CBT Q & A

Cognitive behavior therapy is one of the few forms of psychotherapy that has been scientifically tested and found to be effective in hundreds of clinical trials for many different disorders. In contrast to other forms of psychotherapy, cognitive therapy is usually more focused on the present, more time-limited, and more problem-solving oriented. In addition, patients learn specific skills that they can use for the rest of their lives. These skills involve identifying distorted thinking, modifying beliefs, relating to others in different ways, and changing behaviors.

Cognitive behavior therapy is based on the cognitive model: the way we perceive situations influences how we feel emotionally. For example, one person reading this website might think, "Wow! This sounds good, it's just what I've always been looking for!" and feels happy. Another person reading this information might think, "Well, this sounds good but I don't think I can do it." This person feels sad and discouraged. So it is not a situation that directly affects how people feel emotionally, but rather, their thoughts in that situation. When people are in distress, they often do not think clearly and their thoughts are distorted in some way. Cognitive behavior therapy helps people identify their distressing thoughts and evaluate how realistic the thoughts are. Then they learn to change their distorted thinking. When they think more realistically, they feel better. The emphasis is also consistently on solving problems and initiating behavioral change.

An important first step is to set goals. Ask yourself, "How would I like to be different by the end of therapy?" Think specifically about changes you'd like to make at work, at home, in your relationships with family, friends, co-workers, and others. Think about what symptoms have been bothering you and which you'd like to decrease or eliminate. Think about other areas that would improve your life: pursuing spiritual/intellectual/cultural interests, increasing exercise, decreasing bad habits, learning new interpersonal skills, improving management skills at work or at home. Your therapist will help you develop a goal list and decide which goals you might be able to work toward on your own and which ones you might want to work on in therapy.

At each therapy session, cognitive behavior therapists help patients specify the problems they have encountered during the week or that they expect to encounter in the current week. They then collect data to identify the ideas and behaviors that have interfered with patients' ability to solve problems themselves. Cognitive behavior therapists get patients actively engaged in deciding where to start working. Together, they develop an “action  plan” or homework for patients (to do during the week) to implement solutions to problems or to make changes in their thinking and actions. This process gets patients actively involved in their own treatment; they begin to recognize that the way to get better is to make small changes in how they think and what they do every day. When treatment ends, patients are able to use the skills and tools they have learned in therapy in their day-to-day lives.  

Cognitive therapists, being both practical and collaborative, can discuss the advantages and disadvantages of medication with you. Many patients are treated without medication at all. Some disorders, however, respond better to a combination of medication and cognitive therapy. If you are on medication, or would like to be on medication, you might want to discuss with your therapist whether you should have a psychiatric consultation with a specialist (a psychopharmacologist) to ensure that you are on the right kind and dosage of medication. If you are not on medication and do not want to be on medication, you and your therapist might assess, after four to six weeks, how much you've progressed and determine whether you might want a psychiatric consultation at that time to obtain more information about medication.

One way is to ask your therapist how you might be able to supplement your psychotherapy with cognitive therapy readings, workbooks, client pamphlets, etc. A second way is to prepare for each session, thinking about what you learned in the previous session and jotting down what you want to discuss in the next session.

A third way to maximize therapy is to make sure that you try to bring the therapy session into your everyday life. Therapists should make sure you take home notes or a recording of anything you want to remember, both changes in your thinking and an action plan to follow during the week.

Many patients notice a decrease in their symptoms within a few weeks of therapy, or even sooner, if they have been faithfully attending sessions and doing the suggested assignments between sessions on a daily basis.

Visit the Academy of Cognitive Therapy (ACT) website: www.academyofct.org
You can contact the Academy of Cognitive Therapy at:
Academy of Cognitive Therapy
260 South Broad Street
18th Floor
Philadelphia, PA 19102
Phone: 267.350.7683
Fax: 215.731.2400
E-mail: info@academyofct.org

It's important to remember that cognitive behavior therapists use a different formulation for each psychiatric disorder. We use this formulation in conceptualizing the individual patient which is an essential component to developing a sound therapeutic relationship, setting goals, planning treatment, and selecting interventions. Building trust and rapport with patients from the very first contact, demonstrating accurate empathy, sharing the conceptualization with the patient (and making sure it “rings true” for the patient), and collaborating are also essential. Another important part of every therapy session is helping patients respond to inaccurate or unhelpful ideas. The basic question to ask when a patient is reporting a distressing situation, emotion, or dysfunctional behavior is: “What is going through your mind right now?” Once we help patients identify their dysfunctional thinking, we help them gain more adaptive and accurate perspectives, especially by helping them examine the validity and usefulness of their thoughts. We also help them design behavioral experiments to test the accuracy of their predictions.