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“I’m going to get fired because of this.” If the idea of getting let go from your job after making a minor, fixable mistake plagues your everyday thoughts, you’re likely experiencing amplified feelings of anxiety and stress, which make it hard to cope with challenges rationally.
Catastrophizing, or automatically assuming the worst, over time can reinforce your anxiety
and put limitations on your personal and professional growth.
Cognitive behavioral therapy is a widely used and effective form of psychotherapy that aims to break this cycle by helping you challenge those assumptions and take on healthier, more balanced perspectives. Here’s what to know about CBT and how effective it can be for changing unhelpful, negative thought patterns associated with a number of mental health disorders and physical conditions.
[READ: What Is Neurofeedback Therapy?]
What Is Cognitive Behavioral Therapy?
Cognitive behavioral therapy is a type of psychotherapy that focuses on the problem at hand — rather than emphasizing the past or what led up to the current challenge — and working toward a solution.
CBT is also built upon this idea that our emotional experiences are made up of “how we think, how we act and how we feel,” says Emily Bernstein, staff psychologist at Massachusetts General Hospital and assistant professor at Harvard Medical School in Boston.
A CBT practitioner will help you identify problematic thoughts or behavior patterns and work with you to change those patterns. Practitioners use a range of techniques to help you change the way you think, which in turn reduces suffering and helps you better manage whatever it is that has brought you into treatment, Bernstein says. They also equip you with tools to more effectively handle what comes your way in the future.
CBT is often used as a treatment approach in tandem with medication and/or lifestyle modifications for many mental health conditions, such as anxiety, mood disorders like bipolar and substance use disorders. It’s also sometimes used as part of a treatment plan for physical conditions, such as chronic pain.
[READ: What’s the Difference Between Bipolar Disorder and Borderline Personality Disorder?]
How Does Cognitive Behavioral Therapy Work?
CBT is an umbrella term for a framework approach to treatment that — no matter how it’s specifically applied — has a few key underlying principles, Bernstein says.
Core principles of CBT include:
— Psychological issues often stem from negative or unproductive thought patterns.
— Psychological problems are influenced by unhelpful behaviors that have been learned over time.
— People dealing with psychological challenges can improve symptoms by learning healthier coping strategies, which can reduce symptoms and improve overall function.
With CBT, “I’m trying to help a person learn how to have a broader range of emotional experiences, learn how to tolerate distress, learn how to be more comfortable with their emotions,” explains Bethany Teachman, a professor of clinical psychology and the director of clinical training at the University of Virginia in Charlottesville.
A critical piece of this approach, she adds, is establishing trust and empathy, as well as respect for a patient’s knowledge of their own experiences.
“So it’s not a situation where I’m trying to just teach the patient something or get them to think in a certain way. That’s poorly done therapy,” Teachman says. “Good therapy is about helping a person to be the expert on themselves, understand how things work for them and figure out what changes they want to make in order to live a life that has more purpose and meaning for them.”
[READ: How to Find the Right Mental Health Counselor for You]
Duration of CBT treatment
The length of treatment can vary considerably based on several factors, such as your underlying condition, the severity of symptoms, the goals of therapy and additional outside support.
“Short term can be really short term,” Bernstein says. “There have been CBTs that have been adapted to be a single session that can be really helpful for a lot of people — you give the basics, and they can run with it.”
For many conditions, 12 to 24 sessions is fairly typical, Bernstein adds. But for other conditions, such as insomnia, six sessions over six weeks can be sufficient and is often the standard protocol.
“People have a lot of different targets we’re working on, or more complexity, and just need more support getting over the finish line,” she explains.
Often, CBT in the long run is completed as a phase model of therapy. Initially, the therapist works with the individual to prioritize problems areas and work through those. The second phase is moving toward the end of treatment — perhaps shifting from seeing the person weekly to every other week, then moving to monthly and finally having them check back in over three months, Teachman says.
“As we’re ending treatment, we also do what’s called relapse prevention,” Teachman adds.
Relapse prevention helps you consolidate those gains made and prepare for challenges ahead. For example, Teachman says, she tries to help people think about how they can do check-ins similar to those they’re doing in therapy sessions. That helps them internalize some of the work they’ve done, learn how to evaluate what’s working well for them and what’s not working well and what changes they might want to make.
[Read: Low-Cost Therapy Options for Every Budget.]
What Can Cognitive Behavioral Therapy Help With?
CBT is commonly used as part of a treatment approach for a wide range of mental health disorders, chronic conditions and lifestyle interventions, including:
— Mood disorders
— Anxiety and stress-related disorders
— Substance use disorders
— ADHD/behavioral disorders
— Chronic conditions
— Life situations
Cognitive behavioral therapy for mood disorders
CBT can improve symptoms of mood disorders, such as depression and bipolar disorder, and contribute to a significant improvement in functioning.
