10 Psychological Problems Best Treated by Cognitive Behavior Therapy (CBT)
CBT (Cognitive-Behavioral Therapy) refers to the combination of cognitive and behavioral therapies and has strong empirical support for the treatment of many psychological disorders. The basic premise of CBT is that negative emotions cannot be changed directly, therefore it targets thoughts and behaviors that are contributing to distressing emotions. CBT focuses on building an individual’s skillset or coping skills that enable one to become more aware of their thoughts and feelings, identify how situations, thoughts, and behaviors impact one’s feelings and improve the negative feelings by changing dysfunctional thoughts and behaviors. CBT differs from traditional talk therapy because it places a strong emphasis on clients’ skill acquisition and the use of homework assignments. The goal in therapy is not only to solve clients’ current problems or improve clients’ negative feelings but also to build up clients’ toolkits so that they can become effective in solving their own problems in the future.
This blog will highlight the ten most common problems that CBT can help with.
Depression
CBT can help depression mainly through a technique called behavior activation. Through behavior activation therapist and client work together to reintroduce pleasant events into the client’s life and this helps to improve the client’s mood by reversing avoidance, increasing physical activity, increasing self-confidence, and increasing feelings of usefulness and purpose as well as reducing negative thoughts. Behavior activation can include many different behaviors. The most common ones are re-introducing prior pleasant activities, introducing new pleasant activities, and coping behaviors that will reduce certain life stressors such as filing taxes, cleaning a messy apartment, or calling an estranged family member (Cully & Teten, 2008).
Panic Disorder
CBT targets panic disorder through exposing the client to the feared situation. Exposure sessions help clients learn that they can experience the symptoms of arousal without the feared consequences (Barlow & Cerny, 1988). Interoceptive exercises allow clients to confront the physical sensations associated with panic without letting them spiral into a panic attack. For instance, bodily spinning or hyperventilation can be used in session to induce feelings of dizziness or lightheadedness.
In imaginal exposure, the therapist reads the script of the feared situation to the client in session over and over until the client’s anxiety subsides.
In vivo exposure is used to help clients reduce their tendency to avoid situations that often elicit a panic attack (Clum, 1990). Sometimes a hierarchy of challenging situations is created and the client gradually works through the steps with the help of the therapist. Eventually clients develop the attitude that they will deliberately seek out and confront difficult situations.
Obsessive-Compulsive Disorder (OCD)
Today’s preferred treatment for OCD is weekly CBT therapy sessions that usually include ERP (exposure and response/ritual prevention) exercises. Exposure and response prevention means that first clients expose themselves to the thoughts, images, objects and situations that make them anxious and/or start their obsessions (exposure). Then clients resist doing a compulsive behavior once the anxiety or obsessions have been triggered (response prevention). This results in decreased anxiety and the ability to reduce or stop compulsions.
Bipolar Disorder
Even though most patients who suffer from Bipolar disorder are prescribed medication (usually mood stabilizers), preliminary evidence suggests that CBT is an effective addition to pharmacotherapy. CBT for Bipolar Disorder focuses on psychoeducation and mood regulation. Psychoeducation aims to educate the client on the illness and its consequences, medication options and their side effects, as well as symptoms and early warning signs of episodes. CBT also helps clients identify and track their mood changes, and reduce emotional reactivity through breathing and mindfulness exercises, self-soothing or distraction (Linehan, 1993).
Attention Deficit/Hyperactivity Disorder (ADHD)
Usually, the first line of treatment for ADHD is medication (psychostimulants). However, often medication alone is insufficient for many ADHD sufferers. CBT for ADHD has two main goals – help clients develop coping skills to manage their symptoms and deal with the emotional and functional effects that living with ADHD has on their lives (Brown, 2000). A very useful technique for clients with ADHD is problem-solving. Patients are encouraged to provide real-life examples of specific problems that illustrate their difficulties and work with the therapist to find suitable solutions. It is also important for the therapist and patient to anticipate some problems that may arise and develop plans to solve or manage them.
