Treatment of Psychological Disorders

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy teaches clients specific skills for managing unhelpful patterns of thoughts and changing behaviors.

Cognitive-behavioral therapy (CBT) is a hybrid approach that teaches strategies for managing negative thoughts and changing unhelpful behaviors. The terms cognitive therapy and CBT are often used interchangeably. Cognitive therapy is a specific treatment approach created by American psychiatrist Aaron Beck. Originally developed for depression, cognitive therapy tackles habitual thinking errors underlying psychological disorders. For example, people who are depressed may blame their problems on themselves and focus on the negative aspects of their lives. If a person does not perform well on a task, then they may see themselves as a total failure instead of simply unskilled at that task. Cognitive therapists train their clients to notice their negative thoughts and then test their validity. The therapist also uses modeling and behavior rehearsal in the same way as behaviorists do. CBT combines cognitive and behavioral therapeutic components. It tends to be short-term and action-oriented. Therapists practicing CBT believe that thoughts, feelings, and behaviors influence one another. These therapists help clients identify thoughts and behaviors to be changed. Techniques include substituting negative thoughts with positive ones, setting specific goals, learning to self-reinforce after reaching a goal, and practicing new behaviors in progressively challenging situations. CBT has extensive empirical support and is used to treat many conditions. In some cases CBT is as effective as drugs in treating anxiety, phobia, depression, and compulsive behavior.

An approach to cognitive therapy that contributed to the development of CBT is rational emotive behavior therapy (REBT). Albert Ellis, an American psychologist, introduced REBT in the mid-1950s. REBT addresses the philosophical underpinnings of distorted thinking as well as the thinking itself. In theory if the causes of a problem can be identified and addressed, the problem will recede. For example, if a person experiences anxiety or depression because they fear others dislike them, giving up the need to have others like them will solve the problem. REBT encourages people to accept themselves unconditionally along with the imperfections of others and the world. Unlike CBT, REBT acknowledges that some negative emotions are helpful in certain contexts (e.g., sadness, sorrow, and regret), but anger never is. Rational-emotive therapists teach assertiveness and problem-solving as alternatives to anger.
Thoughts, feelings, and behaviors all influence one another. Cognitive-behavioral therapists may help people change thoughts and behaviors directly or help them change their perspective on upsetting thoughts and feelings.
The most recent forms of CBT incorporate mindfulness techniques, strategies to help people become more aware of their physical, mental, and emotional condition in the moment. Mindfulness techniques may take many forms, such as meditation, deep-breathing techniques, yoga, or walking in nature. Forms of CBT that emphasize mindfulness are often called "third-wave" approaches. Acceptance and commitment therapy (ACT) is a cognitive-behavioral approach focused on mindfulness, active acceptance of difficult emotions, and working toward valued outcomes. In ACT, clients are encouraged to directly face and accept difficult emotions because every life will include some pain. Clients learn mindfulness techniques to help them observe emotions without becoming overwhelmed by them. Rather than struggling against anxiety, anger, or sadness or trying to avoid those feelings, clients instead are encouraged to identify their core values. ACT emphasizes that no matter how a person feels, they can choose to act in a way that supports their values and goals.

ACT is based on the premise that accepting unwanted thoughts and feelings gives them less power. For example, people with anxiety disorders often avoid people and situations they fear. This reduces anxiety in the short term but leads to a restricted life in the long term. ACT teaches people skills for confronting feelings of anxiety rather than trying to avoid them. Next, people focus on identifying the life they want to live and taking active steps to create a life of meaning and purpose despite uncomfortable thoughts or feelings.

Dialectical behavior therapy (DBT) is a cognitive-behavioral approach teaching people how to regulate extreme emotions by balancing opposing perspectives. It teaches people to avoid black-and-white thinking and recognize shades of gray. For example, in relationships, fear may lead a person to avoid expressing needs entirely out of fear of rejection. Or fear of rejection may lead them to explode at a friend over a minor slight. DBT teaches people how to acknowledge their feelings without judgment and to express their needs in a balanced way that will keep relationships positive and healthy. DBT was pioneered by psychologist Marsha Linehan to help people with borderline personality disorder, but it has been successfully used to treat other conditions.