CBT is a short-term approach to psychotherapy that is grounded in the Ancient Stoic school of philosophy. A guiding principle is that people are disturbed “not by things but by the views they take of them” (Epictetus). Similar ideas are found in some Eastern philosophies, such as Buddhist philosophy.
The CBT model emphasizes connections between thoughts, emotions, and behaviours. Most importantly,
(1) Our thoughts can have an influence on our emotions and behaviors.
For example, if someone always thinks of catastrophic situations or worst-case scenarios, he or she may feel worry, anxiety, and fear (emotions), and avoid situations that might be enjoyable (behaviors).
When automatic thoughts occur that might involve faulty interpretations of the situation, it is possible to challenge them, by posing such questions as:
- What is the evidence in favour of my interpretation? Against it?
- What is another way to view the situation? Have I overlooked other information?
- Is the way I’m thinking helpful to me?
(2) Our behaviours have can have an influence on our emotions and thoughts
For instance, a person’s anxiety in social situations may lead him or her to avoid such situations. If he or she challenges this avoidance by entering feared situations (behaviors), the anxiety levels may decrease as comfort is gained, and thoughts may be less biased towards worrying outcomes because these have been disproved.
CBT differs from psychodynamic psychotherapy and psychoanalysis in certain ways. CBT is:
- directed primarily at the relief of current emotional distress
- focused on conscious meanings; does not dedicate time to explore the unconscious
- involves homework and behavioral experiments between sessions
There is compelling evidence suggesting that CBT is effective at meeting its aims and relieving various types of psychological distress.
Sessions last 45 minutes and are typically held on a weekly basis for the duration of the therapy.
The opening phase of a CBT treatment program is an assessment phase which involves identifying and beginning to better understand the negative emotions and symptoms you have been experiencing. This phase also includes an introduction to the CBT model.
Following this, you will engage in
- an ongoing careful analysis of your automatic thought patterns
- exploration of ways in which they may contribute to negative emotions
- challenging of these thoughts through Socratic dialogue and possibly through behavioral experiments
The aim is for you ultimately to learn to challenge your own automatic thoughts. This phase may also involve examining some of your more deeply held beliefs which lead you to have the automatic thoughts you do.
The cognitive model of anxiety emphasizes the fact that people who are anxious often have thoughts around the themes of danger, threat, and vulnerability. They have thoughts such as:
- “I am going to have a heart attack”
- “I will be rejected”
- “something bad will happen to my loved ones”
People with general worry think a lot about possible future danger. These thoughts get repeated over and over without being resolved. Worry can generate and maintain anxiety in the absence of an external threat. It may generate a false sense of control, predictability, and certainty.
Central goals of CBT for anxiety include:
- learning how to examine the evidence to decrease unrealistic perceptions of danger
- implementing strategies to help increase your confidence in the ability to cope with threat
- increasing your ability to tolerate uncertainty overcoming avoidance by approaching situations or people that we avoid
The cognitive model of depression takes as its starting point the negative thoughts that depressed people typically have. People who are depressed often have negative thoughts in several areas:
- self (e.g. self-criticism – “I must be worthless,” “I’m no good”)
- world (e.g. “the world is an intimidating place that I will never fit into”)
- others (e.g. “others don’t think I’m good enough,” “others can’t be counted on when you need them”)
- the future (e.g. hopelessness – “what’s the use, I’ll never get any better”)
A central goal of CBT for depression is to learn how to test negative thoughts by reviewing all the information in your life – positive, negative, and neutral. The aim is not to generate artificially positive views, but more realistic ways of thinking.
A further aim can be to make behavioral changes that can help to improve a very low mood which makes it difficult to function, such as increasing activities and attending to sleep and nutrition.