The basics of CBT

Cognitive Behavior Therapy (CBT, also known as cognitive therapy) is a specific type of brief therapy that has proven to be effective in treating different kinds of mental illness related to anxiety and depression across cultures (Hoffman et al, 2012).

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Adapting to our technological society with online communication and networking, new forms of CBT arised, including online treatment and computer base treatments, that showed the same results as face to face CBT therapy (Andersson, 2016; Anderson et al, 2010).

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Aaron Beck may be considered as the main influence and father of Cognitive Therapy. After being educated in Psychoanalytic theory (dominating theory for therapy in 1950-1960), his research could not find empirical data that support psychoanalytic explanation of depression. Instead, A. Beck noticed that patients suffering from depression have in common a negative bias judgement about themselves. In others words: Negative thoughts about themselves, their past, their future and the world.

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To intervene with the negative thoughts witnessed in his patients, Beck took others methods from behaviorism, social learning, problem solving training, and stress control therapy, finally creating Cognitive Behavioural Therapy. To understand his approach better, a good metaphor is to compare human behavior as a result of information processing just like computers do: The body captures information through our senses (information input), then give meaning to this information (information processing), to finally act as a response to this information (an output). In short words: A situation triggers a thought, the thought triggers a feeling and the feeling facilitates a behavior.

Understanding human behavior as a consequence of cognition and affection means that people’s actions in real life are not determined by the situations that happen to them. Instead, It is the appraisal and/or interpretation of the situations that triggers an specific behavior. In this way, Cognitive Therapy puts the "control" of the problem back on the individual. If my own way of thinking is making me suffer, then I need to change my way of thinking (my values, beliefs, and perception of my present life) in order to stop suffering. Sadly, changing our way of thinking is not an easy thing to do, but psychotherapists have come with many different methods to deal with our perceptions of reality.

In psychopathological states of mind, individuals show deep negative core beliefs about themselves, others and the world (Beck, 2005), these may be expressed in many different ways according to my experience: 1. Helpless: I can't help myself; No one can’t help me; this world has broken me and I’ll never be fixed; I’m inferior; I’m a victim of life; I’m not strong enough; I’m weak and vulnerable. 2. Unable to be love: I don’t like myself; I’ll be reject; I’ll be abandoned; there is something wrong with me and no one will ever love me; I hate myself; I'm a burden

3. Unworthy: I’m crazy; the world doesn’t need me; I’m not good enough; I don’t deserve to be happy; bad things will happen to me.

An important key for the solution of mental health problems from a cognitive approach, is to be aware that these negative thoughts are not “activated” all the time. There are triggers and situations that bring back these thoughts, feelings and behaviors as learned patterns, usually called maladaptive cognitive schemas. These patterns cause symptoms that may lead to different kinds of mental disorders.

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Finding the triggers, identifying the automatic thoughts, acknowledging the feelings that arise with these thoughts and building new ways to relate to these schemas would be the first steps to improve our mental health following CBT.

One way to change through CBT begins with the awareness that we may be wrong. Questioning and correcting the negative beliefs and thoughts could be the first approach to some cases, but not for everyone. So, for those who think that there is no way of changing the way they think, there is still hope (Check Acceptance and Compromise Therapy).

For other who may be willing to change their way of thinking, this are some techniques and tools that you may encounter in CBT:

The main tools in CBT to help patients are:

• Recording out triggers, automatic thoughts, emotions and behaviors.
• Finding out your schemas and core beliefs through behavior's analysis.
• Identifying your Cognitive Distortions (ways in which our mind changes reality to fit in our previous core beliefs).
• Creating alternative thoughts and schemas to cope with our maladaptive core beliefs.
• Facing your fears and testing your core beliefs through progresive exposure. (Ex. If your core belief is that people will abandon you; expose the individual to abandonment and help him/her to cope with the negative emotions that arise).
• Learning new skills to trouble-shot the current situation integrating new healthy schemas.
• Psychoeducation. CBT intervention plans actually include teaching patients to be their own therapist.
• Imaginary works to face fear and assess situations that trigger negative thoughts.
• Relapse prevention plan. Usually after achieving some goals, it is expected to build some plans in case of new incidents or new activations of the maladaptive schemas.

What possible problems can you deal with CBT?

• Depression
• Anxiety (General Anxiety Disorder, Panic Attack, social anxiety, phobias)
• Post traumatic stress disorder.
• Obsessive Compulsive Disorder.
• Eating Disorders
• Personality Disorders.
• Psychosis and unusual beliefs.
• Physical health problems related to chronic pain, tinnitus and long term diseases.

As a conclusion, CBT has earned a lot of fame in recent decades and is one of my main lines of psychotherapy. It is perfectly doable through online settings and gives tools that are possible to take away after a psychotherapy process.

I hope this brief introduction can clarify some questions and offer a comprehensive view of what a CBT therapist can do in order to help overcome mental health problems.

References

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Andersson, G. (2016). Internet-delivered psychological treatments. Annu Rev Clin Psychol 12:157-179. DOI:26652054/

Andrews G, Cuijpers P, Craske MG, et al. (2010). Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta­ analysis. PLoS One 5(10):e13196. DOI: 20967242

Beck, A. (1967). Depression: Clinical, Experimental, and Theoretical Aspects. New York, Harper & Row.

Beck A. (1996). Beyond belief: a theory of modes, personality, and psychopathology, in Frontiers of Cognitive Therapy. Ed. Salkovskis P. New York, Guilford.

Beck J. (2005). Cognitive Therapy for Challenging Problems. New York, Guilford.

Hofmann SG, Asnaani A, Vonk IJ, et al (2012). The efficacy of cognitive behavioral ther­apy: a review of meta-analyses. Cognit Ther Res 36(5):427– 440.