Cognitive Behavioural Therapy

Therapy or counselling is a structured way of providing help to someone experiencing emotional, psychological, or behavioural challenges by a trained mental health professional.

If you are experiencing a fever, you consult a doctor. Similarly, if you are experiencing problems in interpersonal relationships, understanding self, career dilemmas, or emotional problems consulting with a mental health professional can be helpful.

The process is collaborative, where the professional attempts to create a space of sharing, listening and enabling coping mechanisms that can help with their well-being. 

A psychologist or a counsellor may be trained in one or a variety of therapy approaches to help people deal with various problems. Some examples are mentioned below:-

• Behaviour Therapy 
• Psychodynamic Therapy 
• Expressive Art Therapy 
• Cognitive Behaviour Therapy

As our understanding of mental health evolved, the different approaches to providing psychotherapy were researched. Some of the earliest therapy approaches like the psychoanalytical model and behaviourist model of therapy focus on the unconscious mind and reversing the observable behaviours through the tenets of reinforcement and punishment, respectively.

Therapists often utilize different therapeutic approaches because each approach offers unique techniques and frameworks for addressing various mental health concerns.  Additionally, different approaches may resonate more effectively with different clients or be better suited to specific issues or goals.

Having a range of approaches allows therapists to provide a more comprehensive and personalized therapeutic experience.

In this article, we understand one commonly used therapy approach named Cognitive Behavioural Therapy (CBT). This therapy approach has proven effective in dealing with anxiety, depression, eating disorders, obsessive-compulsive disorder, and substance dependence, among others. The name cognitive illustrates thoughts; the leading proponent of CBT. Dr. Aaron Beck, in the mid-20th century, felt that the traditional approaches of therapy at that time were not helping his clients recover from depression.  Therefore, he began focusing on thoughts and their influence on human behaviour. 

Main Principles

1. Unhelpful thinking: Therapists who practice CBT believe the reason for psychological distress originates from unhelpful ways of thinking. As an example, let’s understand Isha’s story. Isha has a party to attend with a group of people she has never interacted with, and as she enters, she believes that nobody is going to like her and people will make fun of her. Here, Isha has no evidence of someone disliking her as she has never been with these people, but the assumption that no one will like her may cause her distress and make her feel anxious about communicating with others. The theory of CBT is that we experience distress or mental health issues not because of a particular situation but because of our interpretations and perceptions of the situation. 
2. Present-oriented: The therapy primarily focuses on the here and now – the current thoughts, emotions, and behaviours of the individual. Unlike some traditional therapeutic approaches that delve extensively into past childhood experiences or unconscious processes, CBT is concerned with the present moment and how one's current thought patterns impact one's well-being. One primary goal of CBT is also to understand the core beliefs of a person. Core beliefs are deeply ingrained beliefs about oneself, others, and the world that influence thoughts, feelings, and behaviors. It uses the kind of thoughts one is having in the present to trace these core beliefs.
3. Short-Term & Goal-Oriented: CBT is designed to be a time-limited therapy, meaning that it is intended to be completed within a specific number of sessions. CBT is goal-oriented, meaning that therapy aims to achieve specific, measurable outcomes set out in the initial sessions. CBT Therapy sessions last anywhere between 6-20 sessions depending on the intensity of the problems, as opposed to a psychoanalytical therapy approach, which can last up to years. 
4. Practical: In CBT sessions, a client learns to identify their thought patterns, emotions, behaviours, and bodily sensations associated with them and is supplemented with practical techniques often termed as homework, which they can practice by themselves in between the sessions.

Common Techniques

1. Identifying thought distortions: In our above example, where Isha is going into a social gathering thinking no one will like her, her thinking is troubled by a thought distortion called “Jumping to Conclusion.” Isha is jumping to a faulty conclusion without really considering all the evidence from the situation. Like Isha, many of us may indulge in faulty thought distortions on a daily basis, influencing our mood and behaviour. A CBT therapist helps you identify these distortions and aids you with tools to challenge them. There are several examples of thought distortions, some of which you can read here.
2. Thought Record: Another common technique used in the initial therapy sessions by CBT therapists is called a thought record. It can be customized based on the needs of the client. The basic premise is to track the various thoughts one has during a day (mainly the ones that one’s that bring up overwhelm) and the emotions, behaviours, and bodily sensations associated with it and brainstorm an alternative thought which can be produced which may not bring up distressing emotions and behaviours.

