What is CBT? Cognitive Behavioral Therapy is a mental health psychological treatment, or psychotherapy. The range of problems it treats is broad, from anxiety and depression to substance abuse and relationship problems. It is considered gold standard treatment (especially for OCD, Social Anxiety, and more). It is also seen as a first line treatment for a range of problems and goals. I’m here to help you nerd-out and understand a bit more about where it comes from and ideas on how it works.
Cognitive Behavioral Therapy in 3 Parts
CBT is often conceptualized on a triangle, such as the following “ABC”:
This triangle reflects no particular order or prioritization.
Every psychotherapy’s core question- and the role of theory.
By and large, it can be argued that any major system of psychotherapy at its heart is asking the question, “How does change occur in people? OR What effects change?” Change can be a quite comprehensive term, and may involve modification of feelings, distress, pain, suffering, hope, and much, much more.
Many people don't know that any medical treatment is born out of theory and still operates in the realm of various theories as to how and why they work. It is argued that the brain is the most complex object in the known universe, so staying “open-minded” (my attempt at a pun) and patient with learning is warranted. Even the assumption that mental health is brain health is based on, well, theory. And it may turn out to be overly reductionist from a research standpoint.
“All thinking involves theories….” (Alderson, 1998).
Most all my readers have experience with a traditional family doctor. They likely practice from what’s known as “the medical model,” which is a theoretical approach. Some may confuse this as only “symptom/problem focused,” but it is more pattern recognition (Aftab, 2020).
CBT is based out of both behavioral, social, and cognitive learning theories (Davis et al., 2017):
When did CBT first come into use?
As with most things that involve credit giving and fame, the début of most theories can be likened to an academic bare-knuckle brawl which lends to the asserting of various individuals and institutions as the rightful heir to said throne. Yes, the key names in its development were certainly Albert Ellis and Aaron Beck, but just as multiple theories converged to birth CBT, so did multiple researchers, voices, and systems. By and large, cognitive theory began disrupting the dominant behavioral theories in the 1960’s and 70’s, gaining steam in the therapeutic community by late 70’s and 80’s.
Ride the wave.
CBT is often seen in “three waves (Hayes and Hofmann, 2017).”
What does it treat?
Treatment for Anxiety, Depression, and OCD are common with CBT. You can find the robust treatment of PTSD, substance abuse, relationship problems, eating disorders, Bipolar Disorder, psychosis, chronic pain, general health, and much more, as well.
Any successful treatment has its limits, and Cognitive Behavioral is no different. Autism by and large is treated through Behavioral Therapy (specifically ABA). Those looking for supportive psychotherapy (talk therapy) to verbally process may prefer someone who spend more time working with this approach (though many CBT clinicians are quite good when warranted). Personality disorders are thought to be better treated holistically by DBT, which, though originally based out of CBT, is distinct in some regards. Furthermore, those lacking insight or awareness may not respond well to the requirements of CBT that involves self-monitoring and actively engaging in various changes based on the individual’s awareness and willingness.
Hallmarks of CBT.
Personalized hallmarks of CBT.
While CBT is largely characterized by the above, variations exist additionally, such as in my practice, where appropriate:
CBT and you.
Though there are many effective therapy treatments to date for a range of issues, CBT comes out as the most researched, most helpful for the widest range of problems, and can be highly personalized. If you are considering (or reconsidering) CBT, it is crucial to advocate for yourself and ask good questions of a potential counseling provider, typically in a first session:
For Further Reading:
What is CBT? (APA)
Cognitive Behavioral Therapy (IQWiG/informedhealth.org)
Evolution of CBT (NIH)
History of CBT in Youth (NIH)
The Importance of Theories in Health Care (NIH)
The Origins of Cognitive Behavioral Therapy (PsychCentral)
A Psychotherapists' thoughts on healthy living.
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