How does CBT Work?

Cognition (thought) ----> Emotion -----> Behavior

Simplest explanation:

The theory shows that our cognition (how we think about ourselves, others, and the environment) cause emotions. Even emotions that seem as rapid as reflexes are in fact influenced by our cognition. The emotions give us the drive to do a behavior.

Note: While CBT has been shown by repeated studies to help a wide array of problems, even healing the person where medications have at best suppressed the problems at the cost of side effects and needing the medications indefinitely, there are two points that should ethically be disclaimed:

1. Medication can be helpful in severe cases, especially when a problem needs more immediate assistance (e.g., the party is coming up that month). Studies have shown the combination to be effective. We can work with your prescriber, or recommend one, if you wish to go this route. We do not recommend only medication.

2. CBT is one of many effective models of therapy with its own strengths and limitations. Most top-rated psychotherapists pull from different models based on an individual's situation instead of a cookie-cutter strategy (aka no "one size fits all" therapy model). See beyond CBT to learn more.

Here's the application of the theory on why a person, "Jen", has social anxiety on the way to a holiday party for work, which also aggrivates her irritable bowel syndrome (IBS):

1. Cognitive Stage: Jen anticipates that she'll be going to the party and her mind flashes with ideas about how it may go poorly.

2. Emotional Stage: Seeming almost as if the emotions start with or before the thoughts, Jen starts to feel anxious & worried about it. Her heart rate increases somewhat and she starts to worry about how she'll handle being there with some unknown people in a relatively unfamiliar environment. Her physically caused IBS is also worsened from this stress as she starts to feel physical discomfort.

3. Behavioral Stage: Jen may now end up in a panic attack, having to pull over or risk an accident. She might have lower abdominal pain or even a bowel movement if the physical cause combined with the stress puts her over the edge. Or, if she has none of the above and makes it to the party, she may have those symptoms at the party. Or, in the best-case-scenario, she'll find attendance at the party to be taxing instead of enjoyable.

CBT can help break the cycle by helping Jen to relax when thinking about her worries about the upcoming party. She can also learn to replace her fearful thinking with hopeful thinking. This can lead to the emotion of "hope", or a positive anticipation. Attending the party can then be productive, fun, and not nearly so taxing.

Her therapy may include exploring her cognitions more thoroughly for better insight, learning what relaxation exercises work for her, journaling, and writing out her negative thoughts and replacing them with positive thoughts. CBT is considered successful when Jen meets her goals of less taxing visits to parties and no stress-induced IBS symptoms.

Special Note: All too often psychiatric, if not non-psychiatric, conditions go misdiagnosed. The wrong diagnosis may not respond properly to treatment. Much time, money, and stress can be saved by ensuring a thorough diagnostic evaluation takes place, rather than meeting with a doctor for 50 minutes and then starting treatment. Please see here to learn about accurate diagnosing.

Therefore, this more complex explanation quoted from Wikipedia works best when the right diagnosis is first identified, or the subsequent steps may be for naught:

"CBT has six phases:[6]

    1. Assessment or psychological assessment;

    2. Reconceptualization;

    3. Skills acquisition;

    4. Skills consolidation and application training;

    5. Generalization and maintenance;

    6. Post-treatment assessment follow-up."