Insights on Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is an effective therapeutic tool that has been time-tested in its efficacy for treating mental health and substance use disorders. CBT has become the foundation for many modern therapies and its use has helped countless people through the decades.
This article will go over the history of cognitive behavioral therapy, what it does, and how it can help you or a loved one on the road to recovery.
What Is Cognitive Behavioral Therapy?
Cognitive behavioral therapy is based on the basic principles of behavioral psychology and cognitive psychology. Its general approach is to identify patterns of thoughts or beliefs that are irrational or dysfunctional and to help the individual develop more rational and functional cognitions. Once the individual has developed a more functional approach to thinking about the world, they can work on changing their behaviors in accordance with their new understanding.
The Cognitive and Behavioral Paradigms of CBT
Though there is a vast array of different styles or types of psychotherapy, all approaches can be traced back to one or more of five major paradigms (schools of thought) that comprise the general approaches of the different schools of psychology. Two of these paradigms are the behavioral school (paradigm) and the cognitive school (paradigm)
Behavioral psychology grew out of experimental work with animals and focused on environmental events that shaped behavior. Behavioral psychology traditionally did not develop theories of how animals or people think about things, viewed things, or how emotions relate to behavior, but instead concentrated on only observable factors that appear to increase the probability that an organism would behave in a specific way.
The cognitive school of psychology was developed in a response to the rather mechanistic approach of the behavioral school. The early founders of what eventually became cognitive psychology argued that understanding cognition (thoughts, beliefs, and even emotions) was essential to understanding behavior. Cognitive therapy was a clinical application of the basic principles of cognitive psychology and focused on how individuals perceive the world as the basic driving force of their issues.
Helping individuals modify their attitudes and perceptions could help them relieve any distress they were experiencing according to the cognitive school of psychology. However, using purely cognitive approaches to therapy was also not sufficient for understanding the entire picture in helping individuals with their issues.
How Does CBT Work?
All the different types of CBT have different approaches and techniques they rely on; however, they are all based on the same core principles. The central principles of any form of CBT include the notion that dysfunctional behaviors and issues with psychopathology result from dysfunctional and irrational beliefs or patterns of thinking, and that identifying, challenging, and altering these dysfunctional cognitions is associated with positive outcomes in therapy.
The actual types of beliefs or irrational thoughts that individuals entertain can be quite varied; however, there are three general categories of irrational beliefs that occur in most people:
- Irrational beliefs or thoughts about the self.
- Irrational beliefs or through about the world or the person’s environment.
- Irrational beliefs regarding the future.
One of the basic assumptions of CBT that is often overlooked is the notion that most people have belief systems that are covert and not often formally stated in a conscious manner. A good portion of modern cognitive psychology is directed at understanding schemas and script, which are very routinized belief systems that people do not consciously state to themselves; instead, these implicit belief structures drive their behavior.
CBT often investigates how individuals acquire these belief systems by attempting to understand their past experiences and how these belief systems were developed. To get to the core of the distress the person is experiencing, therapists use a process that includes:
- An initial assessment to understand the person’s needs.
- Identifying the core issues that drive behaviors and thoughts.
- Helping the person recognize these issues.
- Using cognitive restructuring techniques that helps reframe thoughts to be more realistic.
- Identifying and addressing triggers.
- Practicing coping skills.
Different Types of Cognitive Behavioral Therapy
CBT is actually an umbrella term that describes numerous different types of psychotherapy that follow this approach (identifying irrational beliefs, helping individuals change these beliefs, and helping individuals to modify their behavior). Several of the more recognizable forms of CBT include rational emotive behavior therapy (REBT), motivational interviewing (MI), dialectical behavior therapy (DBT), and acceptance and commitment therapy (ACT).
Rational Emotive Behavioral Therapy
Developed by the psychologist Dr. Albert Ellis, this form of cognitive behavioral therapy proposes that people develop specific assumptions about the world and how they relate in the world. Some individuals develop assumptions that are irrational or unrealistic, and these assumptions can often lead to issues with their functioning and behavior.
Rational emotive behavioral therapy operates by working with the individual to identify and confront these irrational and dysfunctional belief systems, to challenge these beliefs, and to help the individual change them into beliefs that are more realistic.
This approach was originally developed as an attempt to understand where individuals with substance use disorders stood regarding their understanding of their behavior and whether or not they believed that their substance use was problematic for them.
Motivational Interviewing assumes that not everyone who gets therapy for addiction (and other issues) enters treatment at the same starting point. Some people do not believe they have a problem; others may believe they have a problem but do not understand how to address it. Still others may be actually trying to address their problems.
MI has developed a model referred to as the Transtheoretical Stages of Change Model that helps to identify where an individual stands on their conceptualization of their issues and then develops a treatment approach based on the stage of change that the person is in when they come to the therapeutic situation. This approach is an effort to personalize CBT based on the needs of the person.
Dialectical Behavior Therapy (DBT)
This form of CBT was originally developed to treat individuals who had severe psychological issues, such as individuals who were actively suicidal or had a severe personality disorder like borderline personality disorder.
Acceptance and Commitment Therapy (ACT):
In this form of CBT, the initial goal is to help the person develop a realistic self-appraisal that is not based on overall statements regarding their abilities or effectiveness. For example, one of the most common irrational beliefs that individuals entertain is, “Everyone must like me.” By developing more realistic self-appraisals, people can understand why they experience certain emotions and can begin to shed global expectations and labels. This can result in more positive behaviors.
Does CBT Work?
Numerous sources report that CBT therapies are the most researched of all forms of psychotherapy and that in general CBT has empirical evidence to demonstrate its utility in treating numerous different issues and mental health disorders. CBT techniques are the preferred method of intervention for several different disorders, including panic disorder, obsessive-compulsive disorder, substance use disorders, borderline personality disorder, etc.
Even though CBT has demonstrated its effectiveness over numerous situations and disorders, it does have limitations to its use. For instance, CBT techniques may help individuals with bipolar disorder or schizophrenia adjust to certain living conditions; however, there is very little evidence that it can help to directly treat the symptoms of these disorders.
Because CBT therapies require individuals to actually assume responsibility for doing the work, certain individuals may not be appropriate for CBT or may not fully benefit from it. Individuals with severe cognitive limitations may not be able to participate in the cognitive therapy aspect of CBT and may be more suited to strict behavioral therapy interventions. In some cases, CBT techniques may be enhanced with the use of medications, such as the treatment of severe depression, OCD, psychotic behaviors, etc.
Cognitive Behavioral Therapy for Addiction
CBT-based therapies have a time-tested track record for helping people with substance use disorders. This evidence-based treatment modality, as part of a comprehensive care plan, can help people get to the root of their addiction, learn effective coping skills for handling triggers, and provide a firm footing in recovery.
If you or someone you love are struggling with addiction or co-occurring disorders, the specialists at our South Florida inpatient rehab can help. Using an array of addiction-focused results-based healthcare we help people get on the road to recovery.
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