CBT Therapy

What is cognitive behavioral therapy (CBT)?

Cognitive behavioral therapy is a type of therapeutic intervention which uses practical tools to overcome mental health challenges.

CBT can be used in various types of mental illness including addiction, depression and anxiety. It can be used in individual or groups settings with kids, adolescents and adults.

CBT is the most researched type of therapy, teaching you that the way you think creates your mood which in turn affects your behaviors and physical reactions. It helps you evaluate your life situation such as your job, home life, relationships, etc to assess which factors might be affecting your mood.

What are the three main components to CBT?

There are three main components to CBT therapy which involve how thoughts, feelings and behaviors are all interconnected.

1. The first is how cognitions (thoughts) affect feelings and behavior. The narrative in our mind strongly influences the way we feel and how we choose to navigate situations. CBT helps reframe our thinking to be more positive and productive.
2. Just like thoughts can influence emotions, emotions can influence our thoughts. CBT helps people learn how to regulate their emotions and find strategies to shift their mindset while doing so.
3. Both our thoughts and emotions can influence our behaviors. CBT helps to identify maladaptive behaviors and find alternative ways to cope with difficult feelings.

How is CBT different from traditional therapy?

Psychodynamic or more traditional talk therapy tends to focus on a client’s past relationships with their parents.  In cognitive behavioral therapy, the therapist will invite into discussion any relevant concerns from the past such as family dynamics but will focus more on how we can 

improve outcomes in the here and now.

How did CBT originate?

The ideas were originated in the early 1900s. Ideas were derived from the Bible and Greek philosophy. 

Mr. Aaron Beck is regarded as the Father of Cognitive Behavioral Therapy. Although he was not the one that originated the concepts of CBT, he was responsible for coining the term and pioneering the theories that are widely used in treating clinical depression.

Through the years, these CBT concepts keeps getting more and more refined. Studies show that this type of practice is effective in treating substance abuse, relationship problems, anxiety and depression. 

Anxiety is an umbrella term which encompasses social anxiety, generalized anxiety, panic disorder, post traumatic stress disorder, specific phobias, OCD, etc. 

Depression is another umbrella term which encompasses various mood disorders such as Major Depressive Disorder, Seasonal Affective Disorder, Postpartum Depression, and Bipolar Disorder.

What are some examples of different types of treatment that fall under the CBT umbrella?

There are a variety of different approaches to cognitive behavioral therapy. Some examples are:

• Trauma focused CBT:

This is based on the idea that when we have trauma in our lives, we heal by talking about them and subsequently becoming desensitized to them.

• Dialectic Behavioral Therapy (DBT):

This therapy is effective in treating borderline personality disorder, anxiety, and depression and in improving relationships. It is designed to help people regulate the intensity of their emotions and increase their level of distress tolerance.

• Rational Emotive Behavior Therapy (REBT):

This type of treatment helps individuals identify and challenge distorted thought patterns that trigger negative emotions and maladaptive behaviors. It is a goal oriented treatment aimed at improving maladaptive coping mechanisms.

• Exposure Therapy:

Exposure therapy is most commonly used to treat obsessive compulsive disorder, panic disorder, phobias and social anxiety. It encourages people to face their fears and to desensitize to their feared triggers.

• Motivational Interviewing (MI):

Initially designed to help with substance addiction, this type of evidence-based approach helps people with varying degrees of motivation to find the willingness to create behavioral change.

• Acceptance and Commitment Therapy (ACT):

This approach helps people allow their thoughts and feelings to be present without judgement and without actively trying to eliminate them. It incorporates the basic principles of meditation and mindfulness.

What are some interesting evidence based facts about CBT?

On average people have between 80 to 90 thousand thoughts per day making it very difficult to be aware of exactly which thoughts affect mood. Lots of people don’t recognize that their thoughts trigger mood drop. People often tend to be more aware of their feelings than their thoughts which lead them to be emotional and reactive. 

If people are fearful, they may avoid. If they feel depressed, they may stay in bed. If they are worried , they may choose to drink. People often fail to make sound decisions when they are in an emotional state. 

CBT is not based on positive thinking. It is based on a more balanced and realistic thinking. CBT evaluates what aspects of our thoughts are true and what aspects of our thoughts are distorted. 

Decades ago clinical trials were conducted to study the effects of CBT on people who struggled with depression. The subjects in the research study had PET scans to examine brain function before and after a course of CBT treatment. These PET scans take images of neural brain mechanisms, neurotransmitters and metabolic activity. 

Half of the cohort underwent ten weeks of CBT. The CBT group showed a calmer brain on the PET scan and felt significantly better compared to the control group that did not have CBT. The clinical trial has been replicated and shown to be reliable.

Do CBT therapists usually give homework?

CBT therapists use worksheets, assign behavioral goals and may give various readings to help you to understand yourself better. In order to maximize the effectiveness of the treatment, it is important to comply with the homework with regularity. The more you can understand yourself through these assignments, the more likely you will make progress. 

By devoting around a half hour per day of CBT work, a muscle memory will kick in and you will notice the anxiety and depression symptoms fading away. The benefits will be incorporated into your core being and you will not feel like you are doing homework anymore. You will have effectively changed your mindset and coping strategies. 

Some people are resistant to doing homework since they are already overwhelmed with to-dos or do not feel like they should have to do the work on their own. In fact, homework can make someone feel more anxious or depressed. If this is the case, you can work with your therapist in the sessions until you build confidence and are ready to duplicate the process on your own.

Dr. Suzanne Feinstein, Director at Advanced Behavioral Health, LLP, is a Columbia University-trained Clinical Psychologist who specializes in the treatment of depression and other mood-related disorders, the full spectrum of anxiety disorders, body focused repetitive behaviors, OCD, and ADHD. She is highly skilled in using cognitive behavioral therapy (CBT) and a variety of  other evidence-based techniques under the umbrella of CBT such as Exposure Therapy and Response Prevention (ERP), relaxation training, DBT, ACT. etc. She has had great success helping her clients gain control over their mood, anxieties and impulses.