What is Cognitive Behavioural Therapy:

You may have come across the term cognitive behavioural therapy, or more commonly known as CBT, but what it is?

CBT is a talking therapy - developed by the psychiatrist Dr Aaron Beck during the 1960s - that uses conversations between a therapist and patient to help them understand, recognise and overcome unhelpful thought patterns and behaviours that can keep mental health problems going. By identifying and changing these ways of thinking and doing things, CBT can help people take control of their own feelings and actions by helping them interpret and react to situations in more positive ways.

What can CBT do?

Since its initial development, CBT has been adapted to treat a wide range of mental health difficulties. New branches of CBT have been formed that incorporate specific techniques more effective in treating specific problems. For example, the way that CBT is used to treat depression is different from the way CBT is used to treat anxiety.

Bloomfield Health has expert CBT therapists trained in enhanced cognitive behavioural therapy from world leading institutions such as: the University of Oxford's Centre for Cognitive Therapy, and the King's College London Institute of Psychiatry. These experienced therapists help patients overcome mental health difficulties in both face-to-face sessions and online, allowing more flexibility and freedom in accessing help.

Professionals help patients deal with distressing emotions and life events such as feelings of stress and panic, or problems in relationships. They can help in periods of high distress to help cope and manage overwhelming feelings, and longer term working on developing new skills to improve the mental well-being of their patients.

There is a diverse range of skills and techniques therapists teach patients to empower them to improve their mental health, including: goal setting, rebalancing negative thought patterns, role-playing, relaxation techniques and problem solving. By using these methods and developing a therapeutic relationship with patients, CBT has been shown to be an effective treatment for a wide range of conditions, including but not limited to:

• Addiction (Anuradha & Singh, 2018)

• Depression (Lepping et al., 2017)

• Eating disorders (Agras et al., 2017)

• Panic attacks (Pompoli et al., 2018)

• Personality disorders including emotionally unstable (borderline) personality disorder (Davidson, 2008)

• Phobias (Cottraux et al., 2000)

• Post-traumatic stress disorder (PTSD) (Harvey et al., 2003)

• Social anxiety disorder (Heimberg, 2002)

• Generalised anxiety disorder (Stefan, 2019)

Forms of CBT:

Typically, CBT takes place face-to-face with the therapist, however during the last decade, and especially during the COVID-19 pandemic, advances in video conferencing and smartphone technology has meant that increasingly therapy takes place online. CBT has also been incorporated into apps allowing users to take an active role in their own mental health care (Christie et al., 2019).

How would CBT look in practice:

An example of CBT published in a medical journal (Chafey et al., 2009) describes how CBT was used to help a young woman who was failing school and had the following symptoms: frequent sadness, increased appetite and overeating, low self-esteem, anxiety, irritability, insomnia, hopelessness, poor interpersonal relationships, and persistent negative thoughts. She was diagnosed with generalized anxiety disorder, depression, and attention deficit hyperactivity disorder (ADHD).

Initially she worked with her CBT therapist to complete daily mood journals that helped her identify and challenge dysfunctional thoughts. They planned pleasant activities to improve mood and used role playing exercises to help practice social situations and communication strategies. Over time, identifying and changing negative thoughts led to an increase in her self-esteem, which in turn helped her to use skills to stop her thinking repetitive negative thoughts. Difficulties with her parents and their marriage were identified as a contributing factor to her mental health difficulties, and the therapist invited the parents to join in with some sessions so that they could communicate and problem solve family issues.

After therapy, the woman showed significant decreases in depressive symptoms and no longer met clinical criteria for depression.

The future of CBT

CBT can be a powerful tool to alleviate distressing mental health symptoms. Incorporating CBT techniques into new media via emergent technology has the potential to increase its benefits to patients (Spence et al., 2011). Adapting and modifying CBT for inclusion in today’s advanced technological world will provide additional benefits and reduced barriers of entry for individuals seeking assistance with mental health difficulties.

References:

1.     Anuradha, M., & Singh, P. (2018). Efficacy of CBT on internet addiction. Journal of Psychosocial Research, 13(1), 109-119. Retrieved from https://www.proquest.com/scholarly-journals/efficacy-cbt-on-internet-addiction/docview/2088830260/se-2?accountid=14511

2.     Lepping P, Whittington R, Sambhi RS, Lane S, Poole R, Leucht S, Cuijpers P, McCabe R, Waheed W. (2017). Clinical relevance of findings in trials of CBT for depression. European Psychiatry;45:207-11.

3.     Agras, W.S., Fitzsimmons-Craft, E.E. and Wilfley, D.E., (2017). Evolution of cognitive-behavioral therapy for eating disorders. Behaviour Research and Therapy, 88, pp.26-36. 

4.     Pompoli, A., Furukawa, T.A., Efthimiou, O., Imai, H., Tajika, A. and Salanti, G., (2018). Dismantling cognitive-behaviour therapy for panic disorder: a systematic review and component network meta-analysis. Psychological medicine, 48(12), pp.1945-1953.  

5.     Davidson, K.M., (2008). Cognitive–behavioural therapy for personality disorders. Psychiatry, 7(3), pp.117-120.

6.     Cottraux, J., Note, I., Albuisson, E., Yao, S.N., Note, B., Mollard, E., Bonasse, F., Jalenques, I., Guérin, J. and Coudert, A.J., (2000). Cognitive behavior therapy versus supportive therapy in social phobia: a randomized controlled trial. Psychotherapy and Psychosomatics, 69(3), pp.137-146.

7.     Harvey, A. G., Bryant, R. A., & Tarrier, N. (2003). Cognitive behaviour therapy for posttraumatic stress disorder. Clinical psychology review, 23(3), 501-522.

8.     Heimberg, R. G. (2002). Cognitive-behavioral therapy for social anxiety disorder: current status and future directions. Biological psychiatry, 51(1), 101-108

9.     Stefan, S., Cristea, I. A., Szentagotai Tatar, A., & David, D. (2019). Cognitive‐behavioral therapy (CBT) for generalized anxiety disorder: Contrasting various CBT approaches in a randomized clinical trial. Journal of Clinical Psychology, 75(7), 1188-1202.

10.  Christie, G.I., Shepherd, M., Merry, S.N., Hopkins, S., Knightly, S. and Stasiak, K., (2019). Gamifying CBT to deliver emotional health treatment to young people on smartphones. Internet interventions, 18, p.100286.

11.  Chafey, M.I.J., Bernal, G., & Rossello, J. (2009). Clinical Case Study: CBT for Depression in A Puerto Rican Adolescent. Challenges and Variability in Treatment Response. Depression and Anxiety, 26, 98-103.  https://doi.org/10.1002/da.20457

12.  Spence, S.H., Donovan, C.L., March, S., Gamble, A., Anderson, R.E., Prosser, S. and Kenardy, J., (2011). A randomized controlled trial of online versus clinic-based CBT for adolescent anxiety. Journal of consulting and clinical psychology, 79(5), p.629.