Cognitive-behavioral therapy can be used for virtually any form of psychiatric disorder and related psychiatric side effects of physical illness. This article describes how cognitive behavioral therapy is conducted.
What is cognitive behavioral therapy?
Cognitive-behavioral therapy is about positively influencing feelings by changing behaviors and thoughts. It is recognized by the scientific community, and the costs are covered by state health insurance coffers. The terms “behavioral therapy” and “cognitive behavioral therapy” are commonly used synonymously.
Cognitive behavioral therapy is recommended as a first-line treatment for anxiety and obsessive-compulsive disorders. Cognitive behavioral therapy can also be used for depression, eating disorders, alcohol dependence and, under certain conditions, psychotic illnesses. In addition, cognitive-behavioral therapy can be used to relieve mental symptoms associated with traumatic brain injuries.
Therapeutic work is directed toward alleviating current symptoms and building coping skills and social competence. The development of mental illness over the course of a lifetime is only analyzed if improvement is not achieved with interventions that address the present problems.
An important goal of cognitive-behavioral therapy is to increase patients’ independence and ability to act.
An important goal of cognitive behavioral therapy is to increase patients’ autonomy and ability to act. It offers help for self-help. Patients and therapists must form a working alliance. In doing so, sympathy is helpful but not necessary for successful treatment. It is essential that patients speak openly about the thoughts, feelings, and behaviors that are problematic for them. With knowledge of important psychological mechanisms, therapists change these areas.
What are the other goals of cognitive behavioral therapy?
Another goal of cognitive behavioral therapy is to change thoughts and evaluations that are unhelpful in everyday life. This is accomplished by observing the thoughts, emotions, and behaviors that underlie mental illness. Interfering thoughts and behaviors that are detrimental to health are realistically categorized and, if possible, changed in ways that reduce the emotional burden.
Another goal is to treat the illness. In doing so, various factors are important:
- Increased knowledge of one’s own mental illness;
- coping strategies – e.g., specific behavioral techniques for regulating emotions;
- acceptance of certain unchanging aspects of the problems.
Important to know! The effectiveness of cognitive behavioral therapy has been proven in a variety of mental illnesses. This means that many patients are able to successfully alleviate the symptoms of their respective illness with therapy.
How does cognitive behavioral therapy work?
Behavioral therapy depends on individual needs and can be very different for different illnesses. A typical procedure is described here. Often, negative thoughts and beliefs are attempted through this therapy.
Behavior Analysis
At the beginning of therapy, the therapist and the patient describe the exact course of problematic situations. They also develop an explanation of mental illness together. The characteristics of the situation, body reactions, interpretations, behaviors and feelings are taken into account.
For example: the patient has a serious problem at work, and she thinks, “I have made a terrible mistake.” She feels guilt and shame. The patient reacts with this behavior: she leaves her place of work and goes home immediately. She torments herself with thoughts of “I am worthless” and goes to bed.
Feelings arise as a result of a mental evaluation of situations
This example shows that situation, thought, feeling, and behavior affect one another: feelings arise from the mental evaluation of situations. It was not the mistake at work itself that led to feelings of guilt and shame, but that the mistake was judged to be “terrible. It is also important for therapy that the patient clearly lacks the skills to correct the mistake or to express her position purposefully to her supervisor. In turn, detachment from the outside world exacerbates the problem.
Self-Monitoring
An important element of diagnosis and therapy is, among other things, self-observation. This means first noticing and then recalling one’s own behavior in daily life. Writing down the behavior, thoughts and feelings in daily life and then working through the depressing feelings and undesirable behavior in sessions helps.
Checking and changing automatic evaluations
If part of the problem is that the patient automatically evaluates himself and his environment according to certain unhelpful evaluations, therapy focuses on changing these evaluations. Often evaluations occur automatically. For example, when someone considers their successes insufficient compared to the successes of others. Together with the therapist, a check is made to see if this is realistic and reasonable.
Realistic evaluations and assumptions are then developed based on this. An example is the following acceptance: “It is inherent in people to make mistakes, and I can find a solution.” Often patients cannot immediately accept such alternative views; they need practical confirmation from everyday life. Strategies are developed for this during therapy. If the patient in the previous example makes another mistake at work, she herself will first question her spontaneous evaluations and talk about her problem, for instance with a colleague with whom she has a good relationship. Instead of going home and getting upset, she will approach her supervisor and work with her to find a solution. This may even result in a sense of pride and joy and allow her to continue working in a calm state of mind.
Behavioral or Situational Analysis
Situational analysis is the re-examination of emotionally depressing stressful situations from everyday life with the therapist as if under a magnifying glass. Immediately after the experience, patients have to write down some important points: what exactly happened, what they thought, and how they felt. In the therapy session, the therapist and the patient work together to sort out what is causing the particular thoughts and feelings. The thoughts associated with the stressful feelings are checked to see if they are real. In addition, new, helpful thoughts are developed.
Confrontation Techniques
Confrontation, also called exposure, is mostly used for anxiety disorders. In a nutshell, it is about accepting one’s misplaced fears and then learning to overcome them. The patient actively engages in situations that he or she previously avoided. This involves an objective assessment of the actual danger and emotional and physical reactions. In the next stage, it can be useful to specifically induce feelings of fear in order to further deepen the work with fear. To do this, patients are asked to put themselves in situations that cause anxiety. In this case, it is not a question of testing courage or overcoming fear, but of changing the physical and mental reactions to fear. In some cases, it may be sufficient to imagine an object or situation causing fear. During this, dramatizing assessments are tested. For example, does a rapid pulse really mean life-threatening?
On the one hand, therapy diverts attention away from “danger,” and on the other, a tolerance for anxiety symptoms, such as difficulty breathing, is trained. Patients learn that they are not helpless in times of fear, can influence it and thus cope with it. Gradually, they are able to experience more and more situations that they had previously avoided because they were afraid of them.
When is behavioral therapy used?
Behavioral therapy is a recommended form of treatment for most anxiety disorders, some addictive disorders, obsessive-compulsive disorders, psychotic disorders in non-psychotic phases, depression with other co-occurring psychiatric disorders and some personality disorders such as borderline personality disorder. Behavioral therapy is also recommended as a primary treatment for mental disorders caused by physical illness, disorders caused by brain or nerve damage, and eating disorders.
It is helpful if the patient is motivated to work on the problems. But even in difficult circumstances, such as lack of motivation, mental limitations, or lack of trust because of previous bad experiences, behavioral therapy can produce good results. The relationship between the therapist and the patient plays an important role. In behavior therapy, this relationship varies depending on the nature of the problems, from soulful and kindhearted to strict and demanding.
Where to get professional help?
If you are experiencing anxiety, discouragement, sadness or other anxious feelings and these feelings are affecting your daily life, talk to your family doctor, psychiatrist or appropriate qualified professional about it first. If the doctor sees the need for psychotherapy, he or she can advise on how to proceed. If necessary, your doctor can recommend a qualified psychotherapist or psychiatrist.