Approximately 35 years ago, one of the founders of Cognitive Behavioral Therapy, Aaron Beck, together with Gary Emery and Ruth Greenberg, published the book Anxiety Disorders and Phobias: A Cognitive Perspective (Beck, Emery, & Greenberg, 1985). In this book, the authors presented for the first time a cognitive model of anxiety disorders, which represented an important reconceptualization of the nature, causation, and treatment/management of anxiety. At that time, research on the cognitive characteristics of anxiety was very limited, and empirical data were scarce; much of the theoretical foundation was based purely on clinical observations. However, over time, as research into the cognitive characteristics of anxiety and clinical studies of cognitive behavioral therapy for anxiety disorders gradually increased, research-based knowledge and treatment methods in the field were refined and expanded. As a result, today Cognitive Behavioral Therapy is considered one of the best approaches for overcoming anxiety disorders because of its effectiveness and outcomes, its scientific and evidence-based methods, as well as the rationality of its theoretical foundations and its flexible integrative nature.
Today, Cognitive Behavioral Therapy (CBT)[1] is an umbrella term for a number of psychological interventions and psychotherapeutic approaches (for example, Cognitive Therapy, Rational Emotive Behavior Therapy, Dialectical Behavior Therapy, Schema Therapy, Cognitive-Conceptual Therapy) that are united by a common methodology.
The main format in which CBT, like almost all psychotherapeutic approaches, is conducted is individual therapy. This involves a process in which only one therapist and one client participate.
What other formats of psychotherapy are there?
In addition to individual psychotherapy, psychologists may also use other formats of psychotherapy. One example is group psychotherapy, which involves clients who are not otherwise connected with one another but share the same anxiety-related problem participating in a session. Family psychotherapy may also sometimes be used, during which family members of a person with an anxiety disorder can better understand their relative’s problem and learn to interact in ways that do not reinforce the person’s anxiety and the dysfunctional behaviors associated with it.
CBT can be conducted not only face-to-face, for example in a psychologist’s office, but also online, using modern means of remote Internet communication that provide audio and video connectivity (for example, Skype, Viber, WhatsApp, etc.).
Numerous studies[2][3][4] have demonstrated that online psychotherapy, particularly Internet-Based CBT, is not inferior in effectiveness to face-to-face psychotherapy.
The effectiveness of all components of CBT has been and continues to be tested by researchers. At present, CBT is considered one of the most effective approaches for overcoming psychological problems and mental disorders. It has been validated and is used by tens of thousands of mental health professionals—psychologists, psychiatrists, and psychotherapists—around the world.
How long does psychotherapy last?
For most people with anxiety disorders, anxiety symptoms decrease or disappear completely after several months of appropriate psychotherapy. However, some people notice significant positive changes even after only a few psychotherapy sessions.
What are the main principles of CBT?
CBT also includes an educational component (psychoeducation), which means that during psychotherapy you also learn how to manage your own problems or symptoms independently. It introduces new ways of thinking and acting that can help you manage your problems in the long term.
To understand CBT, it is necessary to become familiar with its main principles.
1. CBT targets the “here and now.” One of the most important principles of CBT is that instead of focusing primarily on the causes of a problem or disorder, the work focuses on the symptoms that are present and interfering with our lives right now. Nevertheless, CBT also pays attention to how the problem developed. However, knowledge of the causes of a problem or disorder alone is not sufficient to overcome it.
Imagine that you are very afraid of dogs. Every time you see a dog, you change your route because you are convinced that any dog could bite you at any moment. If you try to understand what caused your fear, you might discover, for example, that your neighbor’s dog bit you when you were a child. This could undoubtedly be a cause of such a fear. However, simply becoming aware of this fact cannot help you stop being afraid of dogs or change your beliefs about them.
2. CBT emphasizes homework. Whether you consult a CBT specialist or try to overcome your problem using self-help books, you will still encounter the need to complete between-session homework. This is one of the most important components of CBT. In this context, homework means regularly applying in your everyday life, on a daily basis, the new skills you have learned during psychotherapy or from self-help books.
Why is homework so important?
