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Cognitive behavioral therapy

Last Update: August 7, 2013; Next update: 2013.

Cognitive behavioral therapy (CBT) is one of the most common and best studied forms of psychotherapy. It is a combination of two therapeutic approaches, known as cognitive therapy and behavioral therapy.

Which methods of treatment are applied depends on the illness or problem to be treated. The basic principle behind therapy is however always the same: What we think, how we feel and how we behave are all closely connected – and all of these factors have a decisive influence on our well-being.

 

Behavior triangle

What is cognitive therapy?

The term cognitive comes from the Latin "cognoscere", meaning "to recognize." The point of cognitive therapy is to form a clear idea of your own thoughts, attitudes and expectations. The goal is to reveal and change false and distressing beliefs, because it is often not only the things and situations themselves that cause problems, but the importance that we attach to them too.

For example, a dangerous thought pattern might be when somebody immediately draws negative conclusions from an occurrence, generalizes them and applies them to similar situations.  In psychology, this generalized way of thinking is called “over-generalizing.” Another distressing error in reasoning is “catastrophizing”: If something disturbing happens, people immediately draw exaggerated conclusions about the scope of the supposed disaster ahead.

Such thought patterns can sometimes develop into self-fulfilling prophecies and make life difficult for the people affected. Cognitive therapy helps people learn to replace these thought patterns with more realistic and less harmful thoughts. It also helps people to think more clearly and to control their own thoughts better.

How does behavioral therapy work?

Behavioral therapy has its origins in American “behaviorism.” This theory assumes that human behavior is learned and can therefore be unlearned or learned anew. Behavioral therapy aims to find out whether certain behavioral patterns make your life difficult or intensify your problems. In the second step you work on changing these behavioral habits.

For example, people who have developed depressive thoughts often tend to withdraw and give up their hobbies. As a result, they feel even more unhappy and isolated. Cognitive therapy helps to identify this mechanism and find ways to become more active again.

In anxiety disorders, behavioral therapy often includes learning methods to help you calm down. For example, you can learn to reduce anxiety by consciously breathing in and out deeply so that your body and breathing can relax. When doing this you concentrate on your breathing instead of what is bringing on your anxiety. These kinds of techniques can help you to calm down instead of getting all worked up with anxiety.

By the way, in Germany, most psychotherapists who are trained in cognitive behavioral therapy call themselves behavioral therapists.

Which thought and behavioral patterns are harmful, which are not?

Harmful thoughts or behavioral habits can make people feel bad about themselves. For example: You see somebody you know on the street and say hello, but they do not say hello back. Your own reaction to that very much depends on how you assess the situation:

ReactionHarmfulNeutral
Thoughts“He ignored me – he doesn’t like me anymore.” “He didn't notice me – maybe he doesn’t feel well. I should give him a call and find out how he is doing.”
FeelingsSomeone who thinks like this feels down, sad and rejected.These thought patterns do not cause any negative feelings.
BehaviorThe consequence of this thought is to avoid this person in the future, although the assumption could be completely false.This thought is a prompt to get back in touch with the person to find out if everything is all right.

How is cognitive behavioral therapy different from other psychotherapies?

Cognitive behavioral therapy is a problem-oriented strategy. It focuses on current problems and finding solutions for them. Unlike psychoanalysis, for example, it does not deal primarily with the past. Cognitive behavioral therapy is much more concerned with dealing with current problems. The most important thing is helping people to help themselves: They should be able to cope with their lives again without therapy as soon as possible. This does not mean that cognitive behavioral therapy completely ignores the influence of past events. But it mainly deals with identifying and changing current distressing thought and behavioral patterns.

Analytic psychotherapy, which has its origin in classic Freudian psychoanalysis, uses different methods. Here the therapist tries to help the patient discover and understand problems and their deeper causes.

When is cognitive behavioral therapy an option?

Cognitive behavioral therapy is used to treat conditions such as depression, anxiety and obsessive-compulsive disorders, and addictions. But it is also an option for treating physical conditions such as chronic pain, tinnitus and rheumatism. It can help to relieve the symptoms.

Cognitive behavioral therapy requires the patient's commitment and own initiative.  Therapy can only be successful if the patient actively takes part in the treatment and also works on their problems between sessions. This can be a considerable challenge, especially with severe conditions such as depression or anxiety disorders.  That is why medication is sometimes used at first to quickly relieve the worst symptoms so that psychotherapy can be started.

Choosing a certain kind of psychotherapy also depends on the goals. If you feel the need for deep insight into the causes of your problems, cognitive behavioral therapy is probably not the right choice. It is particularly useful if you are mainly interested in tackling specific problems and are only secondarily concerned with the “why.”

How does cognitive behavioral therapy work and how long does it take?

It is important that you and your psychotherapist have a close and trusting working relationship. It can sometimes take a while to find the right therapist.

In the first session, you will briefly explain your current problems and outline your expectations. That forms the basis for discussing the goals of therapy and the therapy plan. The plan can be adjusted if your personal goals change over the course of therapy.

Therapy often includes recording your own thoughts in a journal over a certain period of time. The therapist will then check the following things with you: Do I perceive things appropriately and realistically? What happens if I behave differently than I normally do in a certain situation? You will regularly discuss any problems you may have and progress that you have made.

Cognitive behavioral therapy also uses relaxation exercises, stress and pain relief methods, and certain problem-solving strategies.

Compared to analytical psychotherapy approaches, cognitive behavioral therapy is a short-term treatment. But there is also no standard length of cognitive behavioral therapy. Some people already feel much better after a few sessions, while others need treatment for several months. This depends on the kind and severity of the problems, among other things. An individual session lasts about an hour. Sessions usually take place once a week. Cognitive behavioral therapy is offered in psychotherapy practices, hospitals and rehabilitation clinics. It is sometimes also offered as group therapy.

Can cognitive behavioral therapy also have side effects?

Side effects resulting from psychotherapy cannot be ruled out. Being directly confronted with your problems or anxieties may be very stressful at first, and relationships might also suffer as a result. It is crucial to speak openly with your psychotherapist if any difficulties come up during therapy.

Hardly any research has been done on possible side effects of psychotherapy.

Who covers the costs?

In Germany, statutory health insurance pays for cognitive behavioral therapy to treat mental illnesses such as depression, anxiety or obsessive-compulsive disorders as well as addictions. The costs of cognitive behavioral therapy can also be covered for the treatment of severe symptoms that result from a chronic illness. It can however sometimes take several weeks or months until you can see a therapist or until the insurance company approves therapy.

In Germany, a psychotherapy practice can bill the statutory health insurance company directly for up to five trial sessions. This way you can get to know the psychotherapist, find out what the problems are and whether therapy is worthwhile. After the trial sessions, you and your psychotherapist have to prepare an application explaining why therapy is needed. You have to submit this application to your health insurance company before therapy can begin. Besides this application, your health insurance company also requires a medical report from your doctor stating that the symptoms are not caused by a physical problem, and that there are no medical reasons against psychotherapy. The statutory health insurance company decides whether to approve therapy based on an evaluation.

Sources

  • Robert Koch Institute (RKI). Psychotherapeutic healthcare. Berlin: RKI; 2008. (Federal Health Reporting, Booklet 41).
  • IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

    Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.

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