Mini-Literature Reviews: What is CBT?

Let’s get technical - what is CBT and how does it work?

            Cognitive Behavioural Therapy (CBT) is described by Kazantzis et al., (2018) as a therapeutic approach based on the premise that cognitive processes are involved in both the development and maintenance of psychopathologies, particularly those related to impaired functioning and emotional distress. The authors explain that those cognitive processes implicated in emotional distress and impaired functioning are likely to present in therapy and can be addressed, intervened, and shifted through the work of the CBT therapist. The authors go on to identify CBT as a highly adaptable modality which can be shaped to the needs of the client. CBT is supported by countless empirical studies that attest to its efficacy across numerous clinical populations (Kazantzis et al., 2018).

            Carpenter et al., (2018) describe the process of CBT as using scientifically informed interventions as a means of changing dysfunctional cognitions and behaviours. The authors explain that through CBT interventions, clients can reduce their psychological suffering and reduce psychopathological symptoms. The authors also indicate that CBT is associated with outcomes related to reduced symptoms of anxiety and depression and improved quality of life, all of which have significant empirical support regarding the maintenance of those improvements post-therapy treatment. Across studies examining clinical populations of varying race, sex, and ages, related risks of bias regarding these demographics were not identified in CBT outcomes (Carpenter et al., 2018).

            The aim of CBT based interventions, as described by Kolubinski et al., (2018), is to challenge and ultimately weaken previously established negative beliefs in order to cultivate more positive alternative beliefs. The authors note that this is achieved through challenging and evaluating negative beliefs and their associated predictions, reducing physical manifestations of anxiety or depression, changing the individuals’ behaviours, bringing attention to and shifting perception bias, and ultimately reducing self-critical cognitions through both behavioural experiments and cognitive restructuring. CBT is both widely used and researched for the treatment of numerous psychopathological symptoms (Kolubinski et al., 2018).

            CBT is understood to be efficacious for the treatment of depressive symptoms throughout several different delivery methods, as is explained by López-López et al., (2019). The authors note that CBT interventions, despite their complexity, can be provided successfully with varying levels of therapist interaction, with effective self-directed options available for those who may not be able to participate in face-to-face therapy.  The authors note that CBT treatment can even take on hybrid models, where clients can access both multimedia and in-person treatment with notable efficacy. The ability to provide CBT to clients throughout numerous delivery methods helps increase access to CBT care for those who may not have been able to access it without these variation in delivery (López-López et al., 2019).

            CBT as an approach an also provide effective care within varied time commitments through brief CBT, as explored by Shafran et al., (2021). The authors describe that brief CBT can be offered in a low intensity format, where clients utilize more self-help materials and do so for periods of approximately 30 minutes or less, with a total treatment time of approximately 6 hours cumulatively. The authors indicate that low intensity CBT can be effective even with only minimal input from a therapist, but a therapist can be replaced with supportive people within the clients network if necessary. The authors then distinguish brief high intensity CBT, which is based on standard empirically supported CBT treatment delivered by a trained therapist, however contact times are approximately 50% lesser than with traditional longer-format CBT intervention. These variations in treatment options are important innovations that help ensure efficient and effective care can be provided amongst the growing demand for mental health care services (Shafran et al., 2021).

References:

Carpenter, J. K., Andrews, L. A., Witcraft, S. M., Powers, M. B., Smits, J. A., & Hofmann, S. G. (2018). Cognitive behavioral therapy for anxiety and related disorders: A meta‐analysis of randomized placebo‐controlled trials. Depression and anxiety, 35(6), 502-514. https://doi.org/10.1002/da.22728

Kazantzis, N., Luong, H. K., Usatoff, A. S., Impala, T., Yew, R. Y., & Hofmann, S. G. (2018). The processes of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 42, 349-357. https://doi.org/10.1007/s10608-018-9920-y

Kolubinski, D. C., Frings, D., Nikčević, A. V., Lawrence, J. A., & Spada, M. M. (2018). A systematic review and meta-analysis of CBT interventions based on the Fennell model of low self-esteem. Psychiatry research, 267, 296-305. https://doi.org/10.1016/j.psychres.2018.06.025

López-López, J. A., Davies, S. R., Caldwell, D. M., Churchill, R., Peters, T. J., Tallon, D., ... & Welton, N. J. (2019). The process and delivery of CBT for depression in adults: a systematic review and network meta-analysis. Psychological medicine, 49(12), 1937-1947. https://doi.org/10.1017/S003329171900120X

Shafran, R., Myles-Hooton, P., Bennett, S., & Öst, L. G. (2021). The concept and definition of low intensity cognitive behaviour therapy. Behaviour Research and Therapy, 138, 103803. https://doi.org/10.1016/j.brat.2021.103803