In clinical psychology there are various methods of intervention to treat psychological problems and increase the well-being of people. In this article, we will focus on cognitive-behavioral treatment, we will explain what it consists of, what it is for, how it is applied, who should apply it and we will summarize the psychological techniques most commonly used cognitive-behavioral therapies in general and specifically to treat depression and anxiety.
What is Cognitive Behavioral Therapy?
Cognitive Behavioral Therapy (CBT) is based on the relationship between thoughts, emotions, physical sensations, and behaviors. All these areas are interconnected and influence each other. For example: you are faced with the situation of having failed an exam. You can think:
- “I failed because I’m dumb. I’ll never pass.”
- “I failed an exam. I’ll have to try harder next time.”
After thought 1, an emotion of sadness, frustration and resignation will surely come. Such thinking and emotions will lead to a state of demotivation and reluctance. From that state, the action, surely, will be not to study. As a consequence, it is likely that the situation will repeat itself again.
Instead, after thought 2 there may comes an emotion of some sadness but acceptance and hope. Such thinking and emotions will lead to a state of motivation and will to effort. That state pushes the action of studying, consequently, the probability of passing the next exam will be greater.
Another example may be that of a person who believes he is unable to run 10 kilometers. The behavior may be not to do it or it may be to try. If you try and succeed, the change in behavior will affect the consideration of thought.
With the previous examples we can see that, in the same situation, the thought, the emotional state and the behavior are different and influence each other.
Cognitive behavioral therapy intervenes at a cognitive level, that is, in thoughts, and also in behavior, that is, in the actions that are carried out. It consists of changing the way of thinking, replacing thoughts based on irrational beliefs and cognitive distortions with more objective and adaptive thoughts. As well as transform less useful behaviors into beneficial behaviors. Cognitive behavioral therapy focuses on the present and the immediate future; it does not usually delve into the past.
The use of cognitive behavioral psychotherapy has grown a lot as a therapeutic system in the practice of psychology and psychiatry. Currently, cognitive-behavioral interventions are widely accepted and their effectiveness has been recognized by empirical studies.
Its procedures and techniques have been investigated with rigorous experimental methods, therefore it is a scientific therapy. Its scientific basis does not guarantee absolute success, but it does guarantee its effectiveness in general.
What is cognitive behavioral therapy for?
In the first place, it is a form of psychological intervention, but it can be applied in many areas and for different problems. Cognitive behavioral therapy has been shown to be useful in treating the following psychological disorders:
- Anxiety Disorder
- Depressive Disorder
- Affective Disorder
- Eating Disorder
- Obsessive Compulsive Disorder
- Post-Traumatic Stress Disorder
- Substance Use Disorder
- Sleep disorder
- Sexual disorder
In addition, it is also useful for people without a mental health diagnosis, as it helps to better manage stressful life situations, such as:
- Vital Crises
- Couple Problems
- Emotional Upset
- School or Work Difficulties
- Lack of social skills
How cognitive behavioral therapy applied?
In the context of clinical psychology, cognitive behavioral therapy must be conducted by an accredited professional, with the corresponding degree and certification. Therapy can be done individually or in a group.
Regarding the duration of the therapy, it is not considered a long therapy, quite the opposite. The average number of sessions can range between approximately 15 and 20 sessions, lasting between 30 and 60 minutes that can be weekly or fortnightly.
It is recommended that the sessions be weekly at the beginning to be spaced out later. On the other hand, the therapy must be applied in a physical space prepared for it and totally confidential.
The mode of application, the duration and the effectiveness will depend on many factors, including the complexity of the problem presented by the patient, the patient’s involvement and the collaboration received from their environment.
Cognitive Behavioral Therapy Techniques
Cognitive behavioral therapy techniques are those that have been scientifically proven to be most effective in clinical psychology. These techniques focus on modifying thoughts and behaviors by learning new, more adaptive ways of thinking and acting.
Cognitive-behavioral therapy techniques focus on the present, although their objective is the acquisition of habits and skills that provide greater well-being and quality of life and that last over time.
Some of the most important and used cognitive-behavioral techniques are explained below:
Rational Emotive Behavior Therapy
Rational emotive behavior therapy (REBT) is based on the premise that emotional distress is due to the person’s interpretation of a situation and not the situation itself.
The objective of rational emotive behavior therapy is for the person to achieve a change in thought patterns to change the way of interpreting situations. That is, he begins to assess situations with conclusions based on fact and not on subjective assumptions. The REBT follows the following scheme:
- Real situation or event.
- Interpretation of the situation: thoughts, beliefs, conceptions, conclusions, etc.
