Cognitive Behavior Psychotherapy (CBT)
What is cognitive behavior therapy?
Cognitive behavior therapy is one of the few forms of psychotherapy that has been scientifically tested and found to be effective in hundreds of clinical trials for many different disorders. In contrast to other forms of psychotherapy, cognitive therapy is usually more focused on the present, more time-limited, and more problem-solving oriented. In addition, patients learn specific skills that they can use for the rest of their lives. These skills involve identifying distorted thinking, modifying beliefs, relating to others in different ways, and changing behaviors.
What is the theory behind cognitive behavior therapy?
Cognitive behavior therapy is based on the cognitive model: the way we perceive situations influences how we feel emotionally. For example, one person reading this website might think, “Wow! This sounds good, it’s just what I’ve always been looking for!” and feels happy. Another person reading this information might think, “Well, this sounds good but I don’t think I can do it.” This person feels sad and discouraged. So it is not a situation that directly affects how people feel emotionally, but rather, their thoughts in that situation. When people are in distress, their perspective is often inaccurate and their thoughts may be unrealistic. Cognitive behavior therapy helps people identify their distressing thoughts and evaluate how realistic the thoughts are. Then they learn to change their distorted thinking. When they think more realistically, they feel better. The emphasis is also consistently on solving problems and initiating behavioral change.
What is the real mechanism of action behind cognitive behavior therapy?
Cognitive behavior therapy is a non-pharmacologic intervention that involves social interaction. It exploits expectancy and conditioning to effect a change in brain chemicals. This mechanism of action is the placebo effect and it is also the way that any non-pharmacologic intervention such as many alternative treatments work.
Initially, CBT was hailed as the first psychotherapy to be demonstrated with placebo controlled trials to be an effective therapy. Then, numerous other brief or time-limited psychotherapies also proved to be effective. These therapies span a broad range of theoretical ideologies. Many different theories are used to explain why they work. However, the only thing that all these therapies share is that they all exploit expectancy and conditioning to effect a change in brain chemicals. In my opinion, it is the placebo effect at work in all forms of psychotherapy that have been demonstrated to be effective.
I am not saying that these therapies don’t work, they do. I am explaining the neuroscience of HOW they work. This is a new neuroscience that we are currently learning and are actively studying. We now have the ability to look at images of the brain as it is processing information. We can get a crude vision of which parts of the brain are functioning or not functioning in correlation with behavioral effects of interventions such as CBT.
Functional brain imaging evidence that cognitive behavior psychotherapy works
The take home message is very optimistic. I am saying that there are numerous ways to do the placebo effect and that this effect can be maximized and that it can work reliably across a high percentage of patients. When you include psychotherapies in the realm of placebo rather than just looking at direct comparisons with medications you see an effect that can likely work for large numbers of patients.
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