Definition: cognitive-behavioral therapy (CBT) is a usual form of psychotherapy, or talk therapy, in which clients join a few sessions with a mental health counselor (therapist or psychotherapist) and put a systematic plan with the latter in a quick but effective way. This plan will aim at identifying negative or incorrect thinking patterns, changing this way of thinking, and developing clear thinking and problem-solving skills when put in a tough condition in life. It can be used alone or in conjunction with other types of therapies (like antidepressants) in order to treat a number of mental health conditions, or to teach people how to deal with stressful life events (1, 4).

Origin of CBT

• CBT has been widely used since the1970s.
• CBT is grounded in the concept that it is not the client’s reaction to a situation affects perception more than the situation itself does, and under stress, this perception is frequently misleading and unconstructive. When this faulty perception is identified, and the reality of situations is recognized, clients will then be able to improve their perception and ultimately experience less stress. This will enable clients to acquire problem solving skills and behavior modifications (1, 3).
• CBT is based on the cognitive model which portrays the way thinking and perceiving have an impact on feelings and behavior. This model aids therapists classify and treat their clients’ struggles. The model follows this system: situation > automatic thoughts > reaction > emotion, behavior, and physiological response (1, 3).

Who Benefits from CBT?

• Healthy clients who are faced with emotional problems learn these techniques: cope with signs of mental disorders, avoid a revert into these signs, treat a mental disorder which is not responding to medication, acquire methods of dealing with stressful life events, learning how to regulate emotions, solve relationship issues, understand how to communicate with others effectively, manage sorrow and loss, get over emotional distress linked to abuse and violence and deal with enduring somatic symptoms (4).
• Clients who have mental health disorders, including sexual disorders, eating disorders, obsessive-compulsive disorder, depression, post-traumatic stress disorder, schizophrenia, sleep disorders, phobias, bipolar disorders, anxiety disorders and substance-use disorders (4).

Duration of CBT
Fluctuating between five to twenty meetings, CBT is usually a temporary rehabilitation. Determining factors of duration include the following: nature of illness or situation, symptom/ situation and stress severity and duration, time it takes the client to improve and the amount of social support the client obtains (4).

Strategies Used in CBT

• Therapists may ask their clients to do “homework”, like activities, reading, writing, drawing ... that reflect on what is being learned as clients go through the CBT process. CBT may also be used in conjunction with interpersonal therapy, which emphasizes on the clients’ relationships (4).
• CBT usually follows this system: recognizing upsetting circumstances > acknowledging the thoughts, emotions and beliefs that stem out of these circumstances > classifying undesirable or incorrect thinking > modifying this thinking to the better (4).
• A wide range of strategies is implemented in CBT and includes the following (2):
1. Cognitive restructuring/reframing: a therapist will put the client in a hypothetical situation and probe thought processes that arise, so that negative patterns are recognized. This will then allow clients to reframe these thoughts into more positive ones.
2. Guided discovery: a therapist will get familiarized with the viewpoint of clients, pose questions stimulating their thoughts and beliefs, and ask clients to provide evidence to these thoughts and beliefs in order to think from another, more effective viewpoint.
3. Exposure therapy: implemented in the treatment of fears and phobias. Clients will be gradually exposed to higher degrees of the feared stimulus and simultaneously give advice about coping strategies. This will make clients feel less vulnerable and more confident in their encounters.
4. Journaling and thought records: when clients write, they will get familiarized with their emotions. A therapist will ask clients to classify their thoughts as negative and positive, and to write novel thoughts and behaviors that emerge.
5. Activity scheduling and behavior activation: these make it easier for clients to prevent bad habits and implement learnt thinking and behavior from therapy sessions. This is done by. doing things clients usually prefer not to, until this negative perception ceases to exist.
6. Behavioral experiments: assigned in anxiety disorders comprising catastrophic thinking. A therapist will ask the clients to predict the outcome of an undesirable situation, go through that situation and then compare prediction and lived experience. Clients will have progressively lower anxiety as they will understand that their predictions will not occur.
7. Relaxation and stress reduction techniques: deep breathing exercises, muscle relaxation and imagery are a few techniques that reduce stress and expand regulation in clients while facing phobias and social anxieties.
8. Role playing: habituates clients to diverse behaviors in challenging states in order to cultivate problem solving skills, develop social and communication skills and train assertiveness.
9. Successive approximation: a therapist will ask clients to take on difficult situations then break them down into steps for a clearer progression. This boosts self-esteem.

References

(1) Benjamin, C. L., Puleo, C. M., Settipani, C. A., Brodman, D. M., Edmunds, J. M., Cummings, C. M., & Kendall, P. C. (2011, April). History of cognitive-behavioral therapy in Youth. Child and adolescent psychiatric clinics of North America. Retrieved November 8, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3077930/.

(2) Cognitive-behavioural therapy: An information guide - camh.ca. (n.d.). Retrieved November 8, 2021, from https://www.camh.ca/-/media/files/guides-and-publications/cbt-guide-en.pdf?la=en&hash=...

(3) Mayo Foundation for Medical Education and Research. (2019, March 16). Cognitive behavioral therapy. Mayo Clinic. Retrieved November 8, 2021, from https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610.

(4) Understanding CBT. Beck Institute. (2021, August 3). Retrieved November 8, 2021, from https://beckinstitute.org/about/intro-to-cbt/.