The Cognitive Behavioral Miracle – Controlling your Emotions
Most people who have never experienced a cognitive behavioral therapy (CBT) session, or at least read about it, tend to share the notion that what psychologists do is pretty much listen to your problems, sometimes offer advice and different points of view, and make you think about your feelings, actions, and emotions. In this popular view of therapy, the patient (or client) is a rather passive subject, and the therapist is the one doing the work. Personally, I don’t think there has been a more profound revolution in the study of human psychology as the cognitive behavioral revolution.
I first became fascinated with CBT while translating and editing some course materials for the director of the CBT Institute in Ireland, Sylvia Buet. I then discovered that when one mentions behavioral, most people would think of Pavlov-style basic stimuli-response training; while CBT was in reality much more complex. Buet in particular teaches her CBT students to ask clients to sign a contract at the beginning of therapy, which binds them to work to solve their own problems. Esteban Mello, the director of the CBT Institute in Uruguay, consistently uses half of each session to explain the tasks the consulting individual will be expected to perform before their next appointment. In this scenarios, the stereotypical idea of a person who goes to therapy to “take a load off” every week becomes completely obsolete.
In a nutshell
The principles of CBT are based on a very simple idea: we feel according to what we think, in other words, our thoughts and cognitive constructions are at the root of our emotions and behavior patterns. CBT is based on three fundamental propositions:
- Cognitive activity affects behavior;
- Cognitive activity may be monitored and altered; and
- Desired behavior change may be effected through cognitive change.
The original theoretical framework of CBT stems from two main sources, Ellis’ rational emotive behavioral therapy, known as REBT and Beck’s cognitive therapy. Drawing from a concept already present in ancient Greek philosophy, Ellis established the A-B-C-model, where A stands for adversity/activating event, B stands for beliefs and C for consequences. The idea is that while people think that they get upset (consequence) because of an adversity (A) (i.e. something “bad” that happened to them), in reality they get upset because of their beliefs (B) about what happened, and everything negative they associate with the event in their minds, and not because of the adversity itself.
On the other hand, Beck developed cognitive therapy (CT), which focused on the identification of dysfunctional thinking, behavior, and emotional responses, emphasizing on patient-therapist collaboration and a belief-testing dynamic.
Today, CBT encompasses a variety of therapies that share a basic core, one of the most salient characteristics all of these therapies have in common is their standardised protocol of testing and measuring results before any treatment is approved. This means that specific randomized controlled trials must yield significantly positive results, in order for treatments to be adopted. Only when consistently positive results are observed when comparing to treatments based on other therapeutic approaches, can the prospective CBT treatments become an acceptable option.
There are different classes of CBT that are used to deal with different kinds of problems. Cognitive behavioral therapists classify problems according to the degree of influence the individual has on them and their outcomes. While coping skills are the main focus when treating problems which are caused and governed by external factors, cognitive restructuring is the method of choice when dealing with problems that originate from the individual.
One of the first things Mello teaches his patients is to class problems in three different categories:
- Problems upon which the individual has no control whatsoever;
- Problems that depend partially on the individual and partially on external factors; and
- Problems that depend solely on the individual.
For example, a death in the family would be a problem of the first kind. However, if we feel that having a good time after our loved one’s passing implies that we have no respect for them, or that we didn´t love them enough; we may be developing a problem of the second kind, where we have a certain control of the situation, though there are some factors over which we can have no influence. In these cases, CBT will focus on altering these beliefs, so that the person can continue to have a normal, healthy life, without feeling guilty about it.
If we asked the person in this last example, what they are upset about, they would most likely answer “because so-and-so died.” They would thus be focusing on Ellis’ A or adversity, when in reality, what is making them upset is B (i.e. their own beliefs about their loved one´s death´s meaning).
According to the Beck Institute, over 500 scientific studies have proven that CBT has had significantly better results than any other therapeutic approach for a growing number of disorders and problems. These include obsessive compulsive disorder, general anxiety disorder, post-traumatic stress disorder, bulimia, drug and alcohol abuse, social phobias and dissociative disorders, among many others.
CBT is a fundamentally empowering approach, in that it has successfully identified certain ways of thinking that can make the difference between sanity and insanity, between happiness and unhappiness, and it has developed a variety of techniques to teach patients to substitute these dysfunctional patterns of thinking, which are often at the root of their problems.
As research progresses and the theoretical framework expands and evolves, and judging from its past evolution, it is possible to predict that CBT will continue to develop more and more effective techniques and strategies to help patients dealing with all kinds of psychological and psychiatric problems.
Dobson KS. Handbook of cognitive-behavioral therapies (3rd ed.). New York, 2009: Guilford Press.
Ellis, A. (1980). Rational-emotive therapy and cognitive behavior therapy: Similarities and differences Cognitive Therapy and Research, 4 (4), 325-340 DOI: 10.1007/BF01178210
Warren R, & Thomas JC (2001). Cognitive-behavior therapy of obsessive-compulsive disorder in private practice: an effectiveness study. Journal of anxiety disorders, 15 (4), 277-85 PMID: 11474814
Quinn TP. The effect of cognitive behavioral therapy (CBT) on driving while intoxicated offenders. PhD Dissertation, State University of New York at Albany, 2011.