What is cognitive-behavioral therapy (CBT) ?

Cognitive-behavioral therapy (CBT) is an action-oriented therapy, which requires participation and collaboration of both the therapist and patient. Other hallmarks of CBT include; setting tangible gradual goals based on each individual’s values, session agendas, pragmatic oriented problem solving, challenging one’s thoughts, an emphasis on the present and in between session homework. Acceptance & Commitment Therapy (ACT), a more modern version of CBT, emphasizes learning from experiential exercise, i.e., learning from experimental and emotional experience.  It changes not the content of our thoughts, but how we relate to our thinking.  For most issues, CBT is short-term, lasting approximately twenty-four sessions (six months). Some patients may require longer term work to address underlying personality characteristics or more chronic and/or complex disorders.  CBT has become the most thoroughly researched and most often recommended type of psychotherapy for depression, anxiety disorders and a wide range of other psychological issues.

How does CBT work?
The primary focus of modern CBT is to help patients decrease their reliance on self-defeating habits (e.g. avoidance patterns, compulsions, passivity, impulsiveness, aggressiveness) and re-learn more adaptive, life-enhancing ways to cope (e.g. gradual activity scheduling, pleasure planning, conflict resolution, assertiveness, active listening skills, mindfulness, hypothesis testing, distress tolerance, exposure, attention retraining, breathing retraining). Cognitive and behavioral strategies complement each other, so when an impasse in therapy is reached, change in one area can stimulate change in the other. Because our thoughts can contribute to rigid and ineffective behavior, new ways of reacting to and/or relating to our thinking is an essential part of CBT. Experiential methods such as “hypothesis tests” may be used to see how adaptive our thinking and behavior actually is. “Mindfulness” may be used to see thoughts for more of what they actually are and to help us accept living in the present. Perhaps most difficult of all, a commitment to action (traditionally called exposure or desensitization) is based on each patient’s individual values and is an essential part of CBT.

What is the outcome research for CBT? Can medication be used with CBT?
An impressive amount of scientific research has repeatedly documented the powerful effectiveness of CBT. CBT has been shown to be as effective as medication for the treatment of some forms of depression and anxiety. Furthermore, long-term relapse rates are lower for individuals treated with CBT than by medication alone. For severe and complex symptoms, CBT can make a very powerful combination with medication. In some circumstances, starting or continuing psychiatric medication and simultaneously starting CBT, is an effective approach to gain quick momentum.

As a parent can I participate in my child or adolescent’s therapy session?
Parent participation is available on a case-by-case basis.   Some degree of parent participation is typical of working with children and younger adolescents, and more frequent with young elementary & middle school children.

Why is homework important?

Working between sessions is a hallmark of modern therapies.  If the only commitment we make is to show up in the therapy office once per week, the pace of change in therapy may be exceedingly slow, if effective at all.  Learning to experiment, to think and act in flexible and new ways in our home and work environments is the key to transforming ourselves in therapy.  Homework is initially suggested by your therapist, but is increasingly creatively and mutually constructed for each individual.

What is Acceptance and Commitment Therapy (ACT) & why is this type of experiential therapy important in CBT?

ACT is a newer branch on the family of therapies known as a new or third generation of CBT’s. (DBT, ACT, FAP, MBSR, MBCT).  These newer versions of CBT emphasize change through action.  Altering our thinking is done through experimenting with our actions, courageous action, stepping outside our comfort zones emotionally.  This is done in both practical ways (gradually facing situations which are difficult as in typical exposure therapy), but also through “experiential” exercises.  Such experiential exercises are individually constructed, flex our over-reliance on our rational problem solving.  Experiential’s can an even seem bizarre and counterintuitive, and therefore are ways of learning to be more flexible in life, expanding our sense of ourselves and who we are.

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