About one in five adults in the U.S. or 44 million people experience mental illness annually.1 Of that total, major depression affects an estimated 14.8 million people ages 18 and older, or about 6.7% of the U.S. population.2 For some depressed people, the symptoms are troubling, but not severe enough to interfere with daily functioning. However, people suffering from major depressive disorder can experience symptoms so debilitating that they cannot function. These symptoms include poor appetite or overeating, insomnia or fatigue, low energy, low self-esteem, feelings of worthlessness or guilt, difficulty concentrating and recurrent suicidal thoughts.3 Numerous prescription medications are available to help reduce symptoms of depression and other mental disorders. While a pill may be an easier, less expensive solution, medication just masks symptoms and does not treat the key underlying issues. In some cases, medication is absolutely necessary, but psychotherapy plays an important therapeutic role in helping people combat mental illness.
The Origins of Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is one of the most effective and widely researched types of psychotherapy. Behavioral therapy (BT) in its original incarnation was born out of a rebellion against prevailing therapeutic concepts of the day (psychoanalytic and humanistic approaches). Early interventions focused on reducing problematic behavioral patterns using techniques based on well-defined and strictly validated scientific principles. Early BT practitioners incorporated a conditioning approach in which patients would be gradually and progressively subjected to situations they feared until these behaviors lessened or ceased to exist. The “cognitive revolution” in psychology took place in the 1960s and by the next decade, many behavior therapists were practicing CBT.4
CBT as it is known today was developed in the 1960s by psychiatrist Aaron T. Beck, MD, and expanded on by his student David D. Burns. Based on research Beck conducted on depressed patients, he discovered that all of them experienced streams of negative thoughts that seemed to arise spontaneously. He called these “automatic thoughts” and further classified them into three categories: negative ideas about themselves, the world and/or the future.5
The Principles of CBT
Emotional and mental problems can cause normal information-processing abilities to break down due to a consistently negative bias introduced into thinking, perpetuating an ongoing cycle of negativity. CBT helps people learn to identify, challenge and transform distorted beliefs and negative, irrational thoughts into ones that are empowering, realistic and positive. It also teaches people healthy coping skills and behaviors. When people change the way they perceive themselves, this changes the way they react to and view the world around them. As a result, depression, anxiety and even physical pain no longer rule their lives.
Core Beliefs in CBT
The core beliefs associated with anxiety are often tied to a profound sense of helplessness. For example, people may have the feeling that everything is beyond their control, or espouse the belief that “it” is impossible to handle. “It” can apply to a vast array of things, such as a three-hour flight, a performance, an unwanted impulse, a negative outcome, etc. “It” often becomes the metaphorical mountain the mind makes out of a molehill.
Examples of Core Beliefs
- I’m a failure
- I’m worthless
- I don’t get to be happy
- Nothing good ever happens in my life
- My life is cursed
- I’m unlovable
- I’m powerless to improve my situation
Core beliefs trigger faulty assumptions and irrational or unrealistic thoughts that Beck called “thinking errors” — referred to more commonly today as cognitive distortions. All humans are prone to cognitive distortions now and then. People struggling with depression or any type of anxiety disorder experience these irrational and negative thoughts on a regular basis — if not constantly. These underlying patterns fuel depression or anxiety (or both, as they often occur together). Maladaptive behaviors (e.g. using alcohol to cope, or avoiding situations that cause anxiety) occur in reaction to these negative thoughts and feelings. Before long, people find themselves in what feels like an inescapable and damaging behavioral cycle.
Examples of Cognitive Distortions
- All or nothing thinking (e.g. statements that involve “always” or “never”)
- Discounting the positive while focusing on the negative
- Jumping to conclusions
- “Should” statements (“I shouldn’t have said anything!”)
- Catastrophizing (e.g. viewing a situation or event as much worse than it really is or will likely be)
- Making something personal when it isn’t (e.g. your boyfriend breaks up with you because you will be attending colleges on opposite sides of the country, but you insist it is because he no longer cares about you)
- Emotional reasoning (e.g. making a decision based on feelings rather than facts)
- Overgeneralizing (e.g. making a sweeping generalization based on one incident or limited information)
- Labeling (e.g. you make a mistake on a report and call yourself an idiot)
In many cases, core beliefs begin in childhood. For example, a child who was frequently abused by one or both parents will often mistakenly come to believe that he deserves it because he is unlovable or worthless. To further instill that belief, his parents may have even said that to him on multiple occasions. Children do not have the ability to look at the bigger picture or challenge the validity of hurtful things they are told. They take what is said at face value and assume it is true.
Other beliefs develop more subtly. For instance, a string of bad luck can make a young woman who is prone to depression anticipate continued bad luck. Rather than recognizing that many factors were beyond her control, she adopts the belief that her life is cursed — no matter how hard she tries, nothing will ever work out.
The Proven Efficacy of CBT
More than 1,000 outcome studies have been done on the use of CBT as a primary and adjuvant therapy for psychiatric disorders, as well as a wide array of medical conditions. CBT is an efficacious treatment for depression, anxiety disorders, eating disorders and substance abuse. It is also an effective adjuvant treatment used with medication for bipolar disorder and schizophrenia. CBT has also been paired effectively with medication for irritable bowel syndrome, chronic fatigue syndrome, hypertension, fibromyalgia, post-myocardial infarction depression, non-cardiac chest pain, cancer, diabetes, migraine and several chronic pain disorders.6
Reactions occur as a result of thoughts and feelings — the meaning people give to a particular event or situation. When people are suffering from mental disorders, these meanings are negative, painful or scary. CBT for depression and all the other disorders mentioned above is a therapeutic approach that helps people learn to look at things from a fresh perspective and incorporate newly learned behaviors into daily living.
- Mental Health by the Numbers. National Alliance on Mental Illness website. https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers Accessed June 15, 2016.
- Depression Statistics. Depression and Bipolar Support Alliance website. http://www.dbsalliance.org/site/PageServer?pagename=education_statistics_depression Accessed June 12, 2016.
- MacKenzie MB, Kocovski NL. Mindfulness-based cognitive therapy for depression: trends and developments. Psychol Res Behav Manag. 2016 May 19;9:125-32. doi: 10.2147/PRBM.S63949. eCollection 2016.
- The Origins of Cognitive Behavioral Therapy. Psych Central website. http://psychcentral.com/lib/the-origins-of-cognitive-behavioral-therapy/ Accessed June 15, 2016.
- History of Cognitive Behavioral Therapy. Beck Institute website. https://www.beckinstitute.org/about-beck/our-history/history-of-cognitive-therapy/
- What is Cognitive Behavioral Therapy (CBT)? Beck Institute website. https://www.beckinstitute.org/get-informed/what-is-cognitive-therapy/ Accessed June 15, 2016.