It is common for people to share their problems with friends or family members as a strategy for overcoming anxiety, depression, or fear. However, a counselor may always be consulted in case of complex problems. For centuries, simple psychotherapy methods have been applied to solve mental issues. However, modern science has seen significant development and advancements in Psychology with theorists developing more effective psychoanalysis approaches (Ruggiero, Spada, Caselli, & Sassaroli, 2018). A common method currently used is cognitive-behavioral therapy (CBT). It applies specific strategies which are empirically supported to change negative thinking patterns and behavior. In this sense, CBT teaches clients how to connect between emotional state, thought patterns, and behavior (Hayes & Hofmann, 2018). The client is, therefore, encouraged to shift from irrational and negative thinking as a way of alleviating the emotional symptoms resulting from such thoughts.
The origin of CBT traces back to the developments in psychology in 1913 with the work of behaviorist John B. Watson, who is considered to have laid the foundation for research into the field. However, CBT was first practiced in the 1960s after Dr. Aaron T. Beck designed and undertook several experiments testing psychoanalytic concepts (Ruggiero et al., 2018). Beck found consistent cases of negative thoughts in depressed patients, which ensued spontaneously. He referred to them as automatic thoughts, which fell under three categories of negative thoughts: about the world, the future, and themselves (Friedberg & Thordarson, 2017). Since the introduction of CBT, several studies and demonstrations have proven its effectiveness in treating a wide variety of psychiatric, psychological, and medical problems (Kazantzis et al., 2018; Kodal et al., 2018). Consequently, CBT is seen as an effective method for addressing specific contents in mind, which portrays it as being disorder-specific.
Assumptions under CBT
Therapists using CBT guide clients on the ways to recognize deformed cognitions by differentiating between personal thoughts and reality. During therapeutic sessions involving CBT, clients are made to understand the influence of cognition on their feelings (Hayes & Hofmann, 2018). In this case, they get to develop strategies of recognizing, observing, and monitoring their thoughts. The approach assumes distortions are caused by defective cognition about the world, others, and self (Friedberg & Thordarson, 2017). This form of distortions in thinking is caused by failure to plan or inaccurate processing of information. Another assumption made when using CBT is that a person with a cognitive problem is likely to perceive things based on cognitive triads or irrational thinking (Kazantzis et al., 2018). Lastly, it is the norm for humans to interact with the world depending on the mental representation they have about it (Hayes & Hofmann, 2018). In case an individual’s mental representations are inaccurate, then the reasoning will cause distorted emotions and behavior.
Empirical Foundation of CBT
Even though the method is portrayed as being an approach for solving simple psychological issues, CBT produces practical solutions to mental problems common in daily lives. According to Kodal et al. (2018), different problems have distinct ways of manifestation with some moderate and others severe. The ‘replacement’ thoughts introduced by CBT gradually accustom the patient to the feared situation (Kodal, et al., 2018). In this regard, the effectiveness of CBT emerges from the teaching offered to clients on how to harbor maladaptive thinking, which facilitates the patient to develop thoughts based on facts as opposed to assumptions (Kazantzis, et al., 2018). In turn, the modality affects the behaviors of the client positively. The empirical foundation of CBT is that psychotherapy should be based on practical research instead of using narratives and testimonials to guide treatment choices.
How CBT Works
Cognitive-behavioral therapies work by breaking down problems into constituent thoughts, situations, emotions, feelings, and actions. The modality considers these constituents to be interconnected and have an effect on each other (Ruggiero et al., 2018). Thoughts on a particular situation, for example, are likely to affect an individual’s physical and emotional feelings. In this sense, the person will react in response to thoughts and feelings. The focus of CBT is to stop the negative thought cycles responsible for the subsequent reaction by the person about a situation (Friedberg & Thordarson, 2017). According to Kazantzis et al. (2018), CBT can help a patient to develop optimism about the future, which in turn results in a better quality of social life and increases the chances of considering another relationship.
People portray different reactions and interpretations of stimuli. According to Hayes and Hofmann (2018), some of these interpretations tend to be more rational and positive than others. However, clients must continuously exercise thought analysis to be able to identify irrational thoughts. From this point, the patient can replace negative thoughts with more rational alternatives. Consequently, Ruggiero et al. (2018) consider automatic thoughts to be very powerful and have the greatest impact on emotions and behaviors. Furthermore, they are commonly applied in situations generating fear hence Friedberg and Thordarson’s (2017) argument that they affect an individual’s core beliefs. For this reason, the focus of CBT is on eliminating the irrational beliefs and thoughts in the mind of the patient. This confirms the premise that CBT is built on facts rather than assumptions.
