Cognitive-Behavioral Therapy
MIND WELL
Cognitive-behavioral therapy is a scientifically recognized and widely used form of psychotherapy that is based on scientific principles and that research has shown to be effective for a wide range of problems. It originated from the convergence of cognitive psychotherapy and behavioral therapy and is based on the combination of fundamental principles and cognitive and behavioral techniques/strategies.
The basic principles of C/B Therapy:
- Way of thinking affects feelings and behavior.
- The way of thinking can be tested and modified.
- Changes in thinking can bring about the desired changes in feeling and behavior.
So, according to the cognitive-behavioral model, the thoughts (interpretations) we make about things and beliefs about ourselves, others and the world, affect our feelings, the way our body reacts and our behavior in each situation. According to the second basic principle, every form of behavior is learned and can be modified through a new learning process.
CBT is “focused on the present”, i.e. on present difficulties and problems. It works with thoughts and feelings in the here-and-now, and tries to understand a situation by investigating different things:
The way of thinking can sometimes not be functional or realistic, that leads to problematic behaviors and prevent the person from living a fulfilling life. We often experience situations that may reinforce our automatic negative thoughts as well as our deeply held beliefs. These beliefs can negatively affect our behavior and consequently disrupt family, friendship, social and professional relationships. That is why even in moments of mental discomfort, we may think differently about ourselves and what is happening to us. Thinking can become extreme and this can worsen how we feel. So as humans we get ‘trapped’ in vicious circles, where our behavior and the things we do to solve a problem can unwittingly perpetuate it and increase our discomfort (the effect of behavior on thoughts and feelings).
For example, a vicious cycle in the case of depression: negative thoughts and beliefs → negative mood → physical manifestation → isolation → inactivity → reinforcement of negative self-view.
CBT aims to identify the dysfunctional learning that is responsible for the difficulties, to find the mechanisms of maintaining the problem in the present that keeps us “stuck” and to make changes in the way we think and act, so as to improve and change the emotional responses. Reference to the past is used to interpret the emergence of difficulties, that is, to explore how some early experiences contributed to the development of beliefs about yourself and others and how they maintain your current problems. This model is applied with individuals, couples and groups, while it can be used alone or in combination with medication, depending on the case. Finally, it is a personalized treatment tailored to your needs.
Research proves its effectiveness for a wide range of mental disorders and difficulties, such as: anxiety disorders (panic attacks, generalized anxiety, post-traumatic stress disorder), phobias (social phobia, agoraphobia and specific phobias) and obsessions (obsessive-compulsive disorder), (bipolar disorder), schizophrenia, eating disorders (anorexia, bulimia, binge eating disorder), personality disorders, psychosomatic problems, somatoform disorders (hypochondriasis, somatodysmorphia), use of essentials, chronic pain, psychological factors. Sleep problems, bereavement, problems of old age, sexual dysfunctions, and disorders of children and adolescents (ADHD, anxiety, phobias, behavior problems, etc.). In addition, it helps people with health problems or chronic physical conditions, problems in couples and families, chronic interpersonal difficulties, anger management problems and low self-esteem.
In order for someone to “be better” through finding and modifying unrealistic and dysfunctional thoughts, transforming beliefs that make one vulnerable e.g. to anxiety or depression, learning new behaviors and acquiring skills that will help the person have a better quality of life, deal with their problems “outside of treatment” and successfully manage negative situations in the future → “The client should become his/her own therapist.”
The acquisition and utilization of skills is also considered the active ingredient in promoting change.
What skills will you acquire?
You will understand your current difficulties, their causes and what are the factors that are maintaining them in the current phase, as well as the vicious cycles of negative thoughts-emotions-problematic behaviors for yourself and others. You will gain the ability to think realistically, challenge negative automatic thoughts that cause you discomfort and anxiety, and practice new behaviors that are more functional. There will be an improvement in self-image by strengthening self-esteem and you will learn strategies for dealing with problems in everyday life and achieving goals.
