Cognitive Behavioural Therapy is a psychotherapy method of treatment that changes the negative mindset and thought processes. It has become a popular form of treatment, is used in many everyday issues, such as trouble in falling asleep, phobias, and trauma. It is even found effective in the treatment of anxiety, depression and self-esteem issues. CBT has become the answer to nearly all mental health problems.
In all probability, you may have received CBT yourself at some point in time in your life. But the question that arises, is what is CBT? How does it work in decreasing psychological problems, and does it really work? Is it an expensive treatment, or can the techniques be applied at home by yourself? It is difficult to answer these questions, and for a layman, the answers seem impossible. But we have the answers for you provided by a clinical psychologist who practices CBT.
1.The first Question that comes to mind is, what is CBT?
CBT is a psychotherapeutic treatment that is based on the theory that the many problems in a person’s life all basically arise from an incorrect thought process (meaning ‘cognitive’) and behavioural habits. By bringing the mindset toward a positive way of thinking that is healthier and focused on productive aims, suffering can be reduced. During therapy, your therapist would want to dig and identify the thoughts and habits you have which cause you this distress and help you change them into a healthier habit.
For instance, John Doe is suffering from social anxiety, and due to this has started isolating himself from any social gatherings to avoid people, preferring to stay alone at home. By applying cognitive behavioural therapy, the therapist will show the patient how the fear of being in large crowds is irrationally prompted, help him to think differently and to calm his body and mind, and help him to come up with a plan to maintain her calm and not get anxiety attacks before and at a party he may be supposed to attend that weekend. At a follow-up appointment, they would together dissect which methods worked and which didn’t, and change their approach, continue till John is able to comfortably attend social events and gatherings
2.How will you know if CBT is the right approach for your issues?
CBT can be applied to all issues such as treating anxiety, trauma, depression, anxiety and low self-esteem. It can also be applied to issues from ADHD to relationship problems such as communication issues between spouses or unrealistic expectations. If you are having a mental health issue that is focused on how you think of behaving, then CBT can be the answer for you.
But how do you identify which problems are related to negative thoughts or behavioural problems? If you have issues arising in your life because you think on a certain topic too much, for instance musing helplessly over past mistakes or break-ups, or wasting money on online shopping because you’re ‘bored’, then you would in all probability, be able to improve your life with CBT. But if your problems are spiritually related, such as finding meaning to your life or the purpose of your being alive, or even about how your past lives affect your current life issues, then CBT might not be the answer for you, and you may find some other therapies which would work better for you.
3.Why is CBT so popular nowadays?
CBT has been extensively studied in the short time since it was first practised, making it widely known and used. It is an ideal modal for studying, as it focuses on a short, direct mediation that is focused around providing a solution to the issue. This means that the CBT will give a change in the behaviours and thoughts of the patient in clear way that can be measured, which makes it the perfect research material. This also gives us fast answers.
According to Martin Hsia who is a PsyD and a certified CBT practitioner practising CBT in Glendale, California, CBT is applied on a huge percentage of persons suffering from anxiety in some form or the other, such social anxiety, health anxiety, OCD or panic attacks.Encouraging patients to gently face their fears and learn and adopt ways to controlling or diverting their thoughts is how the basic way of applying CBT. Dr Hsia says that CBT is what provides practitioners with the tools to coax patients to face the very things that they have been trying to avoid.
4.How does a CBT session work?
The early sessions of CBT would work in the same way as any other psychotherapy session would, as CBT itself is a branch of psychotherapy; the formalities of therapy such as payment details and what would happen if you cancelled your appointment, what you wish to achieve through therapy, your past history and a look at the issues you are facing. Following this, you would be encouraged to talk about the difficulties you face and the therapist would work with you to come up with a response that would work well for you.
The patient comes with a list of issues they wish to work on or situations that they find themselves getting anxiety. The therapist and patient then work together to draft a plan. The plan revolves around understanding and digging out the thoughts and behaviours which trigger the problem or issues and formulating a method to change these thoughts and coming up with a strategy to adopt this change in the patient’s daily life for the coming week. This ‘applying the change’ is akin to Homework.
