Cognitive Behavioral Therapy (CBT)

CBT is a very broad treatment modality that incorporates so many smaller, more specialized treatment modalities such as exposure and response prevention treatment (ERP). As you would probably guess, CBT incorporates both cognitive (thoughts, beliefs, and attitudes) and behavioral therapy. Sometimes the cognitive and behavioral approaches are used at the same time or only one at a time. For example, ERP is strictly behavioral, but comes from CBT.

Cognitive restructuring is the main purpose of the cognitive part of CBT. The client first recognizes cognitive distortions and then will proceed to challenge those thoughts utilizing various exercises. Some cognitive distortions include negative self-talk, all-or-nothing thinking, over-generalizing, thinking in terms of ‘should’ statements, catastrophizing, minimizing, confirmation bias and so much more. There are countless resources online and books available about cognitive distortions.

Cognitive therapy helps clients investigate the validity of their thoughts. They do this by gathering evidence that could support or refute the thought. Cognitive therapy helps clients develop insight about their maladaptive thinking. Cognitive distortions can lead to feelings of anger, sadness, fear, anxiety, and jealousy. These emotions then lead to maladaptive behaviors. Allowing these emotions to dictate behaviors is practicing poor mental health. The behavioral therapy components of CBT are very powerful. If anyone wants to see change and see change quickly, they must change their behaviors. Clients can gain all the insight they need about their cognitive distortions, but if they don’t change their behaviors, their life satisfaction will not change.

There are numerous types of behavioral therapy approaches within CBT. Some include exposure and response prevention treatment, behavioral activation, habit reversal training, dialectical behavioral therapy, and many more.

At our clinic, while cognitive therapy is still used for several mental health illnesses, behavioral therapy is the primary focus. Of course, changing behaviors also challenges cognitive distortions. For example, if someone is afraid of dogs, the more they are around dogs and develop new experiences with them, the cognition that all dogs are scary reduces. Similarly, someone who reports being depressed will have little motivation and desire to do an activity that they once enjoyed. They might think, “if I go, I won’t be able to have fun.” We don’t wait for clients’ thoughts to change. We have them go anyway, despite the belief that they might not have fun and despite the feeling of depression. Behavioral change is first. Thoughts and feelings change after. Cognitive therapy is still a very important part of the treatment of mood disorders, including depression, postpartum depression, stress management, grief, and those experiencing symptoms of ‘failure to launch.’

Again, cognitive therapy can be used for many mental health illnesses. However, cognitive therapy is rarely, if ever, used for OCD and many anxiety disorders. This is why it is important to see someone who is specialized in treating these afflictions. Typically, when a client with OCD sees a provider who does cognitive therapy or ‘talk therapy,’ the therapist gives the client reassurance (a ritual) and makes the client worse.