Cognitive behavioral therapy ( Cognitive-Behaviour Therapy, CBT) is currently internationally considered one of the most reliable and effective models for understanding and treating psychopathological disorders.
This approach postulates a complex relationship between emotions, thoughts and behaviors, highlighting how emotional problems are largely the product of dysfunctional beliefs that are maintained over time, despite the suffering that the patient experiences and the possibilities and opportunities to change them, due to of maintenance mechanisms.
When interpreting human conduct, cognitive therapy resorts, where possible, to the simplest explanation which often coincides with the recovery of common sense.
The underlying theory underlines the importance of cognitive distortions and the subjective representation of reality in the origin and maintenance of emotional and behavioral disorders. This implies that events would not create and maintain psychological, emotional and behavioral problems, but these would be largely influenced by the individual’s cognitive structures and constructions (an assumption already shared at the time of the Stoic philosopher Epictetus ).
What characterizes and distinguishes cognitive psychotherapy, in fact, is the explanation of emotional disorders through the analysis of the relationship between thoughts, emotions and behaviors.
Cognitive-behavioral therapy (CBT) therefore aims to help patients identify recurring thoughts and dysfunctional patterns of reasoning and interpretation of reality, in order to replace and/or integrate them with more functional beliefs.
CBT has assumed the role of treatment of choice for anxiety disorders, as evidenced by recent documents released by the World Health Organization (WHO) and the Istituto Superiore di Sanità (ISS) .
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Why does cognitive behavioral therapy (CBT) work?
Cognitive behavioral therapy is scientifically based
The clinical intervention is strictly consistent with the knowledge on mental structures and processes deduced from basic psychological research. In addition, cognitive behavioral methods have been shown in controlled studies to be an effective therapy.
In fact, CBT has shown superior or at least equal results to psychotropic drugs in the treatment of depression and anxiety disorders, but much more useful in preventing relapses.
Cognitive behavioral therapy is goal-oriented
Our CBT therapist in London works with the patient to establish the goals of the therapy, formulating a diagnosis and agreeing with the patient himself a treatment plan that fits his needs, during the very first meetings. He then takes care to periodically check progress in order to check if the goals have been achieved.
Cognitive behavioral therapy is practical and hands-on
The purpose of therapy is based on the resolution of concrete psychological problems. Some typical purposes include the reduction of depressive symptoms, the elimination of panic attacks and any concomitant agoraphobia, the reduction or elimination of compulsive rituals or pathological eating behaviors, the promotion of relationships with others, the decrease social isolation, and so on.
Cognitive behavioral therapy is collaborative
Patient and therapist work together to understand and develop strategies that can direct the subject to solve their problems. CBT is, in fact, a psychotherapy substantially based on the collaboration between patient and therapist. Both are actively involved in identifying and questioning the specific ways of thinking that may be causing the emotional and behavioral problems affecting the patient.
Cognitive behavioral therapy is short-term
CBT is short term whenever possible. The duration of therapy usually varies from four to twelve months, depending on the case, with weekly frequency most often. More serious psychological problems, requiring a longer period of treatment, still benefit from the integrated use of cognitive therapy, psychiatric drugs and other forms of treatment.
The combination of two forms of therapy: behavioral and cognitive
Behavioral psychotherapy
It helps to change the relationship between situations that create difficulties and the person’s habitual emotional and behavioral reactions in such circumstances, by learning new ways of responding, gradually being exposed to the feared situations and actively coping with the feared situations. states of discomfort.
Cognitive psychotherapy
It helps to identify recurring thoughts, fixed patterns of reasoning and interpretation of reality that are concomitant to the strong, persistent problematic emotions experienced by the patient. It assists in correction, enrichment, integrating them with other more realistic thoughts, or, in any case, more functional to one’s well-being.
The change of problematic cognitive contents and processes (beliefs, evaluations, expectations, emotions, cognitive distortions, etc.) in cognitive behavioral therapy is not pursued only through the discussion and reformulation of the patients’ dysfunctional beliefs, but through numerous and varied intervention methods, aimed not only at the cognitive aspects of the functioning of the individual, but also at the specifically emotional and behavioral ones.
History of Cognitive Behavioral Therapy (CBT)
The fundamental assumption, postulated for the first time in the 60s by Aaron Beck and Albert Ellis (Beck 1967, Ellis 1962), is that the patient’s mental representations (beliefs, automatic thoughts, schemes) allow, with a minimum of ‘inference, to explain the psychological discomfort and its perpetration over time. Dysfunctional emotional reactions and discomfort are the result of content and formal distortions of a cognitive type: the pathology is the result of dysfunctional thoughts, patterns and processes. The non-modification of these schemes, in spite of evidence to the contrary, is explained by procedural and content errors which “prevent” their invalidation and contribute to the maintenance of the disorder.
In explaining emotional disorders, therefore, the role played by external events is not causal, but personal, idiosyncratic, i.e. based on the belief system and experiences of the individual subject . What makes it possible to explain emotional reactions and dysfunctional behaviors (and therefore disturbances) is the way of interpreting events on the basis of the individual’s cognitive contents and processes.
From this point of view, the mind is described as a system of goals and knowledge with which an individual evaluates his own experience and regulates emotional reactions, mental activity and behavior (Castelfranchi, Mancini & Miceli, 2002). Psychopathological symptoms are conceptualized as the expression of goal-directed activities inherent in the patient’s mind.
Cognitive-behavioural psychotherapy developed in the 60s, as mentioned, with two psychoanalytically trained therapists: Aaron Beck and Albert Ellis.
Contrary to what is frequently believed, i.e. that cognitive therapy is an evolution of behavior therapy, it was born, however, with two clinicians with psychoanalytic training who, in the same period and independently, developed a clinical method which would later become, on a definition coined by Beck, cognitive therapy.
It is, therefore, a therapy that arises directly from the clinic as a method of treatment, in particular as a treatment for depression and anxiety disorders.
The encounter with behaviorism comes only later and follows two paths: on the one hand, cognitive authors, starting from the founders Beck and Ellis, recover from behaviorism both the attention to the scientific method applied to the clinic and clinical outcomes and the repertoire of techniques typical of behavior therapy; on the other, authors of behavioral training, such as Rachman or Meichenbaum for example, integrate the role of cognitive variables in the behavioral theoretical framework.
Although Beck’s cognitive therapy still plays a dominant role in the International Association of Cognitive Psychotherapy, currently , when we speak of cognitive therapy we refer to a non-homogeneous therapeutic method, within which dozens of different approaches are distinguished .
The situation is even more complex if one looks at the international literature and at all the approaches that are defined as cognitive therapy or cognitive-behavioral therapy; even the presence and prominence of the adjective behavioral partly reflects the weight given to principles and procedures of direct behavioral derivation.
What unites all the approaches that recognize themselves in the definition of cognitive therapy is the common emphasis on the structures of meaning and information processing processes and, therefore, the recognition of the cognitive variable as predominant in the explanation of clinical phenomena.
Furthermore, the treatment method always foresees, regardless of the differences in the procedures, the manipulation of the cognitive variable as the main tool for change.