In addition, you will learn to manage negative emotions, anxiety and stress and to be assertive in everyday life and in relationships. Depending on the difficulties and the request, you will acquire skills to improve social interaction and relationships with the other gender (social and cross-gender skills). Finally, you will learn strategies for maintaining change and preventing a relapse.
A good therapeutic relationship is essential for change, the successful implementation of cognitive and behavioral interventions, and the effectiveness of CBT. The nature of the relationship is collaborative. It is based on the principle of collaborative empiricism, where therapist and client work together to address problems, and conveys the message that the client is an equal partner and has a significant part of the responsibility for their treatment, keeping their obligations and the treatment plan.
- First, an assessment is made by gathering information about symptoms and problems that may be related to either anxiety, depression, phobias and physical discomfort, or to crises and changes in important areas of life. In addition, a general history (individual and family) is taken.
- The session is structured. You and the therapist will shape the “agenda” of the topics you will deal with in each session.
- Within the framework of the therapeutic alliance formed together with the therapist, you will work to identify difficulties and understand problems from the point of view of the relationship thoughts-emotions-behavior, in order to develop a common perspective on the problems. Thus, the “case formulation” is formed, i.e. the psychological map of the causes of initiation and maintenance.
- This then leads to the treatment plan, identification of difficulties/problems, formulation of individualized goals and selection of interventions/techniques.
- This will be followed by learning and practicing techniques for changing dysfunctional thoughts, feelings and behaviors based on the case formulation.
- There will be ongoing measurements and assessments of how you are meeting your goals so that you are aware of how your treatment is progressing.
- Finally, there is an emphasis on relapse prevention, i.e. creating an action plan to deal with difficulties and maintain changes.
It is a cure by word and practice. An important and integral part of CBT is “homework”. The main goal is to apply what you learn in the therapist’s office and try new ways of thinking and behaving in practice. An example of homework exercises, from the beginning of treatment, are self-observation journals with daily observation and recording of your thoughts, feelings and behaviors from everyday situations and incidents, gathering new information, evaluating thoughts and changing the way of communicating with others.
Their value and importance is extremely significant for therapy. Research shows that clients who do home exercises improve faster and for a longer time period. First, they help motivate you to take personal responsibility for the successful outcome of treatment. Then you become ‘your own observer’ and you modify your behaviours, thoughts and feelings, thus enabling a way of problem solving after the end of treatment. Home exercises are tailored to your needs, problems and time commitments, and are pre-determined together with the therapist.
The basic principles of C/B Therapy:
- Way of thinking affects feelings and behavior.
- The way of thinking can be tested and modified.
- Changes in thinking can bring about the desired changes in feeling and behavior.
So, according to the cognitive-behavioral model, the thoughts (interpretations) we make about things and beliefs about ourselves, others and the world, affect our feelings, the way our body reacts and our behavior in each situation. According to the second basic principle, every form of behavior is learned and can be modified through a new learning process.
CBT is “focused on the present”, i.e. on present difficulties and problems. It works with thoughts and feelings in the here-and-now, and tries to understand a situation by investigating different things:
The way of thinking can sometimes not be functional or realistic, that leads to problematic behaviors and prevent the person from living a fulfilling life. We often experience situations that may reinforce our automatic negative thoughts as well as our deeply held beliefs. These beliefs can negatively affect our behavior and consequently disrupt family, friendship, social and professional relationships. That is why even in moments of mental discomfort, we may think differently about ourselves and what is happening to us. Thinking can become extreme and this can worsen how we feel. So as humans we get ‘trapped’ in vicious circles, where our behavior and the things we do to solve a problem can unwittingly perpetuate it and increase our discomfort (the effect of behavior on thoughts and feelings).
For example, a vicious cycle in the case of depression: negative thoughts and beliefs → negative mood → physical manifestation → isolation → inactivity → reinforcement of negative self-view.
