent relapses and future episodes of mental illness. CBT treatment has a finite length, and it is therefore designed to give patients practical skills that they can take with them into the future.

Effectiveness of Cognitive-Behavioral Therapy

Cognitive-behavioral therapy is notable for being an evidence-based treatment method. In fact, it is arguably the most well-researched form of talk therapy. A recent study that looked over 269 meta-analyses found that cognitive-behavioral therapy consistently leads to significant reductions of patients’ symptoms. Some researchers claim that CBT is the gold standard of treatment methods. 

One reason why cognitive-behavioral therapy is so effective is that it is a goal-directed treatment. Patients work toward tangible goals during the course of treatment. As a result, when treatment ends they are guaranteed to have made measurable progress in their recoveries. This makes CBT treatment specifically suitable for outpatient treatment centers, where timely reductions in symptomatology are essential.

Cognitive-Behavioral Therapy in Mental Health and Addiction Treatment

Research has confirmed that cognitive-behavioral therapy is one of the most effective treatment methods for a wide variety of mental health disorders and substance use disorders. While cognitive-behavioral therapy was initially developed as a treatment for major depression, its use has expanded to cover most major mental illnesses and interpersonal problems. Conditions for which CBT has been studied as a treatment method include:

  • Major depression
  • Anxiety disorder
  • Eating disorders, including bulimia and anorexia nervosa
  • Attention-deficit hyperactivity disorder (ADHD)
  • Sleep disorders, including insomnia
  • Postpartum depression
  • Anger management disorders
  • Tics
  • Bipolar disorder
  • Personality disorders
  • Obsessive-compulsive disorder
  • Post-traumatic stress disorder
  • Schizophrenia and psychotic episodes
  • Substance use disorders

Substance use disorders are particularly responsive to cognitive-behavioral therapy. This is because substance use disorders are known for having two significant components: mental cravings and unhealthy behavioral patterns. Cognitive-behavioral therapy can help people with addictions address their cravings and recognize the triggers that are associated with drug and alcohol use.

 CBT encourages patients to develop coping tools that allow them to respond healthily even in stressful or triggering situations, rather than reacting automatically. As such, cognitive-behavioral therapy can help people with substance use disorders in a number of ways, including:

  • Helping people quit drugs and alcohol
  • Help people manage their substance abuse in the context of a harm reduction approach
  • Help people stay sober and avoid relapse
  • Help people cope with the emotional turmoil, interpersonal difficulties, and inevitable challenges that often occur during early recovery

Finding Cognitive-Behavioral Therapy Near Me

For individuals who are in distress, cognitive-behavioral therapy is widely available and highly effective. Suffering from a mental health disorder or addiction can be a deeply isolating experience. Unfortunately, a high proportion of sufferers never seek help. In fact, only 11% of people with substance use disorders ever pursue addiction treatment. 

While it may be tempting to try to manage ones symptoms on ones own using personal willpower, doing so is likely to be unsuccessful in the long run. Substance use disorders, along with mental health disorders, are legitimate mental health conditions that require evidence-based treatment. Given that these conditions often lead to severe health, financial, and interpersonal consequences, getting treatment is often a matter of life and death.

CBT Program in Los Angeles

NuView Treatment Center, an outpatient treatment center located in West Los Angeles, offers cognitive-behavioral therapy for individuals who suffer from substance use disorders, major depression, anxiety disorder, and other mental health disorders. Our dedicated clinicians have experience helping people develop the tools they need to recover from severe emotional distress. 

They are trained in techniques for managing the symptoms of addictions. Getting CBT treatment at NuView Treatment Center can help people suffering from addictions develop the tools they need to develop sobriety, avoid relapse, and begin to lead healthy and productive lives without the crutch of drugs and alcohol. Recovery is only a step away: reach out today.

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