What is Cognitive Behavioural Therapy (CBT)?

Cognitive Behavioural Therapy (CBT) is one of many treatment models in psychotherapy that is structured and goal-oriented. It is popularly known due to its evidence-based approach and success in treating a variety of mental health conditions such as depression, anxiety disorders, obsessive-compulsive disorder (OCD), phobias, personality disorders, eating disorders, substance use disorders, and other severe mental health disorders. It has also been shown to be successful with non-psychological medical conditions such as insomnia, fibromyalgia, other causes of chronic pain, and more. CBT is attractive to practitioners and clients due to its adaptability for use with many different problems.

The CBT model is based on three main principles of understanding:

1. With appropriate training and attention, people can become aware of their own thinking.
2. Thoughts mediate emotional and behavioural responses to various situations people find themselves in. The way people construe or think about a situation is pivotal to the way they feel which influences their behavioural patterns. Aka, our thoughts influence our emotions and behaviour.
3. Because cognitions are conscious and influence our responses to varying situations, we can intentionally adapt how we respond. The functionality will increase if we learn to understand our emotional and behavioural responses and deploy appropriate cognitive strategies. Aka, we can increase functionality in our daily lives if we pay attention to the connection between our thoughts, emotions, and behaviours, and specifically, attend to our thought processes and patterns.

Thus, by noticing unhelpful patterns of thinking and/or behaviour, people can learn better ways of coping with them. CBT practitioners will help you identify unhelpful or problematic thinking or behavioural problems and help you to understand how your thoughts affect your actions. By learning this, you and your therapist can then explore healthier thinking patterns and habits.

What does CBT look like in sessions?

CBT practitioners are specifically trained to be objective, non-judgemental, supportive, and knowledgeable in your area of concern. Practitioners provide a safe environment in the session which allows you to speak openly about your mental health concerns. CBT often takes place over a limited number of sessions (typically 5-20) and can sometimes take time as it can involve uncomfortable work. Like other forms of therapy, you should not expect immediate results, but rather think of your therapist as facilitating you through a process to meet your goals.

How Does It Work?

Keeping the three principles in mind, your therapist will work with you to gain an understanding of the issue, ask you a series of questions, help you recognize problematic thoughts and behaviours, and work with you to adjust your thoughts and behaviours.

Understanding the issue relies on you as the client to describe the challenges you are dealing with, symptoms related to the concern, and any other information you find important to share with the counsellor. It is important to disclose if you have received a mental health diagnosis at this stage as well.

Asking questions helps the therapist observe how you might describe your challenges. Your answers help to provide insight into your typical response to challenging situations and subsequent beliefs, thoughts, and feelings.

Recognizing problematic thoughts and behaviours through an interactive series of questions and answers allows your therapist to help you notice patterns in your responses to tough situations. Collaboratively, you will identify unhelpful emotions, beliefs, or behaviours that may be contributing to your difficulties. Keeping a journal where you note down the challenging situation and your responses is a common practice at this stage.

Adjusting your thoughts and behaviours is the end goal of CBT, where your therapist will help you change maladaptive thinking, feelings, and behavioural patterns. By learning about problematic patterns in the previous step, you and your therapist can explore healthier habits to respond to future challenging situations.

Pros and Cons

The benefits of CBT include an increased awareness of problematic thoughts, feelings, and behaviours, and the adoption of healthier habits to combat similar patterns with future challenges. CBT is also significantly researched and is shown to be effective with a variety of different psychological and non-psychological conditions. If you have coverage for a limited number of sessions and enjoy structure within sessions, the CBT model is an appropriate option.

The disadvantages of the CBT model often depend on the client and their preferences for their therapy experience. Some clients do not enjoy the structure of the CBT model, where it can feel routine and “school-like”. If you are looking for long-term talk therapy where you prefer to direct sessions or bounce between areas of concern, the CBT model is likely not an appropriate option. Keep in mind, several therapists practice eclectically where they include CBT tools, interventions, and homework, but do not solely stick to the structure of the model and limited number of sessions. This is to account for the clients who do not prefer a rigid structure in their sessions.

If you are looking for a remote therapist and you reside in Ontario, check out Evergreen Therapeutics. We have a team of therapists who treat individuals, couples, and families through an integrative, trauma-informed, and anti-oppressive approach. Please feel free to visit the website to book a consultation, or to learn more about the services offered.

References

• Beck, J. S. (2011). Cognitive-behavioral therapy. Clinical textbook of addictive disorders, 491, 474-501. Project Academy, Lukianoff & Haidt, 2011.
• Dobson, D., & Dobson, K. S. (2018). Evidence-based practice of cognitive-behavioral therapy. Guilford publications.
• American Psychological Association. What is Cognitive Behavioral Therapy? (https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral) Accessed 8/4/2022.
• Centers for Disease Control and Prevention. Therapy to Improve Children’s Mental Health. (https://www.cdc.gov/childrensmentalhealth/parent-behavior-therapy.html) Accessed 8/4/2022.
• Chand SP, Kuckel DP, Huecker MR. Cognitive Behavior Therapy. (https://www.ncbi.nlm.nih.gov/books/NBK470241/) [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Accessed 8/4/2022.
• Merck Manuals. Treatment of Mental Illness. (https://www.merckmanuals.com/home/mental-health-disorders/overview-of-mental-health-care/treatment-of-mental-illness) Accessed 8/4/2022.