Cognitive Behavioral Therapy (CBT)
Facts to Know:
- Cognitive Behavioral Therapy (CBT) is an evidence-based treatment for a wide range of conditions, including anxiety disorders, mood disorders, eating disorders, psychotic disorders, and insomnia.
- CBT is typically a focused therapy over a limited period of time in which the patient and provider work collaboratively on agreed-upon goals.
- CBT can consist of individual therapy and/or group therapy.
What is CBT?
CBT is a treatment that was originally designed to treat patients with depression but has since been shown to be very effective for treating many different conditions:
- Anxiety Disorders, including generalized anxiety disorder, panic disorder, specific phobia, and social anxiety disorder
- Eating Disorders, especially bulimia nervosa and binge eating disorder
- Psychotic Disorders, including schizophrenia
- Attention Deficit Hyperactivity Disorder (ADHD)
- Obsessive Compulsive Disorder (OCD), which is treated using a variant of CBT called Exposure and Response Prevention
CBT is designed to identify and challenge unhelpful thoughts that are getting in the way of living a fulfilling life, decrease destructive, unhelpful behaviors, and develop healthy behaviors. The specific type of CBT varies depending on which disorder it is being used treat, but all CBT adheres to those three overarching goals. For example, when CBT is used to treat eating disorders, the focus will be on normalizing eating and challenging problematic thoughts about shape and weight. When used to treat anxiety, the focus will be on challenging anxious thoughts and reducing avoidance of anxiety-provoking situations.
CBT is typically a focused and very structured treatment over a limited period of time. The treatment often lasts between 12-20 sessions, but treatment can be longer or shorter depending on the problem and the person’s needs. At the beginning of treatment, therapy sessions usually last 45 minutes, once or twice a week, and they may become less frequent (e.g., once every 2 weeks) as the treatment progresses and the patient improves.
How does CBT work?
While there is no one set of modules that is used across all CBT treatments, there are many common components, which include:
- Explaining and Identifying the Relationships between Thoughts, Feelings, and Behaviors
Individuals are encouraged to note the ways that their thoughts influence what they do (behaviors), and how their behaviors influence what they think and believe. For example, if you think that you will certainly fail an exam, then you may decide not to study. By not studying, you may increase your likelihood of failing the exam, and reinforcing your belief that you were definitely going to fail. One goal in exploring these relationships is to highlight that changing or challenging those thoughts or behaviors will likely lead to changes in other thoughts or behaviors. You may be asked to monitor the relationships between your thoughts and behaviors between sessions.
- Challenging Unhelpful Thoughts
All of our brains take mental shortcuts to try to understand and synthesize the information around us. While efficient, these mental shortcuts can lead to thoughts that are overly broad and distorted (e.g., “all foods with fat in them are unhealthy”). One goal of CBT is to identify when thoughts are hurting rather than helping us, and then to challenge those thoughts by examining the evidence that supports those thoughts and the evidence that refutes those thoughts. This is not the “power of positive thinking”, but the power of accurate thinking.
- Behavioral Experiments
In an effort to change distressing patterns of thoughts and behaviors, you and your clinician may work together to design behavioral experiments during which you will try out a new, healthy behavior and then evaluate the results. For example, if you have been avoiding eating with co-workers at lunch because you fear you will have nothing to say to them, you and your therapist may decide on a behavioral experiment wherein you eat lunch with your co-workers and give yourself the goal of asking one or two of your co-workers a question about their weekend plans. The hope is that by changing your behaviors, you gather new information about the world, challenge entrenched, unhelpful thinking patterns, and live a more satisfying, healthy life.
While therapy sessions only last about 45 minutes per week, it’s helpful to think of CBT as extending beyond the session itself. That is, it is typical for the patient and therapist to collaborate to design “homework” to complete in-between sessions. These assignments provide an opportunity to gather data about real-life experiences, practice challenging unhelpful thoughts, and enacting new behaviors in everyday life. For example, a person struggling with depression might have the assignment of scheduling in potentially enjoyable activities between sessions while also tracking mood fluctuations. Progress with homework is reviewed during sessions, and new goals and homework assignments are created each week.
How can I receive CBT at Columbia?
Here at ColumbiaDoctors, we provide individual and group treatment with providers who specialize in CBT. The Columbia University Center for Anxiety Related Disorders (CUCARD) is a comprehensive treatment center that utilizes CBT in the treatment of anxiety disorders. In addition, the Columbia Day Program and the Lieber Recovery Clinic both incorporate CBT into their comprehensive programs.
All of our locations provide individual CBT as part of our general psychiatry and psychology services. Search our individual providers for a CBT specialist who might be a good fit.
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