For instance, a meta-analysis that reviewed 115 studies showed that CBT for depression is effective for managing the condition, and even more effective when combined with pharmacotherapy. According to researchers, the advantages of CBT include that it leads to significant depression symptom reduction, it can help modify underlying beliefs contributing to depression and reduce the chances of recurrence.
CBT for depression can be helpful for adolescents, adults and older adults, Teachman adds.
Cognitive behavioral therapy for anxiety and stress-related disorders
CBT has be shown to be effective for a number of anxiety-related disorders, stress-related disorders and other mental health disorders, including:
— Generalized anxiety disorder
— Panic disorder
— Phobias
— Obsessive compulsive disorder
— Eating disorders
— Post-traumatic stress disorder
Cognitive behavioral therapy for substance use disorders
CBT can be very helpful for substance use disorders, including:
— Nicotine-based behaviors
— Drug use
Cognitive behavioral therapy for ADHD/behavioral disorders
CBT for children with ADHD is aimed largely at improving their behavior through praise and rewards that motivate them to calm down enough to cope with school or other challenges. That’s different than CBT for adults with ADHD, which teaches thinking and self-management skills.
Cognitive behavioral therapy for pain, insomnia and other chronic conditions
CBT can be very effective for a number of physical and chronic conditions, including:
— Chronic pain
— Tinnitus
— Rheumatism
— Insomnia
“CBT for insomnia is a major success story in the field,” Teachman says.
Cognitive behavioral therapy for insomnia, referred to as CBT-I, is quite effective. Most who undergo four to eight sessions of CBT-I experience a significant reduction in their symptoms — namely the time required to fall asleep, the amount of time spent awake or both.
CBT-I has four components: sleep restriction, stimulus control, sleep hygiene and cognitive therapy. Often it’s counterintuitive, like with sleep restriction. One might think that if you can’t sleep you should stay in bed for longer. But actually experts say it’s important to match your sleep opportunity, or how long you’re in bed, with how long you’re able to sleep, and then gradually work on increasing sleep time.
CBT-I conducted virtually can also have major success. A meta-analysis of 42 randomized controlled trial studies, for example, found that remote CBT-I is effective in improving sleep and other related health outcomes, such as depression, anxiety and fatigue.
Certainly, CBT-I has advantages, but, first and foremost, it’s key that those with chronic insomnia seek help to get a better idea of what’s behind it and explore treatment options.
In some cases, it may be a medical or mental health issue that’s causing sleep problems or making things worse, and cognitive therapy may still be useful. For example, thyroid disease can contribute to sleep woes. Or a person may have another disorder like sleep apnea that needs to be addressed as well. So having a fuller picture is critical.
CBT can also be really effective in treating physical conditions, particularly with pain management, Teachman says.
The concept with CBT is that you have control over changing negative thoughts to positive ones, which may help in reducing both the intensity and experience of pain. Research has shown that CBT can help chronic low back pain sufferers deal better with pain. However, it isn’t necessarily a pain “cure.”
CBT for life situations
CBT doesn’t require any sort of diagnosis of a mental health or physical condition. Sometimes, life is just a little tough, and you could benefit from some support along the way. CBT comes in to help you manage challenging situations and better handle future difficulties too.
Does Cognitive Behavioral Therapy Work?
Yes, behavioral therapy is proven to be an effective, evidence-based psychological intervention technique.
“Behavioral therapies can help for many conditions,” Teachman says. “It’s one of our best studied class of therapies.”
Virtual program effectiveness
Computer-based CBT programs can help boost the effects of traditional therapy or reduce the amount of time needed with an in-person therapist. The programs — which may consist of educational modules, video tutorials and tools like apps and spreadsheets to track moods and behaviors — also offer help to people who don’t have physical or financial access to a therapist or for whom the idea of seeing a therapist is too anxiety-provoking.
Most importantly, interactive online-based CBT programs are often just as effective. One study comparing face-to-face CBT to internet-based CBT for conditions including panic disorder, social anxiety disorder, depressive symptoms, male sexual dysfunction and spider phobia found both routes to be equally helpful.
If you’re severely depressed, on the other hand, a computer-based program may not suffice. Depression is often out of an individual’s control, so steps introduced in a computer program alone may not be enough. What’s more, if someone is suicidal, not having contact with a professional who can monitor them can be dangerous. Other potential downfalls to using only computer-based programs for treatment include higher dropout rates and difficulty tracking outcomes.
