Cognitive Behavioral Therapy (CBT) is a treatment that focuses on changing unproductive thinking and the beliefs that underlie that thinking. For example, a child who is struggling academically may think, “I’m worthless” or “My effort never pays off.” Such thoughts may lead to anxiety or depression and may be expressed in irritability, withdrawal, lack of motivation, fatigue, suppressed appetite, and changes in sleep patterns.
The thoughts that begin the downward spiral are “maladaptive” thoughts or thinking errors. They usually fall into four categories:
- Fortune telling: expecting bad things to happen
- Magnification: making a small negative event big in one’s mind
- Minimization: ignoring positive events
- All-or-none thinking: thinking in absolutes with no grey areas
Changing the Thinking
CBT encourages a child to look at her erroneous thoughts as hypotheses—not facts. With a therapist’s help the child is asked to identify the evidence that supports the wrong thinking. Usually she’ll find that the so-called evidence is minimal or nonexistent.
People who seek CBT can expect their therapist to be active, problem-focused, and goal-directed.
Treatment might require the child to monitor and log her thoughts in order to help her determine what patterns of erroneous thinking exist so she can develop healthier alternatives. In this way, the child learns how to restructure negative thought patterns and to interpret her environment in a more productive way. A child who experiences obsessions and compulsions may be encouraged to expose herself to her fears so that the beliefs surrounding those fears can be identified and modified.
Depending on the age of the child, parental involvement in treatment may be necessary. Parent training is used to support the techniques learned in session. The therapist may also assist parents in instituting reinforcers or consequences at home that will support adaptive behaviors and discourage maladaptive behaviors.
While the above summary is certainly not comprehensive, it provides a brief overview of the principles of CBT and how it applies to various problems. Because CBT has proved effective, it has achieved wide popularity among therapists and consumers. Those who receive CBT training include psychologists, psychiatrists, social workers, and psychiatric nurses. Those seeking treatment using a CBT approach are encouraged to ask their therapist about their CBT training or contact The Academy of Cognitive Therapy and request a referral in their community.
Studies of CBT demonstrate its usefulness for a variety of problems including, but not limited to mood, anxiety, attentional, and impulse control disorders. CBT has been shown to be superior to anti-depressant medication alone for symptom reduction and relapse prevention in individuals with depression and anxiety. However, the best treatment outcomes are obtained when an individual receives a combination of medication treatment and CBT.
Dr. Guttman, a clinical psychologist specializing in CBT is a psychologist in New York City and Westport, CT.
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