Cognitive Behavioral Therapy is a type of treatment that may be useful for psychiatric patients when traditional psychotherapy/talk therapy is not effective. It is an action oriented therapy, in contrast to treatments which delve into a persons past and examine the “whys” behind their feelings. It is a therapy aimed first and foremost at addressing thoughts, rather than feelings.
Cognitive Behavioral Therapy is conducted with clear, measurable goals in mind. For this reason, it is meant to be a short-term solution, unlike psychotherapy, which a person usually undergoes for several years, if not indefinitely. Psychotherapy helps us understand why we feel the way we do, but it does not retrain our brains to interrupt the pattern.
The theory behind Cognitive Behavior Therapy (CBT) is that a person’s thoughts cause their feelings and subsequent behaviors, rather than the events in a person’s past or present. While events and incidents in life can be the initial cause of whatever began the unhealthy thought and behavior patterns, the negative thought process has become habitual. In some cases, a destructive thought causes a feeling, which causes an action, which causes the feelings to intensify, therefore reinforcing our belief in the initial thought. The habituated thought pattern can take on a life of its own, independent of the initial life event, and truly feed off of itself to perpetuate more negative thoughts, feelings, and actions.
If we can change the way we think, the result can be a change in the way we feel. The therapist works with the patient to identify both the thoughts and the behaviors that are causing distress, and to change those thoughts in order to readjust the behavior. This approach to wellness is more mechanical in nature, for example, if a=b and b=c, then a=c. Cognitive Behavioral Therapy can be thought of as a reprogramming of our thought patterns.
This does not mean that life events such as breakups, loss of a job, death of a loved one; or mental conditions such as depression, anxiety, obsessive compulsive disorder, schizophrenia; are not upsetting or devastating. Cognitive Behavioral Therapy is a tool to aid in ones recovery, often coupled with medication and other therapies under the care of a qualified physician or clinician.
Treatment consists of various exercises and homework assignments between sessions. Such assignments include trying out and rehearsing new situations. On a basic level, a person might start by trying a non-threatening thought having nothing to do with the more stressful issues.
For example, from now on when I think of the color yellow, I’m going to stand by a window and admire the sun. I will verbally comment that it’s a beautiful day (this exercise assumes that it is actually a nice day). This particular example is not meant to be a cure, and is not intended to make people change their feelings about the color yellow. I use it as an illustration of simply having a thought and acting on it in a positive way.
Journaling is also an effective approach if used correctly. Patients are asked to keep a detailed diary of their non-productive thoughts, feelings, and actions, remembering that thoughts cause feeling and feelings cause actions in a vicious cycle. Journaling helps to make the patient aware of his or her maladaptive thoughts and to show how they influence behavior. Journaling for this purpose is not meant to be treated as a diary where we recount the events of the day and how they made us feel. That would be closer to a traditional psychotherapy approach. This type of journaling should be factual documentation.
Role playing is an exercise used between clinician and patient. The clinician might take an event that has troubled the patient and reenact it, instructing the patient to think a certain thought, have the resulting feeling, and structure a new action. Role playing can assist with reconditioning our cognition and subsequent behavior, reinforce new positive behaviors, prepare for stressful situations by rehearsing situations and reacting to them in a predetermined new way, and gradually desensitize the patient from the crippling cycle of their cognitive behavioral pattern.
Maria is a 36 years old divorced female. For years, she and her ex-husband were in an on again/off again relationship cycle. It was a constant push/pull tug of war. Her husband wanted to get back together, and for reasons generated in Maria’s childhood, she could neither get back together with him nor leave him completely. The feeling of severing the relationship was more than she could tolerate, and she would become physically sick with anxiety and the feelings of compulsion to call him or go to his house. When he finally ended it for good, she could not let go and had to be hospitalized.
Maria spent years in therapy addressing the whys of her behavior, desperately seeking out the root cause. She felt that by identifying the root cause, the behavior would subside. She wouldn’t feel such a desperation to stay connected to an unhealthy situation. She would be able to disengage and feel an appropriate amount of grief that wouldn’t escalate into fear and hysteria.
She gradually realized that the cause of her behavior (which she was able to attribute to low self-esteem from childhood) was no longer driving the sickness. It had grown into something bigger, something not directly related to the cause anymore. The feelings were so intense, she likened the lack of emotional control she felt to being in prison.
Cognitive Behavioral Therapy assisted her in approaching her issues in a way that was designed to break the pattern. The thought-feeling-action approach proved more effective that the constant talking about and analyzing of the situation. In this instance, talking about it and analyzing it was contributing to the cycle, because of the negative thoughts it brought up.
It is important to know why we do the things we do and to identify the root causes of our upsets. But at some point, that may stop working. There may come a point when Cognitive Behavioral Therapy is recommended for a direct, finite, goal oriented result. This can give renewed hope for a patient in an ongoing struggle for emotional peace.