Often, a combined approach of computer-based and in-person CBT is the best way to go. A meta-analysis that reviewed 40 randomized controlled studies of computer-assisted CBT for depression found that depressive symptoms improved more if the program offered support in-person, by email or another online method, or over-the-phone support from either clinicians or trained professionals, such as technicians or trained volunteer participants. Another study of 154 people with major depressive disorder found that those assigned to a 16-week treatment plan that included both forms of CBT, rather than only traditional CBT, reduced the time spent with a clinician by one-third — with no difference in outcomes.
Measuring CBT Progress
— Setting goals
— Defining a roadmap
— Using clinical measurement-based care
— Talking to the individual
1. Setting goals
“My goal is to help people figure out what their values and goals are, and then how they can get closer to living a life consistent with those goals and values,” Teachman says.
Some questions she’s seeking answers to are:
— What is it that you want to be different in your life?
— What problems are you trying to solve?
— What goals are you trying to fulfill?
— How can we evaluate whether that’s happening?
Treatment is designed around those established goals, Bernstein says, adding that goals can evolve over time too.
2. Defining a roadmap
After establishing goals, the practitioner and client need to work together to agree on how they’ll get there.
“For example, if I’m doing a cognitive behavioral therapy approach, then I know that I’m going to be thinking about how can I help this person think in more flexible and adaptive ways that are less rigidly negative,” Teachman says.
With that, she wants to know how she and the client would know they’re thinking more flexibly.
3. Using clinical measurement-based care
This might mean using questionnaires or assessments to attempt to quantify progress — much like how you’d take a blood test or measure the size of a tumor for treating a medical condition, Bernstein says.
“We administer those measures periodically,” she adds. “Some of them might be weekly or monthly or quarterly, but regular cadence so we can track numerically how things are going.”
4. Talking to the individual
Although a little less concrete and more informal, it’s important for practitioners to check in with the patient and see how they’re doing.
Bernstein says this might include questions like:
— How do you feel like CBT is going?
— What does your functioning look like?
— Are you noticing changes?
— Are your loved ones noticing changes?
— Have your goals changed?
“If someone doesn’t feel better, then treatment doesn’t feel like it’s over yet,” Bernstein says.
For therapists, it may mean digging a little deeper than accepting a “yes, I feel good” response. For example, if someone is struggling to leave the house, the therapist getting more specific and asking if the client went to the supermarket can be more telling than asking if they’re generally noticing changes. Looking for the “evidence” and the demonstrated outcomes is a way to measure improvement, Teachman says.
With that, establishing a relationship built on trust is essential to the success of CBT.
[READ: How Can I Find the Best Psychiatrist?]
How to Find a CBT Practitioner
With a shortage of mental health providers and sometimes less-than-stellar health insurance coverage, it can be challenging to find an effective CBT provider. You can use U.S. News’s free doctor finder, which allows you to search for psychiatrists and psychiatric nurse practitioners by location, insurance, specialty and many other criteria.
In addition, Teachman recommends a few reputable databases to search for practitioners:
— Association for Behavioral and Cognitive Therapies
— Anxiety and Depression Association of America
— Psychology Today
You can search for factors such as expertise and conditions treated, location and virtual or in-person options. Some databases will allow you to filter for insurance providers.
In terms of figuring out what styles work best for you, review the provider’s website, where they often describe their approach to treatment. You should check if their treatment approach is rooted in research as well, because that’s not always the case.
Providers also often have an option for a 15-minute initial phone consultation, where you can figure out if they may be a good fit for you.
“Building good rapport with someone involves really listening to them, respecting them, trying to understand their worldview and respecting what are the things that they care about and they want to prioritize so that I’m hearing what their value system is and what’s meaningful to them,” Teachman says.
It may be hard to figure that out in a brief, 15-minute call. Ultimately, there is some trial and error involved.
What’s important is that you give feedback to your providers along the way.
“If, for example, you feel like you wish your provider was helping you more in a particular area or has some difference in their style or their approach, give them that feedback because therapists are good, but we’re not mind readers,” Teachman emphasizes. “The more that you communicate and be open about what your needs are, the better the chances that the person, the provider, will effectively meet those needs.”
Finding an online CBT program
Just like there are poor clinicians, there are less effective computer-based CBT programs. That’s why it’s important to make sure you choose a program carefully.
First, ask yourself if the nature of your problem is appropriate for computer-based therapy, especially if you’re planning to use it without the assistance of a professional. If you get anxious about taking tests, for example, a computer-based program may work well because it can suggest tangible skills for you to practice, such as sitting in the test room every day and imagining feeling relaxed and confident. In that case, be sure to look for a program that has been studied, requires a diagnostic checkup and offers support from a clinician.
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What Is Cognitive Behavioral Therapy? originally appeared on usnews.com
