What You need to Know About Cognitive Behavior Therapy

What is CBT?
Cognitive Behavior Therapy (CBT) is a form of therapy that Aaron Beck (of the Renowned Beck Institute) pioneered in the 1960s. CBT is an evidence-based therapy. This means that extensive scientific research has proven CBT to be effective in helping people find relief from their symptoms. It is effective for a wide range of conditions such as depression, adjustment to life stressors, anxiety, substance abuse, eating disorders and so on. CBT focuses on the present – it does not delve deep into childhood experiences as do other therapies such as psychoanalysis. The average length of time that CBT will take depends on each person, but it is meant to be relatively short-term. It teaches self-help so that individuals develop skills to use for themselves.
The Thoughts-Feelings-Behavior Connection:
The basic premise of CBT is that we feel the way we feel because of our thoughts. There is always a situation, or trigger that we interpret with negative, positive or neutral thoughts. Thoughts are also referred to as automatic thoughts because we are constantly interpreting the world around us whether we realize it or not. They can be positive thoughts such as “I love sunny days, this is going to be a good day”, neutral thoughts such as “that wall is beige”, and negative thoughts “I can’t do this it’s too hard.” An example of the connection between our thoughts, feelings and behaviors is as follows: If it is raining I might say to myself “I hate rain, it’s going to be a miserable day!” This could result in me feeling irritable, down. The behaviors you might see as a result could be feeling preoccupied, snapping at someone or isolating from others. If I were to consider an alternative way of thinking I might say “It’s raining, not my favorite but I can read that book I have been putting off” I would then feel neutral, less irritable, more receptive to others and interactive. The above highlights the cognitive piece of CBT while there are behavioral interventions as well. CBT helps us to replace unhelpful coping tools with helpful, or adaptive coping skills. Examples include diaphragmatic breathing exercises, progressive muscle relaxation, implementing a structure/routine, behavior management plans such as chore charts with rewards. These are just a few of the varied behavioral interventions CBT therapists offer.
CBT with Adults vs. Children/Teens:
CBT involves the therapist and client working as a team. First, the therapist takes a thorough history. The second step involves formulating a plan for therapy including goals and objectives. Then each session would normally start with checking in on how things have been since the prior session. After that, if tasks/exercises were assigned for homework during the last session the client and therapist would discuss and trouble shoot any challenges. Clients are encouraged to come up with an agenda and questions for each session. The session might involve addressing symptoms, learning about a condition and practicing new skills. The end of the session would summarize all that was covered and address a task to be done in preparation for the next session.
Sessions with children and adolescents typically involve more creativity and play. I meet with parents first if the child is under 13. With adolescents I meet at first with everyone together and then split up the first appointment to allow the teen to feel he/she has some private time to share his/her own perspective on the presenting problem(s). I use activities like worksheets, videos, puppet play, therapy card games, and a white board with visuals to help with teaching and keep kids’ attention. For children under 13 I meet with parents for a few minutes the last part of the session to go over what he/she is learning or working on. Sometimes we will meet together so that the child can be an active part of the conversation. With adolescents my discussions with parents must be with the adolescent’s consent, of course with the exception of a life or death or safety concern. Occasionally I might meet for an entire session with a parent or parent and child to support their relationship, communication or some other issue for the child if it is warranted.
Parents who are looking for more frequent support and learning opportunities for themselves can request parent coaching. This would NOT involve the child in the therapy. It would focus on learning how to implement CBT techniques to manage the child’s symptoms/behavior.
In my practice I occasionally do family therapy on a case-by-case basis. Depending on the presenting issues I might vary who attends session, for instance parents alone at first, then introducing the child/children. I incorporate CBT concepts and techniques when appropriate in family therapy as well.

Below are some additional resources:
https://beckinstitute.org/get-informed/cbt-faqs/
https://www.psychologytoday.com/us/basics/cognitive-behavioral-therapy
https://www.psychologytoday.com/intl/blog/i-hear-you/201810/instant-cbt-the-simplest-way-challenge-negative-thoughts

Books I recommend:
Feeling Good: The New Mood Therapy. David Burns, MD.
The Anxiety and Worry Workbook: The Cognitive Behavioral Solution. David Clark and Aaron Beck.
The Anxiety and Phobia Workbook. Edward Bourne.
The OCD Workbook:Your Guide to Breaking Free from Obsessive-Compulsive Disorder. Bruce Hyman and Cherlene Pedrick
For kids:
Talking Back to OCD. John March.
What to Do When You Worry too Much: A Kid’s Guide to Overcoming Anxiety. Dawn Huebner and Bonnie Matthews.
What to Do When Your Brain Gets Stuck: A Kid’s Guide to OCD. Dawn Huebner and Bonnie Matthews.
Starving the Anxiety Gremlin: A Cognitive Behavioral Therapy Workbook on Anxiety Management for Young People. Kate Collins-Donnelly.

The above article is intended for use as an educational tool and not to replace therapy.