In-Depth: Cognitive Behavioral Therapy

How Does Cognitive Behavioral Therapy Work?

How cognitive behavioral therapy works is complex. There are several possible theories about how it works, and clients often have their own views. Perhaps there is no one explanation. But CBT probably works in a number of ways at the same time. Some it shares with other therapies, some are specific to CBT. The following illustrate the ways in which CBT can work.

Learning coping skills

CBT tries to teach people skills for dealing with their problems. Someone with anxiety may learn that avoiding situations helps to fan their fears. Confronting fears in a gradual and manageable way helps give the person faith in their own ability to cope. Someone who is depressed may learn to record their thoughts and look at them more realistically. This helps them to break the downward spiral of their mood. Someone with long-standing problems in relating to other people may learn to check out their assumptions about other people’s motivation, rather than always assuming the worst.

Changing behaviors and beliefs

A new strategy for coping can lead to more lasting changes to basic attitudes and ways of behaving. The anxious client may learn to avoid avoiding things! He or she may also find that anxiety is not as dangerous as they assumed. Someone who’s depressed may come to see themselves as an ordinary member of the human race, rather than inferior and fatally flawed. Even more basically, they may come to have a different attitude to their thoughts – that thoughts are just thoughts, and nothing more.

A new form of relationship

One-to-one CBT brings the client into a kind of relationship they may not have had before. The ‘collaborative’ style means that they are actively involved in changing. The therapist seeks their views and reactions, which then shape the way the therapy progresses. The person may be able to reveal very personal matters, and to feel relieved, because no-one judges them. He or she arrives at decisions in an adult way, as issues are opened up and explained. Each individual is free to make his or her own way, without being directed. Some people will value this experience as the most important aspect of therapy.

Solving life problems

The methods of CBT may be useful because the client solves problems that may have been long-standing and stuck. Someone anxious may have been in a repetitive and boring job, lacking the confidence to change. A depressed person may have felt too inadequate to meet new people and improve their social life. Someone stuck in an unsatisfactory relationship may find new ways of resolving disputes. CBT may teach someone a new approach to dealing with problems that have their basis in an emotional disturbance.

How Can I Find a Cognitive-Behavioral Therapist?

You can find a cognitive-behavioral therapy by visiting the National Association of Cognitive Behavioral Therapists, who have a directory of certified cognitive behavioral therapists.

Because CBT is a generally taught and widely practiced psychotherapy technique, however, you can also find a therapist more generally via Psych Central’s Therapist Finder.

Can I Learn Some Cognitive Behavioral Techniques Myself?

Since cognitive-behavioral therapy has a highly educational component, much use is made of reading material in individual therapy and this has been expanded into a large self-help literature over recent years. Researchers haven’t paid much attention, so far, to whether these books can be helpful. There is one study of The Feeling Good Handbook, which they found effective for alleviating depression. This suggests that it could be beneficial for other problems, in the same way, although this will depend on the severity of the problem and how long it’s been going on.

Dave’s Story with Cognitive Behavioral Therapy

Dave is a 38-year-old gay man who had suffered disabling bouts of depression, on several occasions in his life, which caused him to make several career changes. He twice tried to commit suicide. He also suffered from a great deal of anxiety and stress, had some drink problems and found it difficult to control his temper, especially when drinking.

Dave was referred for CBT after a typical episode was triggered by stress at work. At his first meeting with his therapist, Dave already knew what he wanted to work on. He had a great sense of failure over his history of depression and what he called his lack of success in his career (‘I’ve really messed up’). He was anxious about his job prospects. He felt unattractive and was worried about ageing and about further losing his physical appeal. He felt his angry impulses were in danger of getting out of control.

In therapy, Dave learned to monitor his actions and his emotional responses. He began to plan activities that gave him a boost and to deal with situations that he had avoided through fear. He learned to identify when he was being extreme or biased in his thinking. He became good at examining his emotion-driven thoughts and reasoning them out so that he got things into proper perspective. His mood noticeably improved, and he began to tackle longer standing problems. He began looking at job prospects, by planning a more realistic choice of career, and sending in applications. He established a more equal relationship with his partner. He dealt with social situations, without demanding attention and special treatment from friends. Dave had to face up to problems that were difficult to take on board, such as his perfectionism and the unreasonable demands he made on other people. But Dave was highly motivated by the crisis in his life to find alternatives.

This is what he wrote towards the end of his therapy:

I have had many painful episodes of depression in my life, and this has had a negative effect on my career and has put considerable strain on my friends and family. The treatments I have received, such as taking antidepressants and psychodynamic counseling, have helped to cope with the symptoms and to get some insights into the roots of my problems.
CBT has been by far the most useful approach I have found in tackling these mood problems. It has raised my awareness of how my thoughts impact on my moods. How the way I think about myself, about others and about the world can lead me into depression. It is a practical approach, which does not dwell so much on childhood experiences, whilst acknowledging that it was then that these patterns were learned. It looks at what is happening now, and gives tools to manage these moods on a daily basis.

The work has moved on to look at deeper beliefs, which can dominate one’s life and cause loads of problems. For example, I have found that I have a strong entitlement belief [a belief that he is entitled to expect certain things from other people]. This is characterized by low frustration tolerance, anger, and inability to control impulses or be told what to do. It has been a revelation to look back on one’s life and see how this pattern has dominated a lot of what I have done. CBT has given me a feeling of being more in control of my life. I am now coming off medication and, with the support of my therapist and partner; I am learning new ways of being in the world. The challenge remains to change these thoughts and behaviors. It will not happen overnight.

Dave is a man who has applied himself very actively to change. As this quotation reveals, CBT offered him much more then the ‘quick’ fix that it is sometimes portrayed as giving.