What is Cognitive Therapy?

As mentioned previously, I am proud to have earned certification as a diplomate of the Academy of Cognitive Therapy (ACT). Cognitive therapy (also known as cognitive behavioral therapy or CBT), is a psychotherapy approach that has been shown to be effective with a wide range of mental health problems, including depression, anxiety, obsessive compulsive disorder, anger management problems, and child behavior disorders. CBT developed out of the work of Dr. Aaron Beck, who suggested that our mood and resulting behavior stem primarily from our thoughts and interpretations of events, rather than directly from the events themselves.

Our tendency to interpret an event in a particular way evolves out of our previous experiences and the beliefs we hold about ourselves, others, and the world.

As such, two people might encounter the same set of circumstances, such as a new acquaintance declining a dinner invitation; but their emotional reactions and subsequent behavioral responses are likely to differ.

For example, Person A – we’ll call him “Albert” – might have the thought:

“This (the declined invitation) means that Jane doesn’t like me,” which lends support to his beliefs: “I always get rejected;” “No one likes me;” and “I am worthless.”

As a result of his unique interpretations of the event, Albert might feel sad and dejected and respond by engaging in poor coping behaviors (e.g., social withdrawal, excessive drinking, or other compulsive behaviors) that will decrease the likelihood of his mood improving.

Meanwhile, in a similar situation, Person B – we’ll call him “Bill” – might respond to the declined invitation with the thought:

“Jane may not be interested in me romantically, but other women are,” which is consistent with the beliefs: “I am a likeable person;” “Other people enjoy my company;” and “This is an isolated incident that need not get me down.”

With this different frame of mind, while Bill might surely feel disappointed, he is more likely to view the situation as a minor setback and bounce back quickly. This different view of Jane’s declining his invitation may lead him to consider inviting someone else to join him for dinner or to proactively look for other enjoyable and meaningful activities to engage in.

Although cognitive therapy is similar to other forms of psychotherapy in that it is talking-based, there are key differences.

Sessions are Collaborative

For one, the therapist – client relationship is interactive and collaborative, with the therapist actively asking questions throughout and providing structure for the session and the client helping to set the session agenda and providing important information about his or her experience.

Treatment is Goal-oriented

Further, cognitive therapy treatment is typically finite. Upon beginning their work together, therapist and client clarify goals for treatment and work toward achieving these specified goals, with the therapist regularly assessing progress.

Homework is an important part of treatment

Third, unlike with other therapy approaches, practitioners of cognitive therapy regularly incorporate “homework” as an integral part of treatment. Based on the assumption that the more opportunities a person has to practice a new skill, the more quickly he or she will develop skill proficiency, each week, the cognitive therapist and client devise together relevant behavioral assignments for the client to do outside of the treatment session. Such homework might involve therapeutic activities as far-ranging as keeping a daily log of anxiety-provoking thoughts or of fluctuations in one’s mood or engaging in a new behavior as an experiment to test out hypotheses about how others will respond. Treatment sessions and homework are focused on teaching the client to identify, challenge, and change automatic thoughts and beliefs that may be contributing to the client’s dysfunctional mood and/or behavior and to help the client to develop more effective coping skills to improve his or her mood and functioning in daily life.