Unless you apply the skills you have learned every day, you will not be able to manage your problem successfully. In order to use these new skills during the moments or situations in which your problem is most intense, they must be very firmly consolidated in your memory. Without daily practice, unfortunately, this is unlikely.
Is there one psychotherapeutic plan that works for everyone?
No psychotherapeutic plan can be effective for everyone. The treatment plan must be adapted to the needs of the individual client and to the type of disorder.
Practicing the new skills required to manage and overcome your own problems is similar to developing new, healthy habits. If, for example, you want to begin doing something regularly, you need to include it in your daily to-do list. At first, this may be difficult, but if you continue, over time it will become a habit. The more you practice CBT techniques, the easier they will become to use, and consequently, the better you will be able to manage your problem.
What should you expect from a meeting with a CBT therapist?
If you have decided to consult a CBT therapist for professional help, you can expect the following:
1. CBT is structured and educational. Counseling and psychotherapy sessions within CBT involve learning new ways of thinking about the symptoms of your problem or disorder. For this reason, sessions are structured so that you and your therapist typically review the homework you have completed and then move on to discussing new information and skills. In the final part of the session, you agree on what to do next and on the homework to be completed before the following session.
2. CBT is collaborative. Because you are continually practicing and acquiring new skills, psychotherapy is a highly active process. You and your CBT therapist will work together to help you understand your symptoms and find ways to manage or overcome them.
3. CBT is time-limited. The duration of CBT and the number of sessions depend greatly on the client’s level of involvement and responsibility in the therapeutic process, individual characteristics, and the specific problem or disorder. However, an experienced CBT therapist can usually estimate how much time and how many sessions are typically required for a particular problem or disorder based on their experience. For example, problems such as anxiety disorders and depression may require 2–5 months or 8–20 sessions. Moreover, during CBT you learn to become your own therapist. Once you can successfully apply the skills acquired during CBT and see positive changes in your life, you can complete psychotherapy and continue working independently.
What will I learn from CBT?
During CBT, we learn to change our thoughts (also called cognitions) and our behavior. This is precisely why it is called Cognitive Behavioral Therapy.
Why is it important to change thoughts and behavior? Because in any situation we have particular thoughts and emotions related to what is happening, and as a result, we perform certain actions and display particular behaviors. These thoughts, emotions, and behaviors are interconnected and influence one another. To visualize this more clearly, they can be represented as a triangle.
Returning to our example of fear of dogs, imagine the following situation. You are walking down the street and see a dog. Upon seeing the dog, you may think that it could bite you. This thought may cause fear or anxiety. As a result, you may change your route. It would look approximately like this.
Now imagine the thoughts, emotions, and behavior of one of your friends who is not afraid of dogs and, moreover, likes them very much.
Thus, fear of dogs can be reduced or overcome if you:
a) Change your behavior
Through exposure—that is, confronting the feared object instead of avoiding it—the intensity of your fear of dogs will gradually decrease over time. You will also discover that not all dogs bite.
OR
b) Change your thoughts
You can also change the “triangle” by changing the thought that “all dogs bite.” For example, you might tell yourself that if all dogs were dangerous and bit people, nobody would keep dogs as pets. When we are anxious, our thinking changes. It becomes more negative, and we are unable to see and understand the whole picture because, at such moments, our thinking becomes focused on possible danger.
Any other information?
One more important point: although Cognitive Behavioral Therapy is structured and has a clear strategy, it is important to remember that the therapeutic process is also shaped by the individual characteristics of the client. Therefore, there cannot be a single psychotherapeutic plan for everyone, nor can methods and techniques affect everyone in exactly the same way.
References
[1] Cognitive Behavioral Therapy (CBT).
[2] Seol, S.H., et al. (2016). Internet-Based Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder in Korea. Psychiatry Investig., 13(4):373–382.
[3] Heber, E., et al. (2017). The Benefit of Web- and Computer-Based Interventions for Stress: A Systematic Review and Meta-Analysis. J Med Internet Res., 19(2):e32.
[4] Hummel, S.B., et al. (2017). Efficacy of Internet-Based Cognitive Behavioral Therapy in Improving Sexual Functioning of Breast Cancer Survivors: Results of a Randomized Controlled Trial. J Clin Oncol, 35(12):1328–1340.