Social Phobia/Social Anxiety
CBT therapists help clients form new patterns of thinking and behaving by cultivating positive and realistic thoughts to replace unrealistic, negative thinking (Arch & Craske, 2008).
Cognitive restructuring is especially important for individuals with social anxiety, as they learn to challenge and question the truth of their beliefs (Hope et al., 2010). This can be done by providing evidence against the problematic beliefs in a Socratic dialogue (Frojan-Parga, Calero-Elvira, & Montano-Fidalgo, 2011). Behavioral experiments are also useful in showing individuals that the disastrous events predicted by their irrational beliefs do not end up happening during exposure exercises. This shows clients the falseness of their beliefs (Arch & Craske, 2008).
Bulimia Nervosa
The most common treatment method for bulimia is cognitive behavioral therapy. At the illness’ core is negative overconcern with body shape and weight that leads to extreme dieting and other unhealthy weight-control behaviors. Extreme dieting also predisposes the individual to binge eating. CBT treatment focuses on enhancing motivation to change, replacing dieting with regular and flexible patterns of eating, decreasing concern with weight and body shape and preventing relapse. CBT has been shown to be more acceptable and effective than antidepressant medication in eliminating binge eating. CBT typically eliminates binge eating and purging in 30-50% of all cases and it also reduces the level of other psychiatric symptoms as well as improves self-esteem and social functioning (Wilson, Fairburn, Agras, Walsh, & Kraemer, 2002).
Generalized Anxiety Disorder (GAD)
CBT is a highly effective treatment of GAD, reducing not only the main symptoms of anxiety but also the associated depressive symptoms and subsequently improving quality of life. A very effective technique for GAD is called relaxation training. In sessions clients learn to reduce their muscle tension and shallow breathing, as both of those are linked to stress and anxiety. Two strategies often used in CBT are Paced Respiration, which involves consciously slowing down the breath, and Progressive Muscle Relaxation, which involves systematically tensing and relaxing different muscle groups. Other helpful relaxation strategies include listening to calm music, meditation, yoga and massage (Mitte, 2005).
Schizophrenia
CBT is now a recommended treatment for schizophrenia, which used to be treated with medications alone. In CBT, the client discovers that there is a link between their patterns of thinking and their feelings that underlie their distress. CBT also focuses on identifying and disputing clients’ irrational beliefs through guided discovery and behavioral experiments. Behavioral experiments can be helpful by engaging the client in situations where they can test the validity of their beliefs and often discover that their beliefs were not correct. These experiments engage the clients in active ways that purely verbal therapy cannot and this creates a deeper level of information processing (Jones et al., 2012)
Fear of Flying/ Flying Phobia
CBT is an effective treatment program for all kinds of phobias. The fear of flying is a common complaint that CBT can treat effectively. Psychoeducation is one of the most crucial components of CBT treatment and is usually supplemented with relaxation training and cognitive techniques. Imaginal exposure exercises are also highly effective. In imaginal exposure clients imagine a situation where they are getting on a plane, sitting on a plane, and any other situation that induces fear. This would likely increase their anxiety in the short-term. However, as they keep on imagining the same situation over and over, their anxiety decreases and they will be able to handle the real-life situation much better. The latest development in the treatment of the fear of flying is virtual reality exposure, where clients are exposed to their fear of flying in a 3D computer-simulation. While this creates a very life-like, high-tech environment, the principles of exposure still work the same way (Da Costa, Sardinha, & Nardi, 2008).
Summary
Even though this blog focused on the 10 psychological problems best treated with CBT, CBT principles and techniques can be applied to a wide range of everyday problems. Relaxation skills are useful in any kind of stressful situation, including taking a test, speaking in public, having an argument with a spouse, feeling angry at a defiant teenager, road rage, and even sleep problems. Problem-solving strategies can be an effective way to deal with work-related issues (time management, prioritizing, difficult boss, etc.), relationship problems or interpersonal difficulties. Most people also have some kind of irrational beliefs that create negative feelings in certain situations. Therefore, anyone can benefit from identifying and disputing irrational beliefs and as a result experience fewer negative emotions and be more effective in their life. Exposure exercises are not only helpful for phobias, but can alleviate all kinds of fears including fear of animals (insects, dogs, etc.), fear of heights, or fear of making mistakes. To sum up, CBT techniques can be a useful addition to all of our lives whether we are suffering from a psychological disorder or dealing with everyday life situations.
