Psychology is a profession that loves its acronyms - if you’ve ever overheard a conversation between two psychologists, you might have noticed that it can be absolutely intelligible to a layperson. Should you use DBT, CBT, or CPT? Well that depends on whether the root of the problem is BPD, or MDD, or even PTSD. Unsure of what it might be? Maybe consult the DSM-5 or the ICD-11. Have the client fill out a DASS, a BDI, or a PCL - that should give you some clarity. While much of this language can help us save time, it probably doesn’t help if you’re trying to navigate the system to find support. As such, it might be useful to take a quick look at one of those acronyms - CBT. CBT stands for Cognitive Behavioural Therapy, and it’s one of the most widely practiced forms of psychotherapy. However, while we might have heard of the treatment, its form, function, and evidence base are not always widely discussed.
Broadly, Cognitive Behavioural Therapy is founded on a few key principles, the most central of these being the belief that thoughts, feelings, and behaviours are all linked. They impact on and change one another constantly, often without us even noticing. Another central principle is that psychological problems are, at least in part, based on ways in which we think or behave that are ultimately unhelpful for the situation. Sometimes we’re not clear on the right way to respond. Sometimes we fall into thinking traps and get stuck. And sometimes, the ways in which we respond might have been very helpful in the past, but for some reason they just aren’t quite working in the current situation. Whatever the reason, if we can learn more adaptive ways of thinking about, responding to, and acting in difficult situations, then CBT posits that we can cope better with what life throws at us. We can relieve some of the pain that those stressors bring.
How can CBT actually help me?
Thoughts, feelings, and behaviours - if you had to identify which one of those areas people are looking to change when they come to see a psychologist, which one do you think it’d be? In my experience, people tend to want to change the way they feel. I want to feel happier. I want to feel more fulfilled. I don’t want to feel anxious any more. I want to get some control over my anger. I want to feel hope. It’s a very reasonable goal to want to change the way we feel. But, as I’m sure you’re all aware, feelings are a very difficult thing to change directly. Have you ever felt calmer when someone told you to “calm down”? Did someone telling you to “cheer up” ever magically fix your mood? Did hearing “don’t worry” evaporate all of your fear? If so, fantastic. But I suspect it didn’t - it’s rarely that simple, and if you were able to change your emotions with the use of one simple phrase, you likely wouldn’t be here reading this blog.
Here’s where the CBT model comes in. If we accept that thoughts, feelings and behaviours are intrinsically linked, it opens up avenues for us to change the way we feel without directly targeting the feelings themselves. If our thoughts and feelings are linked, then maybe some of our thinking styles might just be impacting on the way that we feel, and making painful emotions worse. And if our behaviours and our feelings are also linked, then maybe the actions we take (or those we don’t take) might be contributing to the way we feel too. If we can learn new, more effective ways of thinking, or new, more adaptive ways of behaving, we can change the way we feel. CBT has a number of ways to help us accomplish this, focussed on both the behavioural (what we do) and the cognitive (how we think) parts of the equation.
How does CBT differ from other therapies?
CBT has some degree of both overlap and difference from other popular therapies. Many modern psychological therapies do have an emphasis on thoughts and behaviour, even if they address these concepts in different ways to CBT. Some have even been developed from CBT, and have aimed at adapting it for specific populations - Cognitive Processing Therapy, which is effective at treating Post-Traumatic Stress Disorder, is one such example. CBT, however, is notable for its emphasis on the “here and now”, rather than the past. While the past may be useful for understanding how thought patterns have developed, it is not central to CBT. CBT is also notable for the openness between client and therapist. It aims to be collaborative - that is, the therapist and the client both bring expertise to the table, and both work together to address problems, stressors, and sources of pain. There is no mystery with CBT. The therapist aims to work openly with the client to develop a toolbox of psychological techniques which the client can then use in different situations down the line.
What mental health conditions is CBT effective at treating?
CBT is a broad therapy which has demonstrated effectiveness at treating a variety of mental health conditions. It has been extensively tested since its creation, and has a strong evidence base for providing effective treatment of anxiety disorders, depression, and general stress, among others. Specialised adaptions of CBT also exist, and are effective for treating a variety of other presentations. These include CBT-i (Cognitive Behavioural Therapy for Insomnia), which aims to address sleep disorders, CBT-E (Enhanced Cognitive Behavioural Therapy), designed to treat eating disorders such as anorexia nervosa and binge-eating disorder, and Trauma Focused CBT/Cognitive Processing Therapy, both of which are effective for the treatment of PTSD. CBT forms the backbone of many university courses in psychology, and is widely practiced. It is considered a gold-standard psychological therapy around the world. This is not to say it is the only treatment - different people respond to therapy in different ways, and there is no one-size-fits-all. If you’ve been undergoing a course of CBT and have not found it effective, it’s important to discuss this with your health practitioner so that they can work work towards identifying the obstacles and providing the best therapy for you.
David, D., Cristea, I., & Hofmann, S. G. (2018). Why Cognitive Behavioral Therapy Is the Current Gold Standard of Psychotherapy. Frontiers in psychiatry, 9, 4.
Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive therapy and research, 36(5), 427–440.
Fenn, K., & Byrne, M. (2013). The key principles of cognitive behavioural therapy. InnovAiT, 6(9), 579-585.