CBT aims to identify the dysfunctional learning that is responsible for the difficulties, to find the mechanisms of maintaining the problem in the present that keeps us “stuck” and to make changes in the way we think and act, so as to improve and change the emotional responses. Reference to the past is used to interpret the emergence of difficulties, that is, to explore how some early experiences contributed to the development of beliefs about yourself and others and how they maintain your current problems. This model is applied with individuals, couples and groups, while it can be used alone or in combination with medication, depending on the case. Finally, it is a personalized treatment tailored to your needs.
Research proves its effectiveness for a wide range of mental disorders and difficulties, such as: anxiety disorders (panic attacks, generalized anxiety, post-traumatic stress disorder), phobias (social phobia, agoraphobia and specific phobias) and obsessions (obsessive-compulsive disorder), (bipolar disorder), schizophrenia, eating disorders (anorexia, bulimia, binge eating disorder), personality disorders, psychosomatic problems, somatoform disorders (hypochondriasis, somatodysmorphia), use of essentials, chronic pain, psychological factors. Sleep problems, bereavement, problems of old age, sexual dysfunctions, and disorders of children and adolescents (ADHD, anxiety, phobias, behavior problems, etc.). In addition, it helps people with health problems or chronic physical conditions, problems in couples and families, chronic interpersonal difficulties, anger management problems and low self-esteem.
In order for someone to “be better” through finding and modifying unrealistic and dysfunctional thoughts, transforming beliefs that make one vulnerable e.g. to anxiety or depression, learning new behaviors and acquiring skills that will help the person have a better quality of life, deal with their problems “outside of treatment” and successfully manage negative situations in the future → “The client should become his/her own therapist.”
The acquisition and utilization of skills is also considered the active ingredient in promoting change.
What skills will you acquire?
You will understand your current difficulties, their causes and what are the factors that are maintaining them in the current phase, as well as the vicious cycles of negative thoughts-emotions-problematic behaviors for yourself and others. You will gain the ability to think realistically, challenge negative automatic thoughts that cause you discomfort and anxiety, and practice new behaviors that are more functional. There will be an improvement in self-image by strengthening self-esteem and you will learn strategies for dealing with problems in everyday life and achieving goals.
In addition, you will learn to manage negative emotions, anxiety and stress and to be assertive in everyday life and in relationships. Depending on the difficulties and the request, you will acquire skills to improve social interaction and relationships with the other gender (social and cross-gender skills). Finally, you will learn strategies for maintaining change and preventing a relapse.
A good therapeutic relationship is essential for change, the successful implementation of cognitive and behavioral interventions, and the effectiveness of CBT. The nature of the relationship is collaborative. It is based on the principle of collaborative empiricism, where therapist and client work together to address problems, and conveys the message that the client is an equal partner and has a significant part of the responsibility for their treatment, keeping their obligations and the treatment plan.
- First, an assessment is made by gathering information about symptoms and problems that may be related to either anxiety, depression, phobias and physical discomfort, or to crises and changes in important areas of life. In addition, a general history (individual and family) is taken.
- The session is structured. You and the therapist will shape the “agenda” of the topics you will deal with in each session.
- Within the framework of the therapeutic alliance formed together with the therapist, you will work to identify difficulties and understand problems from the point of view of the relationship thoughts-emotions-behavior, in order to develop a common perspective on the problems. Thus, the “case formulation” is formed, i.e. the psychological map of the causes of initiation and maintenance.
- This then leads to the treatment plan, identification of difficulties/problems, formulation of individualized goals and selection of interventions/techniques.
- This will be followed by learning and practicing techniques for changing dysfunctional thoughts, feelings and behaviors based on the case formulation.
- There will be ongoing measurements and assessments of how you are meeting your goals so that you are aware of how your treatment is progressing.
- Finally, there is an emphasis on relapse prevention, i.e. creating an action plan to deal with difficulties and maintain changes.
It is a cure by word and practice. An important and integral part of CBT is “homework”. The main goal is to apply what you learn in the therapist’s office and try new ways of thinking and behaving in practice. An example of homework exercises, from the beginning of treatment, are self-observation journals with daily observation and recording of your thoughts, feelings and behaviors from everyday situations and incidents, gathering new information, evaluating thoughts and changing the way of communicating with others.
