What is CBT?
The question I get asked most often is, how does therapy work? When initiating treatment, people are often terrified by the prospect of having to reveal themselves to a complete stranger in vain. So, without an understanding of why they’re doing what they’re doing, they drop-out out of treatment. Unfortunately, for whatever reason, some therapists tend to withhold important conceptual information from their clients, presenting themselves as authorities rather than as collaborators. Therefore, I decided to create a short blog post describing the framework of Cognitive-Behavioral Therapy (CBT) to help my readers understand how and why this particular therapeutic model is the most scientifically validated mental health treatment method available.
To give you some background information: CBT is a school of thought created in the 1960s by Aaron Beck, who, like his contemporary Albert Ellis (the founder of Rational-Emotive Behavior Therapy), realized that psychoanalysis, the only real form of therapy at the time, wasn’t as effective as he hoped it would be. Well, technically, Beck created Cognitive Therapy, which was later blended with Behaviorism due to the necessity of both therapeutic forms. So, what exactly is CBT?
CBT is a form of therapy that’s used to treat depression, anxiety, rage, emotional instability, body dysmorphia, low self-esteem, perfectionism, interpersonal troubles, and specific phobias. The cognitive portion of therapy posits that beliefs underlie everything we do, don’t do, and expect (e.g. I avoid speaking up in class because I expect to be embarrassed). Sometimes, our beliefs are too negative, meaning that they distort reality in an unhealthy way, preventing us from acting, or causing us to self-sabotage, because we erroneously expect something bad to happen. At others, they can be too positive, and we don’t allow ourselves to consider what we should do in a dangerous situation (e.g. The belief that things will work themselves out). But, functional beliefs are the ones based in reality, as they allow us to enjoy what we have and attempt to change what we should. Even though some of them may cause us to be sad, they’re still considered healthy because sadness is a natural mode of emotional expression, and necessary for our overall emotional health. (I may be sad that I will never become a famous actor, but I need to grieve the loss of my aspiration in order to move on to another career.)
How Will It Help Me?
So, cognitive therapy proceeds with the rational (Socratic) examination of one’s beliefs about oneself, the world, and others, as a means of exploring whether they’re true, while also discovering how they affect one’s own actions. So, here’s where it gets tricky. The biggest resistance I get is to this portion of treatment. A client will tell me, “Well, I rationally know that I’m not a failure, but I can’t help but feel it.” And I respond by saying, “Of course! Facts don’t often change feelings (they can only reduce them), but actions do.”
And this, as some would argue (and their belief is backed by research), is where the pivotal point of treatment occurs. Now, we enter the territory of the behaviorists. Whether you’re struggling with anxiety, depression, or anger, rational examination can diminish each to an extent and that will allow you to act (or behave differently if you’ve been acting poorly), which is called Behavioral Activation in clinical jargon. But, it’s the action that will create an experience that, in conjunction with your newly formed beliefs, will work together to alter the way you feel about yourself, thus further reducing your symptoms. I think therefore I act! And I act therefore I feel! The entire thing is a cycle which reinforces itself.
1. I rationally believe that I’m worthy based on the evidence
2. I take more risks and achieve positive feedback
3. I interpret the positive feedback through the lens of my new belief, which indicates that the positive feedback is likely accurate
4. Therefore, I now also feel better about myself, too
5. By feeling better about myself, I more strongly believe in my value
6. I take more and even bigger risks
7. I feel better about myself
This, in essence, is how CBT works. And the beauty of it is in its accessibility to all of us. It isn’t some deep intellectual exploration only meant for academics. CBT has the power to significantly change all of our lives, and I hope that therapists will begin to tell their clients how. Because if they don’t, people will continue to run-away without getting the help they need. Imagine having these deep, dark secrets and an authoritative figure telling you that you have to share them simply because it’s for your own well-being. I would probably run, too.