Cognitive Behavioral Therapy (CBT)

What is CBT?

Cognitive Behavioral Therapy, or CBT is the combination of two approaches: Cognitive Therapy and Behavioral Therapy. What follows here are some characteristics of the combination of both approaches, commonly known as CBT.

  • CBT is a way that therapists think about, or conceptualize, psychological problems and their treatment. It helps us guide our understanding of why someone is suffering and how we can help them.

  • CBT is focused, which means we spend most of our time talking about and working on a specific target problem in therapy.

  • CBT is time limited. Treatment is, by design, short-term in nature as opposed to other therapy techniques that have no end-date and no specific goals to achieve.

  • Unlike other forms of therapy, CBT is present-oriented. We are less concerned with how a problem started and more interested in how a problem is maintained, or is continued. The focus is on identifying the factors that maintain the problem and then work to change those factors.

  • CBT is active. This is a therapy of doing things! We sometimes tell our patients that “talk is cheap” to emphasize the fact that we can talk all we want but we have to make put ourselves into action in order to change. This often requires that we leave the office for sessions to test hypotheses and practice new skills.

  • CBT is directive. Unlike other therapies (psychodynamic and other insight-oriented approaches), the therapist takes on more of a direct role, setting the agenda for the session, assigning homework, and coaching on how to think and act in a way that changes the factors that maintain the disorder.

  • There is an emphasis in CBT on measurable gains and testable hypotheses. We set goals, take educated guesses about what will work, and then check in: Did the therapy actually work?

  • CBT is evidence-based. All CBT therapies are studied and researched so that we know they are effective. CBT is not a panacea but it does have the benefit of having a very solid research base.

All therapists at OCD Spectrum use evidence based Cognitive Behavioral Therapy treatments as the first-line treatment for the spectrum of Obsessive Compulsive Disorder (OCD) and similar disorders. This is important because these disorders have very effective treatment protocols and our therapists have had extensive training in employing these techniques. Our goal at OCD Spectrum is truly to make you your own therapist so you can go on and live your life to the fullest with new skills to effectively battle your anxieties whenever they arise.

Cognitive Therapy

The defining characteristic of Cognitive Therapy is simple: the way we interpret events determines how we feel and react. In other words, the way we think about something determines how we feel which influence how we behave. From this main idea has come a set of techniques that help patients learn how to more effectively manage their lives. Everyone would benefit from learning a little bit of cognitive therapy, not just those with anxiety or OCD.

Negative and unrealistic thinking often leads to distress and life problems. When a person is in psychological distress, the way the interpret situations becomes skewed which has a negative impact on the actions they take.

CBT has the goal of making people become aware of the way in which they make negative interpretations and which behavioral patterns reinforce the distorted thinking. The Cognitive Therapy aspect of CBT helps people to develop alternative (i.e., more balanced and rational) ways of thinking which modifies behavior in the aim of reducing psychological distress.

Assumptions of Cognitive Therapy:

  • That mental illness stems from faulty or irrational thoughts (cognitions) about others, our world, and ourselves. This faulty thinking may be through cognitive deficiencies, like lack of planning, or through cognitive distortions.

  • That our cognitive distortions actually distort or twist the way we see events or circumstances in our lives.

  • That we interact with the world through our mental representation of it, or, how we think about it. If we are having psychological distress, cognitive therapy proposes that it is because we are viewing it through distorted lenses. Cognitive Therapy aims to help people see it through non-distorted lenses.

Cognitive Therapy helps a person to learn how to identify irrational thinking patterns so that they can directly challenge them in a non-distorted fashion. This can be difficult at first if you’re not used to it but with practice and dedication, Cognitive Therapy can be very effective. People sometimes have overly strong emotions because they their allow automatic thoughts (or self talk) to go wholly unchecked for their level of irrationality.

Several Irrational Thinking Patterns (Cognitive Distortions):

  • All or Nothing Thinking: Also called, black and white thinking. This is thinking about events in all or nothing terms like “Everyone thinks I’m weird” or “You always say that about me.” It is seeing people or events in absolute black/white terms without recognizing the middle ground. Perfect/worthless; Success/failure

  • Blaming: Focusing on who is to blame for problems rather than what you can do about them. Blaming yourself or others too much.

  • Catastrophic Thinking: This is the tendency to think in stark, catastrophic terms. Blowing things out of proportion or telling yourself that you can’t handle something. Also viewing tough situations as if they will never end. It looks like: “I’m going to be late for work and now my whole day is ruined!”

  • Should or Must Thinking: This is an assumption that there is a right and wrong way to do things. Focusing on how things or people “should” or “must” be. Treating your own standards as rules that everyone must follow.

  • Downplaying the Positives: This is thinking that only looks at the negative side of things and ignoring the good.

  • Emotional Reasoning: This is the thinking that “if it feels this way, it must be this way.” It is letting your emotions be the arbiter of fact.

Behavioral Therapy

Behavioral Therapy is the term used to describe a range of therapy techniques used to change maladaptive behaviors. The therapy is almost exclusively action-oriented and has the purpose of changing behaviors as the main focus. The thinking is that a person can achieve wellness by changing how they behave and what physical actions they take in their daily lives by reinforcing desirable behaviors and eliminating unwanted ones. Behavioral Therapy is rooted in the principles of behaviorism which says that the way we behave is very heavily influenced by our environment.

Behavioral Therapy is unlike some other types of therapy insight-oriented therapies (e.g., psychoanalytic and humanistic therapies) in that it is action-based and highly focused. The behavior itself is seen as the problem and the goal is to teach new behaviors to minimize or eliminate the problem. Behavioral therapy is about learning and suggests that since old learning led to the development of a problem, then new learning can fix it.