What to expect from CBT therapy

Adapted from Cognitive behavioral therapy: How does CBT work?

By Kathleen Davis; https://www.medicalnewstoday.com/articles/296579.php ; Accessed March 18, 2018

Cognitive behavioral therapy is a widely practiced psychotherapy based on the theory that it is not actual events that cause our problems and various disorders, but the meanings we give to the events.

CBT is a one on one, short-term therapy that lasts anywhere from one to twenty sessions. It is problem specific, goal oriented, and is designed to achieve remission and prevent relapse of a specific disorder. Listed below are common interventions practiced in CBT.

As a patient, you may want to know what is expected of you when you work with a therapist that does CBT work. The purpose of cognitive behavioral therapy is to change thinking and behaviors that prevent positive outcomes, so what is expected of the patient is to be open to exploring the thoughts, feelings, and attitudes that trigger unwanted behaviors. The goal is to find the key that unlocks change.

I am fond of the process of experiential learning when applied to learning in therapy. The father of experiential learning and adult learning, Malcolm Knowles, inspired Kolb to develop the “learning circle” to characterize learning, and it can certainly be applied to the therapeutic work done by the patient. The circle goes through concrete experience, reflective observation, abstract conceptualization, and active experimentation (Kolb, 1984). Patients become aware of their behaviors, understand them, and eventually experiment with different ones, after they have identified the cognitions and attitudes they want to change.

That is why, while other forms of psychotherapy involve delving into the past to provide insight into feelings, CBT focuses on "the here and now;" thoughts and beliefs that can be addressed in the present.  To do that, CBT utilizes strategies to develop skills in the patient that involve recognizing distorted thinking, modifying negative beliefs, and practicing relating to others in different ways. Eventually, through ongoing experimentation the individual can learn to behave in the desired way.

One of the foundational ideas in CBT is that misperceptions can lead to unhealthy behaviors. Example: when an individual experiences a stressful event, automatic thoughts come to mind and these automatic thoughts be can lead to negative moods and emotions. Think about being cut off on the freeway and you will instantaneously understand this process.  The person makes a faulty assumption (“How could he do that to me!”) or an incorrect conclusion on the meaning of the event (“I don’t even know how to drive anymore!”) based on no reliable truth but rather the automatic thought process that is often not even recognized. Or, think about when you have misinterpreted a gesture or a word spoken mindlessly by a co-worker. Or when you have overreacted to something someone says to you, because you have been told the same thing so many times before by other people. Or, a person with dental phobia fears going to the dentist because they believe they will suffer severe pain or even death from a dental procedure, because they had a negative early childhood dental experience. To an extreme, a person with this phobia may lose sleep, experience extreme anxiety, and may even neglect caring for his teeth.

This faulty thinking becomes a feedback loop; the individual is stuck in one negative way of thinking, unable to think differently, unless this feedback loop is interrupted and tested against reality. The cognitive-behavioral therapist helps the individual recognize how distorted thinking is keeping the feedback loop undisturbed, how it affects moods and emotions, and teaches how to change rigid thinking patterns. In the example of the dental phobia, the cognitive behavioral therapist can address the faulty thinking (because I had pain with a filling all dental visits will be painful) and develop a plan to overcome the fear.

Throughout the treatment period, both the counselor and the individual discuss and agree on goals and the techniques to be used. The individual must be an active participant in the treatment plan in order to see adequate results with CBT:

  • Identify problem areas
  • Develop awareness of automatic thoughts
  • Distinguish rational and irrational conclusions
  • Stop negative thinking
  • Challenge underlying assumptions
  • See a situation from different perspectives
  • Stop catastrophizing (thinking the worst)
  • Identify what is realistic; is what you think really true?
  • Test perceptions against reality
  • Correct thinking so that it more closely resembles reality
  • Examine the validity and usefulness of a particular thought
  • Identify and modify distorted beliefs
  • Enhance awareness of mood
  • Keep a cognitive behavioral diary
  • Gradually increase exposure to things that are feared
  • Stop "mind reading" and "fortune telling" practices
  • Avoid generalizations and all or nothing thinking
  • Stop personalizing and taking blame
  • Focus on how things are rather than how they should be
  • Describe, accept, and understand rather than judge.

    Distorted, negative thinking leads to problematic behaviors and overall dysfunction. Recognizing faulty thinking, modifying beliefs, and the practice of relating to others in more positive ways can help individuals manage and overcome many common illnesses, phobias, and disorders.

    Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development (Vol. 1). Englewood Cliffs, NJ: Prentice-Hall.