Why Cognitive Behavioral Therapy is Effective

​How would you define “counseling” or “therapy?”

For many people, we start by thinking about the standard therapy setting: a cozy room with a chaise lounge, a large chair, soft lighting, and inspirational quotes framed on the walls. We then picture a therapist sitting in that large chair, with a pen and notepad nodding thoughtfully along with your story, as you lay on the couch looking at the ceiling and contemplating where life went wrong.

If you have ever seen a counselor or therapist in a TV show or movie, this scene is easy to picture. We often think of counseling in the way it is portrayed in the movies. The quintessential “how does that make you feel” question rarely helps the counselor, or the patient, make much progress.

Outside of the fictional world of counseling in the movies, there are multiple schools of thought and theories counselors learn to best aid their patients. While counselors are known to ask a lot of questions, there are methods behind how those questions are asked that can help clients see problems through a new perspective or tie pieces of their story together. Among these theories are “evidence-based” practices, which are tried-and-true methods that statistically lead to positive outcomes for the patient. In addition, evidence-based practices are often more likely to be reimbursed by medical insurance and have been used in mental health research for decades.

Within the umbrella of evidence-based practices is a counseling theory called “cognitive-behavioral therapy”, or CBT. CBT has been shown to be effective across a range of mental health diagnoses, including depression, anxiety, post-traumatic stress disorder, and substance abuse. This therapeutic approach is also backed by years of scientific and clinical research to demonstrate its efficacy in diverse populations of patients and conditions.

But what is CBT, and why is it effective?

To start, let us break down the name itself into its components:

• Cognitive: refers to the human mind. How we perceive and respond to our environment is processed in the brain, and the brain generates thoughts, attitudes, and perspectives that shape our personality.
• Behavioral: refers to how the human body responds to the information it receives from our brain.
• Therapy: refers to how counselors can help patients find harmony between cognitive thoughts and behavioral actions.

Breaking down each word creates a better picture of the therapeutic process. This therapeutic approach looks quite a bit different than the “how does that make you feel” question. The questions counselors in a CBT session ask are geared toward how cognitions influence behaviors.

CBT was founded on three core principles, defined by the American Psychological Association:

1. Psychological problems are based on faulty or unhelpful ways of thinking
2. Psychological problems are based on learned patterns of unhelpful behavior
3. Patients can learn to cope with their cognitive/behavioral problems and relieve symptoms

Essentially, once unhelpful thoughts or behaviors are identified and changed, symptom relief occurs.

As simple as it sounds, CBT is a process and a journey - unique to each patient. The therapeutic process takes time and effort, but CBT offers a gateway into the complexities of human thought and behavior. Let’s take a straightforward example to discuss the effectiveness of CBT.

Imagine a professional basketball player. This basketball player has been playing since he was in elementary school and has had a successful college career and is now playing professionally. But playing for a professional team is a whole new ball game (pun intended). There are new stressors, added pressure to perform at his best, and not to mention the financial benefits he may earn by being a star athlete. He has never experienced stress like this before, and anxious thoughts begin to enter his mind: “am I good enough?”, “will I cause the team to lose this game?” So on and so forth. At the beginning of his first big professional game, these intrusive thoughts occupy his mind. The cheering crowds, bright lights, and screams from the team coach and captain only seem to make things worse, as though the whole stadium is focused on him and his ability to perform. The player is then tasked with a free throw, and this basket could either make or break the game for his team. Instead of focusing on the task at hand, the player thinks to himself “I am a horrible player, there is no way I’ll make this shot.” And not surprising, he misses the basket and the crowd sighs and boos. The player walks off the court defeated and begins to truly believe that he is a bad player and is not talented enough to play professionally.

To the outsider reading this story, you may be thinking to yourself “well of course he missed the basket, it was a self-fulfilling prophecy.” He told himself he couldn’t do it, so he didn’t make it. Now imagine this scene happens over and over again. All of the sudden, the player’s behavior starts to change, and he becomes withdrawn from the team, depressed, anxious, and stressed. As his behavior changes, his negative beliefs about himself strengthen until he truly believes that he is a bad professional basketball player.

This is the power of negative thinking. A talented athlete with all of the skills to make it as a professional basketball player turns into a self-deprecating, depressed person who may decide to quit the team all together.

Overtime, our basketball player’s behavior also begins to reinforce his negative thoughts. This creates a feedback loop: negative thought à negative behavior à negative thought.

This cycle becomes extremely detrimental to mental health and is often hard to break. This is when counseling and CBT can become instrumental in regaining control of our narrative and shifting our negative beliefs about ourselves into positive ones.

Let’s imagine a different situation when he stepped onto the court for the game changing free throw. Instead of saying to himself “I am a horrible player there is no way I’ll make this shot”, he could say “this is a tricky shot, but I am good, and I can make it.” Do you think he will be more likely to actually sink the ball into the hoop this go around? You are probably right.

This is the beauty of CBT and why it is so effective. Yes, it is simple, but often times the simplest answer is the correct one.

Through the process of counseling with CBT, patients learn how to constructively change their negative beliefs about their abilities. For example, writing down positive statements about oneself on a sticky note or on a bathroom mirror aids this perspective shift. By challenging those negative beliefs, patients learn to trust in themselves which leads to self-confidence.

As a result, behavioral changes occur. When we feel confident and capable, our personalities shine through, and we become better versions of ourselves. Overtime, triggers that made us anxious or depressed become less impactful on our day-to-day functioning and those intrusive thoughts have less of a hold on our minds and bodies.

CBT is a simple and straightforward therapeutic approach and while it may be easy to understand at face value, implementing strategies to change negative thoughts and beliefs takes courage and determination. This is when a counselor steps in to help navigate through the growing pains of becoming the best version of yourself. With unconditional support and positive regard, a trained counselor will be with you every step of the way throughout the journey.
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CBT is an effective approach to overcome many of the challenges we face in life. At the private counseling practice of Hilary Morris, LPC, all counselors are trained in CBT and routinely integrate it into therapy sessions. If you are engaged in therapy with us, you may even pick up on some questions or ways of thinking that remind you of our basketball player’s story. If you are not currently working with a counselor but this topic resonated well with you, please reach out to us with questions or if you are interested in becoming a patient with our practice.