What is cognitive behavioral therapy CBT

The cognitive behavioral therapy (CBT) (Synonym: cognitive-behavioral therapy) is one of the psychotherapeutic procedures and is a form of behavioral therapy. A large number of methods of psychotherapy are included under behavioral therapy. The aim is to change attitudes, thinking habits and inappropriate or dysfunctional behaviors such as B. fears, obsessive thoughts or actions, eating and sexual disorders, or depressive disorders. Another form of behavior therapy is, for example, the therapeutic confrontation with fear-inducing situations (confrontation theory), e.g. B. in patients with agoraphobia (claustrophobia).

Behavioral therapy was developed on the basis of learning theory, which is based on the assumption that faulty learning processes lead to psychopathological syndromes. As a further development of this conclusion, modern cognitive behavioral therapy gained popularity around 1960. The term cognition (Latin cognoscere: "to recognize") is translated in German as "knowledge" and describes intrapsychic thought content. It is about the thinking process of an individual or the mental processing process with regard to knowledge, new information or learning content. Cognitions include the following quantities and are influenced by emotions:

  • reviews
  • thoughts
  • Settings
  • Beliefs

Thus, it is not certain events or life situations that are the cause of a mental illness, but rather faulty cognitions or irrational ways of thinking. These offer the therapeutic starting point for cognitive behavioral therapy.

Indications (areas of application)

The classic indication for cognitive behavioral therapy is usually depression. Further indications are:

  • Anxiety and Panic Disorders
  • Enuresis in children (involuntary wetting after the age of 4)
  • Eating disorders - e.g. B. Anorexia nervosa (anorexia)
  • Emotionally unstable personality disorder (borderline personality disorder)
  • Insomnia (difficulty sleeping)
  • Sexual disorders
  • Specific phobias - e.g. B. Arachnophobia (fear of spiders)
  • Somatization disorders (mental disorder that manifests itself in physical (somatic) symptoms)
  • Addictions - e.g. B. Alcohol abuse (alcohol dependence)
  • Tics in children (tics are sudden, repetitive motor or vocal expressions such as a twitch)
  • Training in social behavior - e.g. B. in disabled people to improve social functions.
  • Obsessive-compulsive disorder - e.g. B. Compulsory washing

Contraindications (contraindications)

Cognitive behavioral therapy (CBT) requires a level of cognitive ability so that young children or people with severe cognitive deficits such as B. in the context of dementia, cannot be treated. Any situation in which a patient is temporarily restricted in his or her cognitive ability arises as a contraindication. B. acute psychosis.

The procedure

Among other things, cognitive behavioral therapy can be traced back to the work of the psychotherapist A. T. Beck, whose theory was based on the alleviation of depressive symptoms by changing dysfunctional thought patterns. Here z. For example, depressive patients are instructed to reflect on self-concepts with regard to self-depreciation and chains of thought and to check them with regard to their appropriateness or irrationality. Then, together with the patient, alternatives and new ways of thinking are developed in order to counteract the faulty cognitions. Various techniques can be used to achieve this goal:

  • Assertiveness training - As part of a self-confidence training, z. B. with the help of role-play skills learned to solve a fearful situation.
  • Thought stop - This technique is used e.g. B. Applied in patients with obsessive-compulsive disorder: The patient is instructed to defend himself against obsessive-compulsive thoughts or compulsive impulses by saying aloud "stop" to himself.
  • Decastrophization - Showing alternative course options to the feared catastrophic outcome of a fearful situation.
  • Cognitive restructuring - awareness of automated ways of thinking: A patient with fear of flying is e.g. B. pointed to the comparatively very low risk of an airplane crash.
  • Model learning - learning from other patients in group therapy.
  • Problem solving exercises - learning problem solving strategies.
  • Self-verbalization - positive self-instruction by the patient himself ("I can do it").
  • Reattribution - change in a negative attribution, d. H. For example, switching from internal attribution to external attribution.
    For example, if a patient thinks that only his wrongdoing caused a situation, then it is an internal attribution. If the patient succeeds in convincing that the misconduct of other or external factors have caused the situation (external attribution), the symptoms can be alleviated.

The duration of cognitive behavioral therapy varies with the individuality of the patient. The therapy is usually carried out for one hour, initially twice a week, later once a week. As a rule, 25 sessions are initially approved, and patients are often treated in a psychotherapeutic practice for up to a year or more. At the beginning of a meeting, a specific objective is formulated, and both retrospective and prospective parts of the meeting are included. Often "homework" is given and reflected on in the next session.

The following variants and forms of cognitive behavioral therapy should be mentioned:

  • Problem solving therapy
  • Schema therapy - the basis is the theory of learned basic schemas that serve to satisfy basic psychological needs and thus control human behavior.
  • Self-control therapy
  • Social skills training
  • Behavior modification
  • Behavioral family therapy

Possible complications

In general, no complications are to be expected with cognitive behavioral therapy. If a partnership is the subject of the therapy, consequences for the partnership may arise as a result of the cognitive behavioral therapy.

More information

  • Patients with aPanic disorder who were successfully treated with cognitive behavioral therapy (CBT) showed in magnetic resonance imaging a changed activity in a brain area that processes panic-related word pairs. Conclusion: CBT prevents associations that are symptomatic for patients with panic disorder [7].
  • CBT appears to reduce the incidence of renewed self-harm (associated with suicides) [6].
  • At Jadolescents with a first psychotic episode CBT alone or in combination with antipsychotics appears to relieve symptoms in adolescents [8]:
    • Antipsychotics alone had reduced the PANSS total score (Positive and Negative Syndrome Scale) by 6.2 points after six months
    • Psychotherapy by 13.1 and with combination therapy by 13.9 points

literature

  1. Möller HJ, Laux G, Deister A: Psychiatry and Psychotherapy; Dual series. Georg Thieme Verlag 2005
  2. Aldenhoff J: Psychiatric Therapy. Schattauer Verlag 2007
  3. Schramm E: Interpersonal Psychotherapy. Schattauer Verlag 2010
  4. Bandelow B: Short textbook psychiatry. Springer Verlag 2013
  5. Batra A, Buchkremer G, Wassmann R: Behavioral Therapy: Basics - Methods - Areas of Application. Georg Thieme Verlag 2012
  6. Hawton K, Witt KG, Salisbury TLT et al .: Psychosocial interventions following self-harm in adults: a systematic review and meta-analysis. Lancet Psychiatry 2016 Aug; 3 (8): 740-50. doi: 10.1016 / S2215-0366 (16) 30070-0. Epub 2016 Jul 13.
  7. Yang Y et al .: Effect of CBT on Biased Semantic Network in Panic Disorder: A Multicenter fMRI Study Using Semantic Priming. At J Psychiatry. 2019 Dec 16: appiajp201919020202. doi: 10.1176 / appi.ajp.2019.19020202
  8. Morrison AP et al .: Antipsychotic medication versus psychological intervention versus a combination of both in adolescents with first-episode psychosis (MAPS): a multicentre, three-arm, randomized controlled pilot and feasibility study. Lancet Psychiatry 2020; https://doi.org/10.1016/S2215-0366(20)30248-0

     
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