Benefits and Risks
CBT ensures the patient has a support network during the recovery period. Considering the method is action-based, the therapist tends to interact with the patient on a regular basis, which guarantees the client of someone to turn to (Kazantzis et al., 2018). Besides, the patient is always aware that someone is interested in their recovery and is motivated to work toward changing negative behaviors. Additionally, CBT makes it easier for patients to build their self-esteem because they put their attention on identifying solutions to their problems (Friedberg & Thordarson, 2017). By finding answers, they tend to believe in themselves to conquer the disorder. Mental problems are always caused by the inability to cope with stressful situations. However, CBT facilitates patients to deal with such events in their lives by learning to express themselves. On the other hand, there is a low risk of undergoing cognitive behavioral therapy for patients (Kodal et al., 2018). However, patients are likely to feel emotionally uncomfortable because of the possibility of exploring previous painful emotions and experiences.
Despite the effectiveness of CBT, it also has limitations, especially in the treatment processes. Friedberg and Thordarson (2017) raise a concern over the potential of the method to encourage positive thinking considering which it is difficult to actualize positivity in clients. Even though therapists are likely to use all means possible to help a client, results can only be achieved if there is a cooperation between the two. Both parties must play their part to realize the much-needed recovery. According to Kodal et al. (2018), cooperation means patients must be willing to participate in all aspects of the therapy, of which there is no guarantee. Therefore, it would be inappropriate to conclude that CBT is fast and effective. Additionally, the method is delivered in a structured manner, which makes it unsuitable for patients with learning difficulties or complex mental health problems. Besides, clients experiencing personality disorders and treatment-resistant depression are discouraged from being subjected to CBT. Kodal et al. (2018) further claim CBT is used alongside antidepressants in complex mental problems. The various instances where the method may be ineffective prove its limited capacity.
Barriers to Implementation
CBT is always effective when delivered by experts, which means many patients are likely to be seen by the same human resource. However, Kodal et al. (2018) state that expert therapists are limited, a situation which leaves many patients unable to access the much-needed services. Similarly, mental health experts provide the gateway for psychological interventions. According to Hayes and Hofmann (2018), when these experts hold ambivalent attitudes about the right patients for CBT and the patients likely to accept or benefit, there will be an impact on both referrals and uptake of CBT.
CBT stands out to be is a well-develop and proven therapy. Given the empirical foundations and mechanism of operation, it is evident that the method is effective for the treatment of patients experiencing a combination of behavioral and cognitive issues. Furthermore, CBT is the preferred modality for treating both moderate and severe mental health problems. However, it can only be effective if there is a collaboration between the therapist and the client. During its application, the target of CBT is multiple vulnerable areas to provide intervening measures. Apart from having a well-defined structure, the modality takes a short period to administer. On the contrary, the method also has limitations and barriers, particularly the overdependence on a collaborative relationship between the therapist and client and the views of experts on eligible candidates for CBT. Despite the setback, cognitive behavioral therapy is practically proven with reasonable evidence linked to its application. Through continued research on the method, new information will enhance the effectiveness of the therapy and ensure the provision of better mental health.
Friedberg, R. D., & Thordarson, M. A. (2017). Cognitive-behavioral therapy. In J. F. Jent, T. M. Brown, B. C. Davidson, , L. Cruz & A. Weinstein (Eds.), Handbook of Childhood Psychopathology and Developmental Disabilities Treatment (pp. 43-61). Cham: Springer.
Hayes, S. C., & Hofmann, S. G. (2018). Process-based CBT: The science and core clinical competencies of cognitive behavioral therapy. California: New Harbinger Publications.
Kazantzis, N., Luong, H. K., Usatoff, A. S., Impala, T., Yew, R. Y., & Hofmann, S. G. (2018). The processes of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 42(4), 349-357.
Kodal, A., Fjermestad, K., Bjelland, I., Gjestad, R., Öst, L. G., Bjaastad, J. F., & Wergeland, G. J. (2018). Long-term effectiveness of cognitive behavioral therapy for youth with anxiety disorders. Journal of Anxiety Disorders, 53, 58-67.
Ruggiero, G. M., Spada, M. M., Caselli, G., & Sassaroli, S. (2018). A historical and theoretical review of cognitive behavioral therapies: From structural self-knowledge to functional processes. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 36(4), 378-403.