CBT – Cognitive Behaviour Therapy
Cognitive behavioral therapy (CBT) is a straight-forward psychotherapeutic approach and exercises aiming at ridding someone of unhelpful cognitive distortions. It is one of the most widely used psychotherapeutic approaches today and one of the most controversial ones. It is often accused of being “shallow” and addressing symptoms, not causes, particularly by proponents of “depth therapy” such as psychoanalysis. Part of that controversy at least is because CBT is so popular. And it is so popular because:
- It has been proven to effect positive change in an enormous array of different mental health issues from anxiety to addiction, eating disorders to trauma. Numerous studies indicate that CBT enhances functioning and quality of life, and is often as/more effective than other psychotherapies/medications.
- It can be hugely useful for acute situations when patients need urgent help. Taking their holistic situation in account a therapist can opt for CBT as a “handbrake” to help them as quickly as possible (before their lives careen “over the edge”). By that imagine someone experiencing acute depression or anxiety and who needs urgent help, i.e. before their spouse leaves them, before they lose their job, etc. In the right context it is a vital tool for any integrative psychotherapist.
- It is quite “packageable”. Far from psychoanalysis that can take years to uncover and treat issues, CBT can show results in weeks. It lends itself well to simple, short, clear programs, with clear outcomes outlined. In that sense it has been the little darling of state-sponsored mental health programs, which favour clear, short, planned, outcome-based protocols.
CBT by its own nature has evolved, and been proven time and again effective as conceptual framework, but very much so too, in clinical practice and real life effect. CBT is possibly one the most “shallow” therapeutic schools out there, yet ironically one where there is most scientific, documented evidence to prove it effects positive change. This is something fairly unique in psychotherapy, as most schools of thoughts do not measure as rigorously or frequently positive change in their patients, things remaining more subjective and personal.
CBT Genesis and historical precursors
Modern CBT is widely accepted to have emerged in the 60’s, put together as a coherent structured psychotherapeutic model by Aaron Beck. There is however a wide consensus that CBT is the end result of different historical and cultural considerations.
Most relevant (to this blog specifically from ancient Greece nerds) is maybe the Stoic influence. Here you must understand that the term “Stoic” had a wider meaning in ancient Greek philosophy. It was not just about an individual’s ability to withstand pain. It was a much wider philosophy centering around the basic ideas of meaning, courage, existential responsibility, and epistemology. The Stoics were one of the first philosophers to look deliberately at how we understand the world, how we form opinions, how we combine thoughts.
Marcus Aurelius was one of the first thinkers to outline so clearly the importance of emotions and how gaining some control over them avails enormous benefit.
Stoics asserted that we are highly responsible for how we react to events and must continuously seek to live by principle and meaning, but accept with good heart the changing circumstance. To know the different between what can be addressed and not, and to launch fully into what can be, without wait, without fear, and without reservation. And ideally with a clear mind, without overdue emotional bias or mendicant “thinking”:
It was not only Marcus Aurelius, the other titan of Stoic thought Epictetus spoke of logic as a tool to avoid false beliefs, and how those could trigger destructive emotions.
In modern terms, CBT can also be traced back to the birthing of behavior therapy in the early XX century. John Watson, Pavlov and many others studied the effect of conditioning not just on cognition but also behaviour. Marcy Cover Jones, Hans Eysenck and Arnold Lazarus developed new behavioral therapy techniques in the first half of the 20th century.
Modern CBT – Aaron Beck & Depressed patients’ “NATs”
CBT in its modern form was founded by Aaron Beck in the 1960s. Beck – a psychiatrist and psychoanalyst – does research on his depressed patients. Discovers that ‘negative automatic thoughts’ (NATs) are strongly linked to negative shifts in mood.
Unimpressed by the results of “depth therapy” in depression, Beck challenges existing therapeutic protocols. He ends up developing his own, new therapeutic model premised on the notion that our thoughts and beliefs (cognitions) have a direct impact on how we feel and behave (Think-Feel-Do).
He posits that by examining in detail how we “see” things, how we process ideas and how we store them to recombine them into later contexts, and how this translates in our actions is the key. The one mechanism that is the most efficient and effective to effect positive change in a patient. By rediscovering their cognitive model, as well as how this leads to different behaviors, some of which unhelpful.
Key concepts and principles of CBT
Automatic thoughts
This is a central idea in CBT, that our mind often works in an automated mode. Some of the thoughts it will conjure can be negative (NAT – Negative Automatic Thoughts) and unhelpful.
Cognitive model
How we actually see things, with our own senses and filters and distortions into a whole, as opposed to the outside objective reality. The way that individuals perceive a situation is more closely connected to their reaction than the situation itself.
Cognitive formulation
The beliefs and behavioral strategies that characterize a specific disorder, how our biases take shape in a concrete, patterned sense.
Conceptualization
Understanding of individual clients and their specific beliefs or patterns of behavior
Cognitive Behavioral Therapy as a therapeutic protocol
CBT practitioners follow a set of assumptions and principles about the human mind:Psychological problems are based, in part, on faulty or unhelpful ways of thinking.
- Mental suffering and psychological issues are based at least in part on learned, unhelpful patterns of behavior and cognitive distortions.
- It is always possible to learn better ways of coping with these patterns, feeling better and turning into higher functioning, more effective individuals.
- CBT therapies typically involve practice, effort, repetition to change something as deeply set as a thinking pattern. These may be actually pretty quick compared to other psychotherapeutic approaches, but the point here is not the time expenditure (a few hours over a few weeks) rather, that the practice is inherent to the method and to the therapeutic goal.
Here again CBT seems to borrow directly from the Stoics, at the birth of the western tradition. Heraclitus (who served as model for Marcus Aurelius) had long observed the actual NEED for practiced and patient effort to build “good character”.
In real terms during a CBT session the therapist will work with the patient to develop the best understanding of the NAT, of the cognitive distortion, and how to address it, change it towards more real and helpful cognition. It can feel like “protracted effort” at times to own up to one’s distortions, how they create problems and how to evolve them.
It can feel like patient effort to practice certain scenarios and examine time and again a certain real-life situation with new lenses, more aligned to problem solving than automatic response. It is plain difficult to own up to one’s weaknesses and difficulties. It is difficult to use confidently a new cognitive model when one’s brain is derailed by the emotion of a real-life conflict or problem. Practice does make… much better.
The good news however is that results are often visible in a matter of weeks. The “practice” itself is not even that hard, many patients experience massive growth in only a dozen sessions. The other good news is that if CBT will in time arm the patient him/herself with the tools to examine their filters and distortions, to adapt and clarify their thinking, emotions and generally enjoy higher coping skills.