- The emotions that arise from the interpretation of the situation. If the interpretation is negative, surely the emotions are unpleasant.
- Question the validity of the interpretation of the situation by discussing irrational thoughts.
- Favorable change in emotions following awareness of irrational cognitions.
Cognitive restructuring is a cognitive therapy technique that consists of modifying thought patterns:
- Understand what cognitive distortions are, that is, negative and irrational thoughts that affect mood and behavior.
- Being aware of thoughts: learning to identify one’s own cognitive distortions.
- Record your thoughts: write down the situation you are in, the thought that appears, the emotion and the behavior.
- Look for an alternative thought that is more functional than the distorted thought.
The procedures that the psychologist uses for this change of thoughts are:
- Analyze thought. Ask yourself if the thought is true and make a rational analysis of it.
- Socratic questioning: asking questions such as “Is this totally true that I’m thinking?” or “what evidence do I have of it?”.
- Examine the usefulness of the thought: “does this thought help?” or “pros and cons of thinking.”
- Put yourself in a worst case scenario: ask yourself “what if…?” or “what’s the worst that could happen?”
The exposure technique bases its effectiveness on the principle of habituation, which has shown that repeated exposure to a stimulus produces a lesser response each time from the subject. For example, if one day he sees a spider, his body will react because the alarm system will be activated. However, if you see a spider every day and it has no consequences, each time the interpretation of danger is less and therefore the psychophysiological reaction is less.
This technique is especially indicated for anxiety problems, fears and phobias and avoidance behaviors. The exhibition must have planning and support provided by a specialist. The types of exhibition are: the live exhibition or the exhibition in a symbolic way through the imagination or virtual reality technological devices.
Systematic Desensitization also aims to decrease the psychophysiological reaction to anxiogenic stimuli. The first part is to break down the situation that produces the activation of fear or anxiety in small parts and rank them from the least to the most feared.
For example, with the fear of speaking in public we could put, as a first step, the situation of saying a couple of sentences in front of a totally trusted person; as a second step, make a 2-minute speech in front of two trusted people; as a third step, make a 4-minute speech in front of some relatives or trusted people. And so on until you reach the most feared situation. It is recommended that the desensitization hierarchy be made up of between 20 and 50 phases. Next, it is a question of facing the situations following this hierarchy, the indications of the psychologist and applying relaxation techniques.
Cognitive behavioral therapy for depression
Depression is defined by a set of cognitive, affective and behavioral symptoms. It is mainly characterized by negative thoughts about oneself, about the environment and about the future. There are different depressive disorders included in the DSM-V with their corresponding criteria and characteristics, the most common being major depressive disorder. Depression is a disabling disorder that affects many people, therefore, a large amount of research has been carried out for its treatment.
Cognitive-behavioral treatment for depression consists of learning to interpret situations more objectively, also changing behaviors. Psychological intervention begins with a functional analysis and psycho education, that is, the explanation of the factors that have caused and maintain the situation, as well as how to solve it.
Cognitive-behavioral treatment for depression usually begins with behavioral changes, as these are simpler and have more immediate effects. Therefore, we could start with behavioral activation, which consists of engaging in behaviors and activities that are pleasurable and rewarding. They can be activities that the patient already did before, or even new activities. To do this, activity scheduling and task assignment are used.
Next, the cognitive strategies will be applied. We would continue with cognitive techniques to identify dysfunctional cognitions and change them to more adaptive thoughts, such as cognitive restructuring and problem solving.
The treatment of depression must be applied by a qualified and accredited professional.
Cognitive behavioral therapy for anxiety
Anxiety is made up of a set of cognitive, physiological and behavioral symptoms. It is mainly characterized by worrying thoughts and physiological arousal. There are different anxiety disorders included in the DSM-V with their corresponding criteria and characteristics, such as generalized anxiety disorder, panic disorder, agoraphobia and other phobias.
Cognitive-behavioral treatment for anxiety consists of learning to interpret situations more objectively and understand and reduce physical sensations.
Psychological intervention begins with a functional analysis and psycho education, that is, the explanation of the factors that have caused and maintain the situation, as well as how to solve it.
Cognitive-behavioral therapy techniques for anxiety include exposure to anxiety-producing stimuli as well as physical signs of anxiety, systematic desensitization to habituate to both external and internal stimuli, cognitive restructuring, and reality testing in which the patient can verify that what he feared has not happened or has not been as serious as he imagined.
Cognitive behavioral therapy techniques for anxiety also include breathing and relaxation techniques to manage the physical sensations of anxiety, as well as meditation, such as mindfulness, perfect for focusing attention on the present
Anxiety treatment must be applied by a qualified and accredited professional.