CBT

What is it?

Nichole Fairbrother, PhD, RPsych

Reprinted from "CBT" issue of Visions Journal, 2009, 6 (1), p. 8

Cognitive-behavioural therapy (CBT) is a kind of talk therapy that is used to treat a range of different psychological problems (see sidebar).

CBT is a merging of behaviour therapy and cognitive therapy.1 Behaviour therapy first emerged in the 1950s and was based on the idea that people can learn to change or modify their behaviour.2-3 Cognitive therapy developed in the 1960s. The idea behind cognitive therapy was that how a person thinks about their experience will have a significant impact on how they feel.4 Over time, these two approaches merged.

All forms of CBT are based on the idea that both our thoughts and behaviours play an important role in our emotional experience. Sometimes our thoughts and behaviours can contribute to a negative emotional experience. A key assumption behind CBT is that the way we think about events in our life has an important impact on how we experience and respond to those events—that is, how we feel and behave.

The ingredients in CBT will vary depending on the problem being treated, but there are a number of common features.

CBT is evidence-based

There are many different kinds of treatments offered to help people. Some treatments have been scientifically tested and others have not. Evidence-based treatment means that a particular treatment has been evaluated in a scientifically sound way and has been found to work well. CBT has been evaluated and found to work well for many different kinds of problems. It is currently the psychological treatment approach with the most scientific support.

CBT is collaborative

The client and the therapist work together to understand and resolve the client’s difficulties.

CBT is educational

All forms of CBT involve some education about the nature of the client’s difficulty and the elements of treatment. This education, often called psychoeducation, is provided in the first one or two treatment sessions. Sometimes clients are given handouts or other reading materials to provide them with information about their problem and how CBT can help them.

CBT is short-term

Cognitive-behavioural therapy will usually last anywhere from five to 20 sessions. The number of sessions depends on the nature and the severity of the problem being treated. Sometimes more sessions may be offered, especially if the client needs help with more than one kind of problem.

Additional sessions, sometimes referred to as booster or refresher sessions, may also be included as part of treatment. For example, one or two additional sessions may be scheduled to take place three and/or six months following the end of the weekly therapy sessions. Booster or refresher sessions may also be scheduled by the client on an as-needed basis. Booster sessions can help to ensure that progress in therapy is maintained. Also, any new issues that arise following treatment can be dealt with before significant problems develop.

CBT: becoming your own therapist

One important goal in CBT is to help the client become their own therapist. This is done partly through education and homework exercises. The therapist also teaches coping and other skills. The client learns new ways of doing things and new ways of coping that they can continue to use even after therapy has ended.

CBT is structured

Therapy sessions in CBT are usually focused on reducing the client’s current symptoms and improving their functioning. In order to stay focused, the therapist and the client create a plan for the session to make sure that what they cover will be most beneficial to the client.  

CBT and homework

CBT aims to teach the client new ways of dealing with their emotions and behaviours. The therapist will ask the client to apply what they learned in the therapy sessions to their life outside of therapy. Typically, the client and the therapist will work together to set homework tasks at the end of the session for the week to come.

CBT focuses on thoughts, behaviours and feelings

In addition to education and skill development, the client’s thoughts, behaviours and feelings are a key focus of therapy.

Thoughts: In CBT, the therapist helps the client examine and evaluate their thoughts in problematic situations. This may involve teaching the client to become aware of their thoughts, monitor their thoughts and come up with ways to test the accuracy of their thoughts. Testing beliefs may take place in the therapy session (e.g., a client with panic disorder may engage in breathing exercises to test the belief that symptoms of panic lead to fainting). Or a client may test beliefs as part of the their homework for the week (e.g., disclosing something personal to a friend to test the belief that this will lead to rejection).

Behaviours: Clients sometimes develop certain patterns of behaviour in an effort to experience less distress. These patterns may be helpful in the short-term, but they can be unhelpful in the long-term. For example, it is common for people who feel anxious in social situations to avoid these situations. In the short-term, this approach can help reduce anxiety. But in the long-term, this way can lead to social isolation and worsening anxiety. The therapist’s job is to help the client come up with new ways to handle social situations that improve coping and reduce anxiety.

Feelings: Some of the techniques used in CBT focus on directly changing how people feel. For example, relaxation techniques can significantly reduce feelings of tension and stress. Most of the time, however, it is the focus on beliefs and behaviours that lead to important changes in feelings. Even though the goal of therapy is to improve how people feel, CBT tends to spend most of its time on beliefs and behaviours.

CBT is adaptable

CBT can be delivered in a variety of formats and by a range of providers. For example, CBT can be delivered to individuals or groups. Often CBT is provided by a trained therapist, but it can also be facilitated by a peer or a coach. Many high-quality CBT self-help materials are also available and may be used on their own or as an adjunct to treatment.

Structured CBT treatments for many different types of problems have been developed. Some variations of CBT have incorporated other therapeutic approaches or techniques. These include mindfulness and acceptance and commitment therapy, which involves a collaborative assessment of the client’s values and goals.

CBT is also very well suited to being adapted to each client’s specific concerns. Structured protocols can be modified or blended to provide clients with treatment that is tailored to their specific needs.

 
About the author
Nichole is a psychologist and an Assistant Professor with UBC’s Island Medical Program and Department of Psychiatry. She has a background in cognitive-behavioural approaches to anxiety and depression. Her research is in the area of reproductive mental health, with a focus on anxiety disorders.
Footnotes:
  1. Clark, D.M. & G. Fairburn, C.G. (Eds.). (1997). Science and practice of cognitive behaviour therapy. Oxford, UK: Oxford University Press.

  2. O’Donahue, W. (Ed.) (1998). Learning and behavior therapy. Boston: Allyn and Bacon.

  3. Wolpe, J. (1990). The practice of behavior therapy (4th ed.). New York: Pergamon Press.

  4. Beck, J.S. (1995). Cognitive therapy: Basics and beyond. New York: Guilford Press.

 

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