Their value and importance is extremely significant for therapy. Research shows that clients who do home exercises improve faster and for a longer time period. First, they help motivate you to take personal responsibility for the successful outcome of treatment. Then you become ‘your own observer’ and you modify your behaviours, thoughts and feelings, thus enabling a way of problem solving after the end of treatment. Home exercises are tailored to your needs, problems and time commitments, and are pre-determined together with the therapist.
Frequently asked questions
What is psychotherapy?
Psychotherapy is the treatment of psychological issues and mental disorders carried out mainly through discussion and communication between the therapist and the patient, rather than through the use of pharmaceuticals or other medical and biological methods. There are different types of psychotherapy: individual, group, couple and family. Psychotherapy is a systematic approach to understanding mental health problems and a method of dealing with psychological problems and difficulties. It is based on clinically proven theories, good clinical practice with the application of specific techniques and interventions to address the causes of psychological problems, and is supported by empirical data. According to the British Psychological Society, psychotherapy is considered an additional qualification for someone already working as a psychologist or psychiatrist. To specialize in psychotherapy, training in a specific psychotherapy model is necessary. There are different approaches to psychotherapy for a psychiatrist and a psychologist (e.g. psychoanalytic, cognitive-behavioral, systemic, etc.).
What is the difference between a psychiatrist and a psychologist?
Many people confuse and equate the role of a psychologist with that of a psychiatrist, since both are mental health professionals. However,there are significant differences. A psychiatrist is a doctor, that practices the medical specialty of Psychiatry and can prescribe medication to relieve discomfort and treat mental health disorders, whenever it is required. Psychiatry is a specialized category of medicine that includes the prevention, diagnosis, treatment and research of mental disorders. Psychiatry differs from psychology in that it approaches emotional and behavioral problems using a medical model. A psychologist is not a doctor and cannot prescribe psychotropic medication. However, in many cases the two specialties can work together and help to deal with psychological difficulties.
Is there a possibility that I might need medication?
There is a possibility that, after the evaluation and in the context of the therapeutic planning, the therapist could also propose collaboration with a psychiatrist for the administration of medication. The answer to the question: “Is there a possibility that I might need medication?” is not simple. Prescribed medication is necessary in specific disorders and is useful in cases where the person is in a period of exacerbation of a certain problem. Cognitive Behavioral Therapy is combined with pharmacotherapy in specific cases for better therapeutic results and until there is a remission of the unpleasant symptoms. Medication is not helpful in personal difficulties that are not due to the existence of a mental disorder and in functioning problems that exist in the personality level.
Will treatment help me?
There is a possibility that, after the evaluation and in the context of the therapeutic planning, the therapist will also propose collaboration with a psychiatrist for the administration of medication. The answer to the question: “It may be normal to have some misgivings about whether to start treatment because there are doubts about the prospect of improvement and fears about the process and the impending change. That’s why some clients go into the process of postponing (“It’s not the right time”) or avoiding altogether. The truth is that you cannot be sure in advance whether the treatment will help you. There is no such thing as a “right time”, and any delay can exacerbate any difficulty. However, it is worth giving yourself the opportunity to try and do something that can bring about a significant change in your life, as this is a highly effective treatment that has helped many people. Finally, if you have decided that that the desired changes are not there, you can stop.
Can I stop before the treatment is completed?
Some people stop treatment without completing it. This can be due to several reasons. For example, some patients stop treatment when initial goals have been met and they feel better, or conversely, when they believe there is no improvement and they are not doing well enough. Improvement is gradual and comes with time and effort. Changes occur upon completion of the treatment. When there are similar concerns and thoughts it would be beneficial and helpful to discuss them in therapy.
What happens when there is a lack of improvement?
There is also the possibility that a long period of time may pass without progress (no change in your thoughts and mood). In this case it will be necessary to: investigate the possible problems that may have arisen within the therapeutic relationship, deal with the behaviors that hinder the therapeutic process, review the interpretation and the plan for each case, and choose different techniques and interventions that best meet your specifics.
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