By Jonathan E. Goldberg, Ph.D.
Cognitive behavior therapy (CBT) is an empirically validated form of therapy. This means it has been scientifically studied and found to be effective in addressing various mental illnesses that individuals experience. CBT focuses on the interaction of thoughts, feelings and behaviors and how these different components correspond to different mental illnesses (e.g., anxiety and mood disorders).
With CBT, a clinician works with an individual to understand how automatic, negative thoughts can contribute to emotional feelings as well as physical feelings and how the individual can engage in positive behaviors that help to manage these feelings. Behaviors can be adaptive or maladaptive, meaning behaviors can lead to healthier levels of functioning or can lead to poorer levels of functioning.
When I talk about CBT, I describe it as a form of coaching. The clinician is more like a coach who helps individuals practice thinking rationally, managing emotions effectively and developing healthy ways to cope with symptoms. CBT is a collaborative, two-person model so time is spent helping individuals feel comfortable talking about issues and helping them understand that these issues will be addressed collaboratively.
CBT is also a strength-based treatment so it does not focus on vulnerabilities or weaknesses but rather it offers the opportunity to develop strengths. The clinician will talk about how to use the capacities individuals already have to address the issues they are facing.
People often assume, rightly or not, that therapy is about digging into unconscious conflicts that are responsible for symptoms. This is a very old way of looking at the therapeutic relationship.
The word I use most to describe CBT is collaborative. It is two individuals in a room who are working on a common goal. As a result, CBT-trained clinicians are usually engaging, interactive and instructive. They do not just empathetically listen. They are there to help problem-solve and address troublesome symptoms that are getting in the way of an individual’s life.
CBT-trained clinicians focus on identifying practical strategies and adapting different behaviors to support recovery. They may talk about the dynamics behind symptoms, but this is not where they start. They typically start with the individual’s goals.
This is different from what clinicians typically do in traditional forms of psychotherapies. They usually do a lot less talking and teaching and only focus on the specific mental illness that is present.
CBT is used for a variety of illnesses. At first, CBT focused mostly on mood disorders and anxiety. However, now it is used with lots of different mental illnesses, including schizophrenia, psychotic disorders, substance use disorders and personality disorders.
Once an individual learns about the CBT model, in terms of how thoughts, feelings and behaviors correspond with each other, it can be used to address many different, diagnosable mental illnesses as well as normal changes in feelings and behaviors.
Oftentimes, CBT-trained clinicians will start the first session with an assessment of how well the individual is functioning and what specific issues he or she is there to address and how significant these issues are in his or her life.
There is a lot of initial talk about what the individual is experiencing and how his or her symptoms are impacting relationships, work, school, etc. Clinicians also take time to understand the onset of the issues the individual is experiencing and their clinical course. For example, they may ask questions like: When did you first start experiencing symptoms? How have they changed throughout your life? How have they impacted different areas of your life?
Most importantly, CBT-trained clinicians take time in the beginning to understand the individual’s treatment goals. It is important from the onset that they understand what the individual is looking for from treatment.
In order to get the most out of treatment, coming up with goals is very important. Young adults should have a personal understanding of what they would like from treatment. Much more than other types of psychotherapy, CBT is collaborative, so the clinician is looking to understand what a young adult is looking to accomplish. This is going to direct the treatment itself. The clinician is there to help the young adult meet his or her goals.
There are homework assignments with CBT. These assignments can include working on challenging automatic, negative thoughts, monitoring symptoms and finding new ways to cope with symptoms. Homework is important to get a sense of the progress being made between sessions. Young adults need to be motivated to work outside of the treatment sessions.
I tell the young adults I work with that a lot of the work does not occur during the 50-minute sessions, but outside of the sessions. I openly encourage discussion via email and phone calls to get a sense of how my young adults are doing when we are not meeting.
I recommend young adults use a notebook to jot down thoughts, particularly automatic, negative thoughts. This helps to get a sense of the anxiety or discomfort these thoughts create and how these thoughts are triggered in different situations (at home, in school, with friends, etc.).
Luckily, it is easier to locate appropriate clinicians now more than ever. Young adults can just go online and Google CBT and the state they live in to bring up clinicians. I had my practice advertised over the internet and most of my colleagues do this too.
Psychology Today (www.psychologytoday.com) provides a wonderful tool that allows people to type in a zip code and a list of clinicians and their specialties pop up. Young adults may also contact insurance clinicians. When I enrolled in BlueCross BlueShield, they asked me what my specialties were. Young adults can call their insurance clinician to ask for a list of CBT-trained clinicians that work within their insurance network.
There are clinicians who advertise that they do CBT but they actually do more traditional psychotherapy. Here are some questions parents and young adults can ask to ensure what a clinician is advertising is CBT:
There are three top issues I often see in young adults:
I recommend the following resources:
I always enjoy books by David Barlow. Another author, David Burns, does a lot of contemporary work with CBT and has several self-help books that include specific strategies people can use to address negative thoughts.
Strategies I recommend to young adults include:
One thing I love about CBT is it is a very hopeful and optimistic, strength-based treatment. CBT-trained clinicians are using resources young adults already have to address the symptoms that are interfering with their functioning. Together, young adults and their clinicians can make a change. The clinician is a supportive person that young adults can be genuine with and trust. CBT is all about working together on common goals.
by Jonathan E. Goldberg, Ph.D., licensed psychologist, clinical instructor of psychiatry, Harvard Medical School.
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