Cognitive Behavioral Therapy (CBT) in a Nutshell

Dr. Tali Shenfield | May 1, 2013

Cognitive behavioral therapy is a goal-oriented, short-term treatment in which a therapist and client work collaboratively to solve the client’s problematic thinking and behavior in order to resolve difficulties and change the client’s negative emotions.

Cognitive behavioral therapy is considered short-term because treatment occurs over eight to twelve sessions, at a frequency of about once a week in which the client visits the therapist for about 50 minutes per session.

CBT is a goal-oriented therapy in which the client comes to the therapist with problems that they need help resolving. Together they take a practical approach to examine the strategies and thought processes that will lead to desirable solutions or steps toward improvement in the client’s thinking and behavior.

Cognitive behavioral therapy aims to identify the client’s negative feelings (that may or may not be known to them) and assumptions. The client is encouraged to examine his negative assumptions to determine if they are true and to change his behaviour accordingly. Because thoughts, feelings and behavior are all intertwined, a change in one is expected to cause change in the others, and this is a good first step for individuals who may be battling with anxiety, anger and depression. Taken together with other strategies (and sometimes medications,) CBT has proved to be helpful as the first step to resolution of other long-term problems such as eating disorders, drug and alcohol addictions, post-traumatic stress, and panic attacks.

CBT has been deemed effective in a number of scientific trials, especially for people who have specific, identifiable problems and goals. It is not intended to provide deep insight. It may require additional treatment sessions or other therapy approaches depending on the nature and severity of the problem. CBT is not intended for people whose problem is vague or if the client does not play an active role in therapy.

An active role in therapy, from the point of view of the client, means that he or she does the homework that is assigned by the therapist (based on agreed upon terms) after each session. Homework may include keeping a thought journal, setting new goals, working out strategies to meet the client’s goals, and pushing the limits of the problem for which the client is seeking help. "Cognitive behavioral therapy acts to help the person understand that this [dysfunctional thought pattern] is what’s going on. It helps him or her to step outside their automatic thoughts and test them out,” writes Ben Martin, Psy.D. (2007)

For example, an anxious man who gets nervous and panics in crowded social situations may be asked to identify and keep a record of his negative thoughts, feelings and actions when he is placed in a crowded environment. Alternatively, his therapist might ask him to write out how he might change his thoughts, actions, and feelings to better cope  in a crowd. The therapist might also involve the client in an activity (outside of therapy) that forces him to challenge his fears and face them head-on in gradually more stressful scenarios.

The history of cognitive behavioral therapy began in the 1960s when a psychiatrist by the name of Aaron Beck was working with people troubled by their negative thoughts and emotions. He noticed that his patients tended to have cyclical negative thoughts running through their minds that led them to express feelings in line with these thoughts. This would then be more outwardly observed in how they behaved. Having realized the link between thoughts, feelings and actions, Beck believed they were the key to helping his clients. He believed that people are usually unaware of their thoughts and being able to identify and talk about what he termed “automatic thoughts” could be a beneficial strategy that would help his clients understand and overcome their problems.

The goal of therapy is to challenge negative thought patterns and prove them to be unrealistic. This will help a client uncover new ways of framing his world so that his thought patterns become less negative and more positive. When the client recognizes that new thought patterns lead to less negative feelings and actions, he can find new ways of facing his world and the challenges within it. These tools and strategies are expected to generalize and carry forward to new challenges that the client learns to face on his own, outside of therapy It is believed that cognitive behavioral therapy can have long-lasting positive effects for individuals with emotional disorders, even after therapy has been discontinued. Benjamin Martin cites a few studies in which 12 sessions of CBT were as helpful to individuals battling depression as medication when individuals were assessed at a two-year follow-up.

In sum, cognitive behavioral therapy can be a practical, useful and effective approach to helping people battling emotional disorders who wish to take a collaborative role in recovery.  CBT has proven to be the most effective approach in treating anxiety, panic attacks, and obsessive-compulsive disorder. It requires identifying repetitive and negative thoughts, feelings and actions and sometimes placing oneself in vulnerable scenarios to put an end to and overcome the cycle that may be holding them back or keeping them from living a more fulfilling life.

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About Tali Shenfield

Dr. Tali Shenfield holds a PhD in Psychology from the University of Toronto and is a licensed school and clinical psychologist. She has taught at the University of Toronto and has worked at institutions including the Hospital for Sick Children, Hincks-Dellcrest Centre, TDSB, and YCDSB. Dr. Shenfield is the Founder and Clinical Director of Advanced Psychology Services.

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