Description of a Session
At the beginning of treatment, patient and therapist discuss the patient’s reasons for entering into CBT. Together they identify the goals for therapy and decide on a treatment plan. Follow-up sessions are often weekly but can be more frequent. Both the therapist and the patient take an active part in the therapeutic process, with the therapist often acting as a guiding coach or tutor. Therapists often give their patients “homework” such as practicing specific tasks, such as initiating a certain number of social conversations for patients working on shyness, or doing readings that have been selected based on the patient’s specific needs. Another popular technique is “thought recording” in which the patient identifies the thoughts and emotions that accompany a specific event. These are rated on a scale of how they impact the patient. During the course of therapy alternative thoughts are recognized and mood and emotion reevaluated based on their replacement value.

CBT stresses the relationship between therapist and patient in a process called Collaborative Empiricism. In this process, various thoughts, attitudes, beliefs and behaviors are tested and Socratic Questioning may be used to determine their validity and usefulness. If something is found to be invalid or counterproductive, more adaptive behaviors/cognitions are identified. CBT is therefore an educational process. Patients come to be able to identify and change automatic thoughts, which they are often not aware of at all. These thoughts can significantly alter the “mood” of any situation.

Role-playing may be used to help make the patient aware of thoughts and behaviors. Breath control and other relaxation modalities like visualization and progressive relaxation are often incorporated to help the patient counteract anxiety and reactions to stressors. Pleasurable rewards or privileges are used as reinforcement for performing difficult or undesired tasks. Controlled and gradual re-exposure to a stimulus that provokes anxiety is often employed in working with fear-based problems.

Course of Treatment
Unlike more traditional insight-oriented and long term types of psychotherapy, people often enter CBT treatment with a specific goal in mind that they want to work on for a limited amount of time. Rather than trying to explore one’s psyche and gain a fuller understanding of intra-and-interpsychic processes, CBT patients usually want to change something rather specific in their lives such as shyness, anxiety, or compulsive troublesome thoughts without necessarily understanding the underlying psychological issues. Once CBT patients feel that the initial goal has been accomplished and the unwanted behavior or thought patterns have been eliminated or changed, the therapeutic process usually ends. It is for this reason there is no standardized course of treatment.

Though CBT can be a longer-term treatment, it is often brief, lasting only a few weeks or months. After termination of treatment a follow up session is often scheduled to assess the patient’s progress, address possible relapses and the potential need for further treatment.

Side Effects
There are no side effects or adverse reactions to cognitive behavioral therapy, which may make this type of therapy an attractive treatment alternative in cases where long term psychotherapy is not wanted or possible and medication is not desired or necessary. Also see Safety Issues.

Safety Issues
Cognitive behavioral therapy itself is a safe technique. However, in cases where a more severe psychiatric diagnosis has been made such as personality disorder, this type of psychotherapy may be contraindicated. Also CBT may not be an appropriate therapeutic approach for persons coping with traumatic experiences and/or more complex psychological and emotional issues. In those cases more long term psychotherapeutic treatment may be more beneficial. When there is doubt, a psychiatrist or psychologist should be consulted before therapy begins. CBT is also considered safer than the use of medication since there is no possibility of addiction or drug-related side effects.

Other Modalities that Work Well with this Approach
Since CBT embraces the use of techniques like biofeedback, hypnosis and desensitization during therapy, these as well as a variety of other self-help techniques can be used as adjuncts to treatment. These may include visualization or guided imagery, self-affirmations, self-hypnosis, meditation, and others.

Content last modified on Mar 2, 2004