CBT: what is it and how does it work?

Cognitive Behavioural Therapy,  or CBT is one of the most well known types of psychological therapy.. But how does it work, and why is it so effective?

CBT was developed from the 1950’s, and came to prominence in the 1980’s. It was based on form of Behavioural Therapy, usually used to treat people with phobias. This was based on the principles of classical conditioning: that a conditioned stimulus, when paired with an unconditioned stimulus, produces a conditioned response. This is illustrated by the classic Pavlov’s dogs experiment, as shown below:

This process was used a basis for techniques to reduce fear, for example through systematic desentisation – gradually exposing patients to the phobic stimulus in a hierarchy system in order to reduce their fear (e.g. bottom layer of hierarchy: looking at picture of a spider – top layer: holding a spider in your hand). Part of this therapy is to teach the patient to relax during each step, as that prevents anxiety.

CBT builds on the exposure used in behavioural therapy in order to also address the cognitions behind the fear or anxiety. For example, in panic disorder,  patients suffer from recurrent panic attacks which cause intense fear and distress. The cognitive theory of panic disorder (Clark & Wells, 1995) states that panic attacks are brought on by a misinterpretation of physiological symptoms of anxiety such as palpitations or dizziness. The individual interprets these as that they will immediately suffer a physical or mental disaster e.g. a heart attack.

Part of the CBT for patients with panic disorder is exposure – they will go into a crowded place (if this causes panic attacks for them) and record their feelings, in order to discuss with their therapist. However, it has been found that exposure alone is not as effective as if the cognitions which maintain the disorder are not addressed. These are known as safety behaviours (Salkovskis, 1988): for example if a person who has anxiety about crowds and thinks they are going to faint if they are in a crowded place, they might sit down so they don’t faint. The sitting down is the safety behaviour – it prevents people from realising they wouldn’t have fainted from being in a crowd, they think they only reason they didn’t faint was because they took that action. If exposure is paired with strategies to reduce safety behaviours, it is much more effective at reducing panic and anxiety (Salkovskis et al, 1999).

CBT is recommended as the treatment of choice by NICE (the public body which develops treatment guidance for the NHS) for depression and all anxiety disorders – not just panic disorder. In order for it to be effective, Clark et al, 1994 have shown that a ‘cognitive shift’ must occur in patients (a change in their beliefs), or risk of relapse is much higher.

Let me know if you’ve got any questions or would like more posts like this – hope you found it interesting!