3. Fact or Opinion: In this exercise, individuals are instructed to write down various thoughts (often the ones that contain criticism/judgment towards self), and they are guided to categorize each statement as either a verifiable fact or a personal opinion. This process encourages self-reflection and the examination of thoughts. People learn to identify and question their subjective interpretations, fostering a more objective and rational approach to understanding situations. This activity helps in restructuring our thought processes and empowering individuals to manage their mental health more effectively. As humans, we experience a range of thoughts and emotions throughout the day. CBT suggests that not every thought or feeling one has indicates the truth and, thus, one should use caution when it comes to believing thoughts.
4. Behavioural Activation: A principal population on whom CBT was developed were people dealing with depression. A common symptom of depression is a loss of interest and energy in everyday activities. Behavioral activation focuses on increasing behaviours that bring a sense of accomplishment, pleasure, or satisfaction. Therapists help individuals set specific, achievable goals for activities that they may have stopped doing or are avoiding due to their emotional difficulties. These activities can range from simple daily tasks like bathing to more significant ones such as applying for a job. By systematically planning and scheduling these activities, individuals learn to counteract the withdrawal that often accompanies depression. It encourages people to become more aware of the relationship between their activities, emotions, and thoughts. Through consistent practice and support, individuals can regain a sense of purpose, contributing to long-term improvements in mood and overall well-being.

Self-help Books and Websites

1. Book by David Burns- Feeling Good

It is a popular book often recommended to clients dealing with depression and low self-esteem with principles based on the tenets of Cognitive Behaviour Therapy. 

2. Online workbooks

CBT is one therapy approach that is easy to practice once you have a basic understanding of the modality and awareness of the problems you are facing. You can access one such free workbook that follows the principles of CBT here.

Pros

1. Adaptability: Since CBT is practical, it can be adapted to a variety of emotional difficulties and settings. One such adaptation is the Thinking Healthy manual. Thinking Healthy manual was developed by the World Health Organization for social workers to help women with perinatal depression in rural areas of third-world countries based on the principles of cognitive behaviour therapy. 
2. Integration of Different Therapy Approaches: CBT has been influential in the development of several therapeutic approaches, and some of these have originated directly from CBT principles or have been significantly influenced by them. Some examples include Mindfulness-Based Cognitive Therapy & Dialectical Behaviour Therapy.

Cons

1. Overemphasis on Rationality: Some individuals may find CBT's emphasis on rational thinking to be limiting, especially when dealing with highly emotional or irrational experiences.
2. Limited Exploration of Underlying Causes: Critics argue that CBT tends to focus on symptom management and may not delve deeply into the underlying root causes of psychological issues.

In conclusion, CBT stands as a widely used and effective approach for addressing emotional and psychological challenges. CBT continues to play a significant role in the evolving mental health landscape, with its practical and goal-oriented approach. 

References 

Atif N, Krishna RN, Sikander S, Lazarus A, Nisar A, Ahmad I, Raman R, Fuhr DC, Patel V, Rahman A. Mother-to-mother therapy in India and Pakistan: adaptation and feasibility evaluation of the peer-delivered Thinking Healthy Programme. BMC Psychiatry. 2017 Feb 23;17(1):79. doi: 10.1186/s12888-017-1244-z. PMID: 28231791; PMCID: PMC5324237.

Beck, J. (2023, October 10). CBT in 2023: Current trends in cognitive-behavior therapy. Psychiatric Times, 30(4), 123-145. https://www.psychiatrictimes.com/view/cbt-in-2023-current-trends-in-cognitive-behavior-therapy

World Health Organization. (2015, March 15). Thinking Healthy. https://www.who.int/publications-detail-redirect/WHO-MSD-MER-15.1