Rightways to Success: cognitive behavioural therapy (CBT)

CBT can help individuals recognise and challenge negative thought patterns that are causing them distress. — Pixabay

Cognitive behavioral therapy is a form of psychotherapy that is based on the idea that our thoughts, feeling and behaviors are all linked.

Recently, I was approached to write about psychotherapy and its efficacy, rather than delving into matters concerning mental health policy and upscaling of services.

Therefore, I thought it was appropriate to write on this subject that is often spoken about, but about which little is actually understood.

Psychotherapy is a type of mental health treatment that involves working with a mental health professional such as a psychiatrist or a clinical psychologist, to identify and address psychological issues.

It can involve different types of interventions, such as cognitive behavioural therapy (CBT), psychoeducation and psychodynamic psychotherapy.

The goal of psychotherapy is to help individuals gain insight into their thoughts and feelings, develop healthier coping strategies, and improve overall well-being.

What is CBT?

The most popular type of psychotherapy is CBT.

It is a form of psychotherapy that helps individuals to recognise and modify thought patterns and behaviours that are contributing to their psychological difficulties.

CBT relies on the idea that our thoughts, feelings and behaviours are all interconnected, and that changing our thinking in certain areas can lead to positive changes in our feelings and behaviours.

An example of a CBT intervention for a patient would be to have them identify and challenge any negative thoughts or beliefs that may be contributing to their emotional distress.

The patient would learn to recognise irrational thinking and replace it with more balanced and realistic thoughts.

The therapist would also help the patient to become more aware of their triggers and how to take more effective action in managing difficult situations.

The core principles of CBT are:

Cognitive restructuring

This is the process of identifying and changing thinking patterns that may lead to negative thoughts and beliefs.

Exposure and response prevention

This technique focuses on reducing the fear associated with thought patterns and behaviours by gradually exposing an individual to the source of their fear and preventing any reaction from occurring.

Behavioural activation

This technique encourages individuals to engage in enjoyable activities, even when they may find it difficult to manage their feelings.

Relapse prevention

This technique helps individuals understand how to maintain their positive changes and prevent a recurrence of old thoughts and behaviours that may contribute to mental health concerns.

There are many different types of CBT, including:

Cognitive therapy

This focuses on identifying and challenging irrational and maladaptive thought patterns to improve emotional regulation.

Dialectical behaviour therapy

This helps individuals learn to better manage intense emotions, self-harm behaviours and interpersonal relationships.

Rational emotive behaviour therapy

This helps identify irrational beliefs and replaces them with more adaptive, realistic thought patterns.

Acceptance and commitment therapy

This helps individuals become more aware of their thoughts and feelings, and encourages them to become more psychologically flexible and accept difficult experiences.

Mindfulness-based therapies

These help individuals become more aware of the present moment and develop a non-judgmental attitude towards thoughts and feelings.

Efficacy of CBT

Behavioural activation encourages individuals to engage in enjoyable activities, even when they may not feel emotionally up to it. — AFP

Several studies have found that CBT is effective in treating a variety of mental health conditions, such as depression, anxiety, insomnia, post-traumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD).

For example, a meta-analysis published in the Journal of Consulting and Clinical Psychology found that CBT was more effective than placebo in reducing symptoms of depression and anxiety.

One assessment review found that CBT was more effective than other forms of psychotherapy in reducing symptoms of anxiety and depression.

Another study published in the American Journal of Psychiatry found that CBT was more effective than antidepressant medications in reducing symptoms of mild depression.

CBT can be used to effectively address a variety of other psychological conditions too, including phobias, substance misuse, eating disorders, personality disorders, anger management, relationship issues and chronic pain.

CBT can also help individuals develop more effective coping strategies for stress, improving self-esteem and enhancing overall psychological well-being.

Limitations of CBT

Mindfulness techniques, where individuals become more aware of the present moment, are part of CBT. — dpa

Although CBT is an effective form of psychotherapy, there are potential limitations and pitfalls to be aware of.

For example, it requires a high degree of commitment and effort from the individual in order to achieve successful outcomes.

Additionally, since CBT primarily focuses on changing thought patterns and behaviours, it may not be as effective in addressing any of the individual’s underlying emotional issues.

Moreover, some individuals may find the cognitive restructuring techniques employed in this therapy to be psychologically challenging.

Also, it may not be as effective for individuals in more severe mental health states, such as those experiencing psychosis.

Some have argued that CBT does not acknowledge the role of biological factors in mental health issues, and that it can be an overly-mechanistic approach.

Biological factors in mental health refer to the brain and body’s physical and chemical processes that contribute to psychological issues.

These include neurological, genetic, endocrine and biochemical pathways, such as neurotransmitters and hormones, which can influence thoughts, feelings and behaviours.

An example of this would be hormonal imbalances in medical conditions like thyroid disorders, causing psychological manifestations.

CBT is not as well understood as some other forms of psychotherapy, in part because it is a relatively new form of treatment.

Additionally, many clinicians lack the knowledge and skills to properly implement CBT, and this can prevent individuals from receiving evidence-based treatment.

Finally, there is a lack of adequate research and comprehensive training programmes that can help clinicians gain the necessary skills to effectively utilise this therapy.

In my clinical practice, I have often been asked two questions.

Firstly, if CBT can be started together with psychotropic medications.

And secondly, if CBT can be the only form of treatment in place of psychotropic medications.

CBT can indeed be given together with psychotropic medications.

The combination of CBT and medication is often the most effective treatment for many mental health conditions, including depression and anxiety.

Medication can help reduce the symptoms of the condition and CBT can help to address underlying causes of the disorder, such as negative thinking patterns, lifestyle choices and patterns of behaviour.

Because of this, CBT may not be an appropriate sole substitute for psychotropic medications in the vast majority of cases.

It is important that each patient’s individual needs are considered carefully when determining the best treatment plan.

Ultimately, it is best to discuss with one’s mental health therapist the method of treatment that is most suited for an individual’s needs, rather than insisting on a therapy that seems appealing.

The mental health needs of every individual is unique, and therefore, a customised approach should be preferred for the best outcome.

Prof Datuk Dr Andrew Mohanraj is a consultant psychiatrist, the Malaysian Mental Health Association president and Taylor’s University Impact Lab on Mental Health and Well-being director. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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