What Is Cognitive Behavioral Therapy?

Cognitive Behavioral Therapy (CBT) is a therapeutic modality that has the distinction of being evidence-based. This means there is sufficient research published in reputable scientific journals to substantiate the claim of CBT’s salutary effect on people suffering from anxiety, depression, and other mental health issues. However, it is important not to ascribe to CBT powers that it doesn’t necessarily have. A larger amount of research on the efficacy of CBT when compared to other therapeutic modalities can probably be attributed to CBT’s focus on symptom reduction and behavior management. It is, of course, easier to quantify and measure the instances of dysfunctional behavior than, let’s say, the level of personal fulfillment or a sense of authentic existence.

How CBT Understands Dysfunction

1

Maladaptive Thought Patterns

distorted ways of interpreting experience

2

Maladaptive Emotions & Behaviors

painful feelings and unhelpful responses

3

Dysfunction in Life

real-world impairment and instability

CBT is based on the idea that maladaptive thought patterns lead to maladaptive emotions and behaviors, which, in turn, cause dysfunction in a person's life. These problematic thought patterns come in different flavors. First, there are core beliefs—some of the deepest, most fundamental convictions people hold about themselves, others, and the world. Such beliefs are understood to form in childhood and are often held subconsciously. Second, there are cognitive biases—automatic filters that people apply when thinking about their circumstances. Cognitive biases work to ensure that the way we understand what is happening to us doesn’t contradict or challenge our core beliefs. Third, there are regular conscious thoughts that deal with data already prepackaged and selectively filtered by cognitive biases and emotionally colored by core beliefs. This whole cognitive machine (the “C” in CBT) leads people to feel and behave (the “B”) a certain way. The role of therapy (the “T”), then, is to educate the client about the existence of said cognitive machine and help him or her reprogram it.

Three Layers of Maladaptive Thought Patterns

1

Core Beliefs

deep beliefs

2

Cognitive Biases

automatic filters

3

Conscious Thoughts

everyday thoughts

Different schools of CBT recognize different sets of core beliefs and cognitive biases. They also recommend different treatment protocols for various conditions. Nevertheless, the following three core beliefs are most commonly cited: 1) worthlessness as a view of self; 2) unlovability as a view of self through the eyes of others; and 3) helplessness as a view of the world in general. To compensate for the sense of worthlessness, one may pursue perfectionism; for unlovability, become a people pleaser; and for helplessness, strive for hypercontrol. There are well over a dozen types of cognitive biases that can be deployed in service of such core beliefs. Among them are black-and-white thinking, overgeneralization, catastrophizing, magical thinking, pigeonholing, rigid normative thinking, and many others.

CBT is not an insight-centered modality. Recognizing one’s problematic core beliefs and unconscious biases is only the first step. It needs to be followed by a sustained pattern of more functional thinking and behavior on the part of the client. The “heavy lifting” in CBT is done through the homework assigned by a therapist. If the client accepts CBT’s tenets and is willing to follow the therapist’s recommendations in earnest, the alleviation of emotional discomfort and positive behavioral changes are very likely. However, to some clients, CBT’s prescriptive guidance and focus on symptom reduction might appear somewhat superficial. In such cases, psychodynamic and existential approaches to therapy may be a better fit.