CBT typically takes eight to twelve weeks for effectively tackling the symptoms the patient faces. In psychotherapy, this is considered a quick resolution, and for it to work, the techniques and methods learnt to need to be adapted to everyday life outside of therapy too. CBT Homework focuses on exercises to calm and relax the mind and body, maintaining a journal to note down the thoughts and feelings faced during the week, working on a part of you that you want to improve on by using worksheets, reading notes, papers or books on issues similar to yours, or actively participating in situations where you can practice your new techniques. John Doe would want to participate in social events and meetings which would normally trigger her anxiety to be able to practice her new techniques and overcome her fears.
In cases such as depression, if John’s depression is caused by his own mind speaking negatively to himself – getting upset at small failures and belittling himself constantly – he, with his therapist, would want to try a technique known as ‘thought stopping’, where John has to mentally scream ‘Stop!’ to break the negative flow of thoughts in his mind. At the same time, he would have to redirect his mind to positive thoughts such as meditation, or self-affirmation. When not in therapy, John would be required to practice this at least once a day as Homework. By talking about it the following week, John and his therapist can determine if it has been effective, and what needs to be changed for the coming week to make it more so.
6.How long will the CBT go on for?
CBT is limited from a few weeks to a few months, depending on the severity of the symptoms, and how long it takes to completely eliminate them from your life. As most patients do not come to therapy with only one issue, the length would depend on how many issues you have and how severe they are, but it is important that the overall therapy be brief.
This is where CBT majorly differs from other therapy methods. One of the founders of CBT, Donald Meichenbaum says that the main approach to CBT is in asking ‘what’ and ‘how’ questions. ‘Why’ is not much important, or productive. Whilst other psychotherapy methods focus on why, trying to dig into the details of why the depression, anxiety or other issues have come up in your life, CBT focuses only on the current existing thought processes and behaviours. Not focusing on why you have a height phobia, it focuses on eliminating your fear. This is fine with some people who only want to do away with their symptoms, but not with others who wish to know why these symptoms came up in the first place. For those people, psychodynamic therapy would work better.
7.Can CBT techniques be used outside of therapy sessions?
If you have maintained a journal in your life, or a diet diary, or a fitness monitoring device, you have already been applying CBT to yourself. By referring to David Burn’s Feeling Good, or Edmund Bourne’s Anxiety and Phobia Workbook, both of which are available online, you can apply CBT techniques in your everyday life. But therapy is still the best answer for building a technique that would be most suitable for you.
8.How expensive is CBT, and is it covered by insurance?
CBT is psychotherapy and as such, if you have an insurance cover for behavioural medicine and psychotherapy, CBT therapy would get mostly covered, if not entirely by it. But if you are not in insurance, it would cost upwards of $200 in private clinics, but be free, or very little at community clinics. But as mentioned, CBT is a quick therapy form and would work out cheaper than other methods over a period of time. You can search for a suitable therapist for yourself on websites such as GoodTherapy or Psychology Today.
9.How do I compare CBT to other forms of psychotherapy, what are its bad points?
Patients may at times want to simply get therapy at a place where they can sit and process their thoughts and experiences with gentle coaxing with their therapist. They may not want to deal with any symptoms or behavioural issues they have, but want to simply grow in their lives and wish to have a therapist for a long-term benefit. They may be wanting to look up their old memories, understand their dreams and failures and work on their relationships with their therapist. As CBT is a more direct approach and does not focus on the ‘why’ of an issue, it would not be suitable for such persons. But many CBT practitioners are also skilled at other approaches besides CBT and will be able to meet the requirements of their patients, as needed.
As even Dr Hsia says, CBT tries to work on a ‘one-size-fits-all’ kind of model, where they believe the same technique would work for all people. CBT also focuses only on curing symptoms, and not the main cause of what is causing those symptoms, and as some psychologists believe, until and unless the real issue is resolved, the short-term relief methods would fail soon enough. But, as a patient, you need to decide what method would work well for you, and only a trial and error method would help you figure that out.
You could talk it out with your prospective therapist to determine what could work for you. Regardless of the kind of treatment you seek, it is important that in the end, it works for you and you feel safe talking about your issues with your therapist.