Cognitive behavioral therapy (CBT) (synonym: cognitive-behavioral therapy) is one of the psychotherapeutic methods and is a form of behavioral therapy. Under behavioral therapy is a variety of methods of psychotherapy. The goal is to change attitudes, thinking habits, and maladaptive or dysfunctional behaviors such as anxiety, compulsive thoughts or actions, eating and sexual disorders, or depressive disorders. For example, another form of behavior therapy is therapeutic confrontation with anxiety-provoking situations (confrontation theory), e.g., for patients with agoraphobia (claustrophobia). Behavior therapy was developed on the basis of learning theory, which is based on the assumption that faulty learning processes lead to psychopathological syndromes. As a further development of this conclusion, modern cognitive behavioral therapy gained popularity around 1960. The term cognition (lat. cognoscere: “to recognize”) is translated in German as “Erkenntnis” and describes intrapsychic thought content. It is the thinking process of an individual or the mental processing process regarding knowledge, new information or learning content. Cognitions include the following variables and are influenced by emotions:
- Evaluations
- Thoughts
- Settings
- Beliefs
Thus, not specific events or life situations are the cause of mental illness, but rather faulty cognitions or irrational ways of thinking. These provide the therapeutic starting point for cognitive behavioral therapy.
Indications (areas of application)
The classic indication for cognitive behavioral therapy is usually depression. Other indications include:
- Anxiety and panic disorders
- Enuresis in children (involuntary wetting after the age of 4).
- Eating disorders – e.g. anorexia nervosa (anorexia).
- Emotionally unstable personality disorder (borderline personality disorder).
- Insomnia (sleep disorders)
- Sexual disorders
- Specific phobias – e.g. arachnophobia (fear of spiders).
- Somatization disorders (mental disorder that manifests itself in physical (somatic) symptoms).
- Addictive disorders – e.g. alcohol abuse (alcohol dependence).
- Tics in children (tics are sudden, recurrent motor or vocal utterances such as a twitch).
- Training of social behavior – for example, in disabled people to improve social functions.
- Obsessive-compulsive disorders – e.g. compulsive washing.
Contraindications
Cognitive behavioral therapy (CBT) requires a level of cognitive ability, so young children or people with severe cognitive deficits, such as dementia, cannot be treated. Additionally, any situation in which a patient’s cognitive ability is temporarily impaired arises as a contraindication; these include acute psychosis, for example.
The procedure
Cognitive behavioral therapy traces its origins to the work of psychotherapist A. T. Beck, among others, whose theory was based on alleviating depressive symptoms by changing dysfunctional thought patterns. For example, depressed patients are instructed to reflect on self-concepts with regard to self-deprecation and chains of thoughts and to examine them with regard to their appropriateness or irrationality. Subsequently, alternatives and new ways of thinking are worked out together with the patient in order to counteract the erroneous cognitions. Various techniques can be used to achieve this goal:
- Assertiveness training – In the context of assertiveness training, skills are learned, for example, with the help of role plays, in order to solve a fearful situation.
- Thought stop – This technique is used, for example, in patients with obsessive-compulsive disorder: The patient is instructed to resist imposing obsessive thoughts or compulsive impulses by saying “stop” out loud to himself.
- Decatastrophizing – pointing out alternative courses to the feared catastrophic outcome of a fearful situation.
- Cognitive restructuring – making aware of automated ways of thinking: For example, a patient with a fear of flying is made aware of the comparatively very low risk of a plane crash.
- Model learning – learning from other patients in group therapy.
- Problem-solving exercises – learning problem-solving strategies.
- Self-verbalization – Positive self-instruction by the patient himself (“I can do this”).
- Reattribution – Change of a negative attribution, i.e., for example, switch from internal attribution to external attribution. For example, if a patient thinks that only his misbehavior caused a situation, it is an internal attribution. If the patient succeeds in convincing that the misbehavior of others or external factors have also caused the situation (external attribution) can cause relief of symptoms.
The duration of cognitive behavioral therapy varies with the individuality of the patient. In most cases, therapy is conducted for one hour, twice a week at the beginning, and later once a week. Usually 25 sessions are initially approved, often patients are in treatment in a psychotherapeutic practice for up to a year or more. At the beginning of a session, a specific objective is formulated; furthermore, both retro- and prospective session components are included. Frequently, “homework” is assigned and reflected upon in the next session. The following are variations and forms of cognitive behavioral therapy:
- Problem-solving therapy
- Schema therapy – based on the theory of learned basic schemas that serve to satisfy basic psychological needs and thus control people’s behavior.
- Self-control therapy
- Social skills training
- Behavior modification
- Behavioral family therapy
Possible complications
With cognitive behavioral therapy, complications are usually not expected. If a partnership is the subject of therapy, consequences for the partnership may arise as a result of cognitive behavioral therapy. Further notes
- Patients with panic disorder who were successfully treated by cognitive behavioral therapy (CBT) showed altered activity in a brain area that processes panic-related word pairs on magnetic resonance imaging. CONCLUSION: KVT interrupts associations that are symptomatic for patients with panic disorder.
- KVT appears to reduce the incidence of recurrence of self-injurious behavior (is associated with suicides).
- In adolescents with a first psychotic episode, KVT alone or in combination with antipsychotics, appears to alleviate adolescent symptoms:
- Antipsychotics alone, the PANSS (Positive and Negative Syndrome Scale) total score had decreased by 6.2 points after six months
- Psychotherapy by 13.1 and with combination therapy by 13.9 points.
