All About Cognitive Behavioral Therapy

Cognitive Behavioural Therapy, or CBT, is one of the most popular forms of psychotherapy mostly used in one-on-one counselling sessions. As the name suggests, CBT is based on a mix of cognitive (mental processes like thoughts) and behavioural approaches. This therapy was started by Aron Beck in the 1960s. 

CBT helps identify negative thought patterns that impact your emotions and behaviour and replace them with more rational or helpful ones. According to CBT, people experience these negative thoughts that come on automatically when in a triggering situation. These arise from certain irrational beliefs that people develop about themselves, others or the world.

It is considered efficient because it is structured and helps identify unhealthy patterns fairly quicker than other therapies. CBT might also be combined with other approaches like pharmacotherapy, family therapy or other individual therapy techniques. CBT is also sometimes used in group or family settings.  

Techniques in CBT

Thought tracking: Your therapist might ask you to maintain a record of any unhelpful repetitive thoughts, the triggering situations, the emotions associated with the thoughts and how you behaved in those situations. This can help identify any irrational beliefs or unhelpful thought patterns. 

Cognitive restructuring: You might later be asked to replace these automatic negative thoughts with more objective and helpful thoughts. This may involve learning about common cognitive distortions like black-and-white thinking or fortune-telling. 

For e.g. “I am a failure” would be replaced with, “I have failed at time and at times succeeded. Like everyone else, I can’t win in every situation. It’s okay for me to fail at times.”

Behavioural activation: Most mental health problems will lead to losing interest in regular day-to-day activities, hobbies and socialising. Behavioural activation encourages people to engage in behaviours that positively impact their emotional state. 

For e.g. spending small amounts of time doing something you enjoy, it could be a creative hobby like gardening or painting or an activity like going for a walk in nature or cooking your favourite meal.

Stress-reduction techniques: You might engage in relaxing activities like breathing, guided relaxations or guided imagery. These techniques can help deal with stress in a triggering situation. 

What is it used for?

CBT is used in both clinical and counselling settings. It means that even people without mental health disorders can benefit from its techniques. Research has shown that it is helpful in treating: 

1. Depression
2. Bipolar disorder
3. Anxiety
4. Substance use
5. Post-traumatic Stress Disorder (PTSD)
6. Eating Disorder
7. Behavioural addictions
8. Phobias
9. Body dysmorphia
10. Psychotic disorders

Other issues that CBT helps deal with:

• Stressful life situations
• Preventing relapse
• Low-self esteem
• Managing emotions in a healthy way
• Relationship conflicts
• Communication skills
• Grief
• Anger issues
• Coping with trauma
• Coping with a physical illness

What is a session like?

A CBT therapy will last for about 45-60 minutes. Before starting your sessions, you can think about what you want to discuss. You will be discussing this with your therapist anyway, but having some idea beforehand can give you more clarity. In the first few sessions, the therapist will try to understand your symptoms and also psychoeducate you about your conditions. They might ask you about your expectations from therapy and set goals. 

Later sessions would involve identifying negative thought patterns and the connection between your thoughts, emotions and behaviour. By changing unhelpful beliefs, you may be able to deal better with any challenging situations you face. You will also learn various coping strategies like relaxation, stress management, identifying emotions, and assertiveness. 

This will involve talking about your thoughts and emotions, for the most part. If you have difficulty expressing emotions, your therapist will guide you and get you in a comfortable state. In between sessions, your therapist might give you homework, like maintaining a thought journal, reading articles, or doing behavioural exercises. 

The basic steps involved through the sessions include identifying problems in your life, identifying the thoughts and feelings around these behaviours, identifying negative patterns and replacing them with more helpful ones. 

You might experience some discomfort during and after the sessions. This is because you might have to deal with difficult emotions and painful memories. You may feel emotionally drained or upset, or angry for a while. It may make you confront thoughts and memories that you’ve suppressed. 

Your therapist will not give you life advice or make your problems disappear. They will only teach you to cope with these situations healthily. People often expect quick results from therapy, but that is usually not the case. It can feel tempting to skip sessions, but this may affect your progress. It would be better to speak with your therapist about how you feel. 

This might make you feel like it is making things worse, but this is the therapy process. Let your therapist know how you feel; an efficient therapist can help you deal with those feelings. You may learn coping skills to deal with this discomfort. 

Confidentiality will be maintained during your sessions. However, it may be breached under certain circumstances, like if you are a threat to yourself or someone else. You can also ask your therapist about how they maintain confidentiality. 

How much does it cost?

Typically the length of therapy is anywhere between 5-20 sessions. This may depend on your condition, the severity and the duration of the problem. It may also change depending on how you make progress, your life situations and external support. Each session in India may cost you anywhere from Rs. 400 to Rs. 5000. 

CBT can help you manage negative thoughts and lead a healthy life. It can improve your mood in the first 5-6 sessions. You can get therapy in the comfort of your own home through online sessions or look for a therapist nearby and go for offline sessions. 

If you or someone you know is struggling with a mental health problem, reach out to a mental health professional. When choosing your therapist, check for their qualifications and specialisations. You can also look for reviews online. You can browse through our list of mental health providers all over India here. 

Sources:

Chand, S., Kuckel, D., & Huecker, M. (2022, September). Cognitive Behavior Therapy. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK470241/

Crum, J. (2021, June). Understanding Mental Health and Cognitive Restructuring With Ecological Neuroscience. National Library of Medicine. https://doi.org/10.3389%2Ffpsyt.2021.697095

Gautam, M., Tripathi, A., Deshmukh, D., & Gaur, M. (2020). Cognitive Behavioral Therapy for Depression. Indian journal of psychiatry, 62(Suppl 2), S223–S229. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_772_19 

Villines, Z. (2021, October 25). What is behavioral activation? https://www.medicalnewstoday.com/articles/behavioral-activation