References
Cully, J.A., & Teten, A.L. 2008. A Therapist’s Guide to Brief Cognitive Behavioral Therapy. Department of Veterans Affairs South Central MIRECC, Houston.
Beck, J.S. (1995). Cognitive therapy: Basics and beyond. New York: Guilford Press.
Overholster, J.C. (2000). Cognitive-behavioral treatment of panic disorder. Psychotherapy, 37, 247-256.
Clum, G. A. (1990). Coping with panic: A drug-free approach to dealing with anxiety attacks. Belmont, CA: Brooks/Cole.
Barlow, D., & Cerny, J. (1988). Psychological treatment of panic. New York: Guilford.
Bevan, A., Oldfield, V.B., & Salkovskis, P.M. (2010). A qualitative study of the acceptability of an intensive format for the delivery of cognitive-behavioural therapy for obsessive-compulsive disorder. British Journal of Clinical Psychology, 49, 173-191.
Linehan , M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford Press.
Scott, J., Paykel, E., Morriss, R., Bental, R., Kinderman, P., Johnson, T. et al. (2006). Cognitive behavioural therapy for severe and recurrent bipolar disorders: A randomised controlled trial. British Journal of Psychiatry, 188, 313-320.
Brown, T. E. (Ed.). (2000). Attention deficit disorders and comorbidities in children, adolescents, and adults. Washington, DC: American Psychiatric Press.
Ramsay, J.R. & Rostain, A.L. (2005). Adapting psychotherapy to meet the needs of adults with Attention-Deficit/Hyperactivity Disorder. Psychotherapy: Theory, Research, Practice, Training, 42, 72-84.
Macarthur, J. (2013). An integrative approach to addressing core beliefs in social anxiety. Journal of Psychotherapy Integration, 23, 386-396.
Arch, J. J., & Craske, M. G. (2008). Acceptance and commitment therapy and cognitive behavioral therapy for anxiety disorders: Different treatments, similar mechanisms? Clinical Psychology: Science and Practice, 15, 263–279.
Hope, D. A., Burns, J. A., Hayes, S. A., Herbert, J. D., & Warner, M. D. (2010). Automatic thoughts and cognitive restructuring in cognitive behavioral group therapy for social anxiety disorder. Cognitive Therapy and Research, 34, 1–12.
Froján-Parga, M. X., Calero-Elvira, A., & Montaño- Fidalgo, M. (2011). Study of the Socratic method during cognitive restructuring. Clinical Psychology & Psychotherapy, 18.
Wilson, G.T., Grilo, C.M., & Vitousek, K.M. (2007). Psychological Treatment of Eating Disorders. American Psychologist, 62, 199-216.
Wilson, G. T., Fairburn, C. G., Agras, W. S., Walsh, B. T., & Kraemer, H. D. (2002). Cognitive behavior therapy for bulimia nervosa: Time course and mechanisms of change. Journal of Consulting and Clinical Psychology, 70, 267–274.
Mitte, K. (2005). Meta-analysis of cognitive-behavioral treatments for generalized anxiety disorder: a comparison with pharmacotherapy. Psychological Bulletin, 131, 785–95.
Jones, C., Hacker, D., Cormack, I., Meaden, A., & Irving, C.B. (2012). Cognitive behavior therapy versus other psychosocial treatments for schizophrenia. Oxford Journals/Schizophrenia Bulletin, 38, 908-910.
Da Costa, R.T., Sardinha, A., Nardi, A.E. (2008). Virtual reality exposure in the treatment of fear of flying. Aviation, Space, and Environmental Medicine, 79, 899-903.
