Theory Series: Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) is the unofficial gold standard of therapy today. It was founded in the 1960s by Aaron Beck and has slowly gained popularity since. With roots in behaviorism, CBT focuses on the link between thoughts, feelings, and actions. While many popular, historical theories posit that feelings are the catalyst for thoughts, and ultimately actions, CBT flips the script, asserting that feelings and actions are predicated on thoughts. This approach is remarkably pragmatic in nature, with little focus on philosophy or human nature. Instead of focusing on the past, or the root causes of WHY we are the way we are, CBT meets people where they are, addressing specific, undesirable thought patterns directly. In other words, in the context of this theory, it is unimportant why an individual might be anxious. Instead, the anxiety is addressed directly by identifying, and replacing negative or anxiety producing thought patterns with more positive, realistic ones.
Although there is no predetermined length to implement CBT, it is comparatively short-term depending on the number of cognitive issues being addressed. Clients are taught to first recognize their thought patterns, before evaluating their level of negativity. This requires a basic application of mindfulness practice, understanding that an individual's consciousness exists separate from their thoughts. This helps them recognize that thoughts are transitory and do not define their identity. Those thought patterns are then evaluated and named with reference to a short list of defined negative thought patterns laid out by the CBT theory. Although there are several variations, the basic components of CBT typically exist on
Identify behavior/thought pattern that needs changing.
Uncover deep seated negative beliefs that feed the identified behavior/thought.
Examine the negative belief system and recognize its ineffectiveness.
Develop more adaptable, well-suited thoughts/behaviors for the situation.
Recognize the old, negative belief systems when they are being repeated, and replace them with updated thoughts/behaviors.
Repeat step 5 until old belief systems decrease reduce to manageable levels or cease completely.
There are countless benefits to CBT, which is the reason it is so widely practiced. It is beautiful in its simplicity. Because it is so pragmatic, even the most skeptical client can see how it would be beneficial to replace negative thoughts with more positive ones. Furthermore, because CBT asserts that thoughts lay way for emotions and behaviors, it is broadly applicable to clients dealing with a wide variety of issues. While it is especially effective in dealing with anxiety and depression, CBT is also used to treat PTSD, eating disorders, personality disorders such as borderline personality disorder, and substance abuse, to name a few. Done correctly, it can be a short-term therapy compared with some of the more humanistic approaches which require dredging up each client's past, sifting through their experiences carefully to identify negative patterns. Instead, CBT treats the issue where it is manifesting, instead of at the root. On the other hand, some clients may prefer a more in-depth approach, benefitting from the intimacy that comes with a therapist listening intently. Others assert that the approach is too directed to a specific issue, and fails to take in broader context, such as environment. It’s main criticism is that CBT treats the symptom, and not the issue itself.
Both the benefits and negatives of CBT are reasonable in my view. CBT is an invaluable tool that every therapist should know. However, I believe it is limited in its breadth and is not ideal when dealing with clients who require/desire longer term treatment. I have limited personal experience as a client of CBT and have also completed several CBT module-type courses online. While they were helpful, I believe there is no substitute for working directly with a therapist to implement and practice the specific steps of CBT.
For more on DBT, I recommend reading Feeling Good - The New Mood Therapy by David Burns who was a student of Aaron Beck. This is often considered the book that made CBT popular and provides an easy-to-follow explanation and guide for implementing CBT. Happy reading!
