Arlene B. Englander

Licensed Psychotherapist, LCSW, MBA, PA

CBT – Questions and Answers

What is Cognitive Behavioral Therapy (CBT)?

This is a question that I’m frequently asked as people hear about the effectiveness of CBT in the treatment of anxiety, depression, OCD, stress and eating disorders. Cognitive behavioral therapy is a form of psychotherapy that emphasizes the importance of our thoughts in affecting how we feel and what we do. The term “cognitive” refers to thoughts or perceptions. One key concept of CBT is the fact that it’s our thoughts, not just outside events, that create our moods and ultimately influence our behavior.

How did CBT originate?

Some believe that the first intentionally therapeutic approach to CBT was practiced by Albert Ellis, Ph.D. in the 1950′s when he developed what he first referred to as an ABC approach, later named Rational Emotive Behavior Therapy. Others trace it to Aaron Beck, M.D. who, in the 1960′s, called his treatment technique Cognitive Therapy. However, there is evidence of similar theories as far back as the Stoic philosophers, Marcus Aurelius and Epictetus, the latter having written, “Men are not distracted by things but the view they take of them.”

Back in the late 1890′s, the world-renowned composer and pianist, Sergei Rachmaninoff, then in his mid-twenties, suffered from depression after the death of his mentor, Tchaikovsky, and the embarrassment of a bad performance of his first symphony. He despaired of ever writing music again, but was successfully treated by a practitioner of cognitive therapy in the late 1890′s and went on to compose his second Piano Concerto, one of the most frequently performed concertos today.

Finally, it was Karen Horney, M.D., one of the founders of the Association for the Advancement of Psychoanalysis in 1941, who wrote in 1950 about what she called “the tyranny of the should”, “self-minimalizing thoughts” and other thought patterns she had noticed in her practice – all precursors of current CBT’s concepts.

How does CBT work?

The beauty of CBT is that by developing an awareness of our habits of thought, we can tune in to our “pain-producing thoughts” (my term) and learn to answer them back in a comforting, compassionate way. A few examples of “pain-producers” are “should statements”, labeling”, “all or nothing thinking” and “catastrophizing”. By becoming aware of our habits of thought, we can develop the new habit of answering back and successfully disputing them, until the tendency to think in the old, pain-producing way is extinguished. Because our thoughts help create our feelings, our feelings become our moods, and our moods influence our behavior, clients learn to take control of their thoughts, feelings, moods and behavior this way. It’s rewarding to see that happen.

Is there proof that CBT is effective?

Yes. For example, according to a seminal report in the journal “Psychological Science in the Public Interest” in 2002, written by Steven D. Hollon from Vanderbilt University and his colleagues, only 25% of patients receiving cognitive therapy relapsed within one year of treatment as opposed to 81% of those who took only SSRI’s. Combining therapies often works better than using just one type, yet for long-term effectiveness CBT has been proven to work best. In fact, studies done at UCLA and other research centers has shown that new neural pathways, observable on brain scans, can be seen subsequent to effective treatment with CBT!

How long does the treatment usually take?

This is usually short-term therapy, with 16 sessions being the norm, although a number of my clients have “graduated out” sooner. There is sometimes homework, but it is short, and clients find it enjoyable, because it involves practicing techniques for taking better control of their lives.