Cognitive-behavioral therapy (CBT) was initially devised during the 1970s by Aaron Beck and has since been developed by other psychologists (for example, David Burns, MD) and is now used to treat many conditions that individuals who have experienced significant and protracted childhood trauma are at increased risk of suffering from (especially depression and anxiety).
Put simply, cognitive behavioral therapy (CBT) works on the basic observation that:
1) how we think about things and interpret events affects how we feel
2) how we behave affects how we feel
3) by changing how we think about things, interpret events and behave will CHANGE HOW WE FEEL.
I have over-simplified here but those are the essential three points and my aim in this blog is not to present information in an over-complex way.
RESEARCH INTO EFFECTIVENESS OF CBT IN GENERAL
CBT is widely used by therapists to treat survivors of childhood trauma. A meta-analysis (a review of 106 studies) carried out by Holman et al., 2012, assessed the effectiveness of CBT) found that it was particularly beneficial for the treatment of anxiety disorders, somatoform disorders, problems with controlling anger, stress, and bulimia. The study concludes that, overall, there exists a very strong evidence base that CBT is an effective form of psychotherapy. I myself underwent a course of CBT some time ago and found it very helpful.
RESEARCH INTO EFFECTIVENESS OF CBT FOR THE SPECIFIC TREATMENT OF PTSD
Another, study conducted by Kar entitled: Cognitive Behavioural Therapy (CBT) For The Treatment Of Posttraumatic Stress Disorder: A Review examined how successful CBT had been for treating and preventing PTSD following a variety of different kinds of trauma, including trauma experienced during childhood.
The study found, by reviewing a number of relevant studies, that there is substantial evidence that CBT can be both a safe and effective way of treating PTSD. However, it also found that in up to half of cases those who undergo CBT for the disorder fail to improve in a clinically significant way (although, of course, no form of therapy for PTSD can boast a one hundred percent success rate).
The study also found that CBT could be used effectively by therapists who had only undertaken brief training in the therapy and successful when applied via internet services.
Whilst there is some evidence that CBT can be helpful in the PREVENTION of PTSD, more research is necessary to confirm this.
CBT helps individuals to correct dysfunctional ways of thinking and there is also evidence that it can help the brain repair itself after developmental damage caused by trauma has been incurred. I look at both these beneficial effects below:
CORRECTING DYSFUNCTIONAL WAYS OF THINKING (WHAT WE THINK ABOUT THINGS DECIDES HOW WE FEEL) :
Our thinking styles affect our state of mind and emotions. Survivors of childhood trauma often develop thinking styles that are extremely negative and may give rise to what is sometimes called a COGNITIVE TRIAD of negative thoughts. These are:
– negative view of self
– negative view of the world
– negative view of the future
I have referred to this NEGATIVE COGNITIVE TRIAD in previous articles, but it is worth revisiting. The aim of CBT is to change these negative thinking patterns into more positive ones. It aims to correct FAULTY THINKING STYLES.
FAULTY THINKING STYLES:
Individuals who suffer from this cognitive negative triad of negative thoughts, as I did for more years than I care to remember, are generally found to have deeply ingrained faulty thinking styles; I provide the most common ones below and give a very brief explanation of each type (if the examples seem a little extreme, it is merely to illustrate the point):
e.g. someone is rude to us and we conclude: ‘nobody likes me or ever will’.
So, here, the mistake is vastly over-generalizing from one specific incident.
2) POLARIZED THINKING:
e.g. ‘unless I am liked by everyone then I am unpopular’.
This is sometimes referred to as ‘black or white’ thinking ie. seeing things as all good or all bad and ignoring the grey areas.
e.g. ‘I know for sure this will be an unmitigated disaster and I’ll be utterly unable to cope.’
Here, the mistake is to overestimate how badly something will turn out or to greatly overestimate the odds of something bad happening. It often also involves underestimating our ability to cope in the unlikely event that the worst does actually happen. Also known as ‘WHAT IF…’ style thinking.
e/g. taking an innocent, casual, passing remark to be a deliberate and calculated personal attack. Here, the mistake is thinking everything people do or say is a kind of reaction to us and that people are predisposed to wanting to gratuitously hurt us.
5) SELF BLAME :
e.g. someone says our team has not met its monthly target and we then look for ways to convince ourselves it is specifically and exclusively due to something we have done wrong. With this type of faulty thinking style, we blame ourselves for something for which there is no evidence it is our fault.
6) MINIMIZATION :
e.g. ‘I failed one exam out of ten, therefore I’m stupid and a complete failure’.
Here, the positive (passing nine out of ten exams) is pretty much ignored (minimized) and the negative (failing one exam) completely disproportionately affects our view of ourselves. Individuals who minimize the positive tend to also MAXIMIZE (ie. make far too much of) the negative.
What tends to underlie all these faulty thinking styles is that we UNNECESSARILY BELIEVE NEGATIVE THINGS IN SPITE OF THE FACT WE HAVE NO, OR EXTREMELY LIMITED, EVIDENCE FOR SUCH BELIEFS. Therefore, we unnecessarily and irrationally further lower our own sense of self-esteem and self-worth. Because of these faulty thinking styles, we increase our feelings of inadequacy and depression.
How Cognitive Behavioral Therapy Can Help Repair The Cortex:
Now let’s turn to how CBT can help repair the brain – by way of illustration, I will concentrate upon the cortex.
We have seen from other articles that I have published on this site how severe and protracted childhood trauma can adversely affect the physical development of the brain, including, most importantly, the prefrontal cortex; this damage to the cortex, amongst other effects, can make it much more difficult for us to control our emotions.
This is because the prefrontal cortex is the ‘thinking / rational’ part of the brain that we use to control our emotions (which are generated in the part of the brain known as the limbic system).
If its functioning is impaired, we are in danger of our emotions dictating our behavior at the expense of our more rational judgment (which, in severe cases, of course, can be a recipe for personal disaster in ways that would constitute a very long list).
Cognitive-behavioral therapy (CBT) helps to retrain the functionality of the prefrontal cortex so that we can increase our control over our emotions, as opposed to permitting our emotions to be in control over us.
In more technical terms, CBT, by helping to change the way in which we think and behave, enhances the ability of the prefrontal cortex to inhibit the irrational and dysfunctional emotions that may otherwise cause us to make decisions, or act in ways, of which we later feel regretful or ashamed.
In essence, then, CBT can help our cognitive system to over-ride our emotional system, rather than letting our emotional system over-ride our cognitive system.
SUPPORTING EVIDENCE :
A study conducted by Porto et al. (2009), which carried out a meta-analysis of the relevant research, supported the idea that CBT does indeed beneficially alter the brain on a neurobiological level by changing neural circuits in a manner that helps to control dysfunctional emotions, as has other studies.
Kar N. Cognitive-behavioral therapy for the treatment of post-traumatic stress disorder: a review. Neuropsychiatr Dis Treat. 2011;7:167-181. doi:10.2147/NDT.S10389:
Porto P.R. et al. (2009).Does Cognitive Behavioral Therapy Change the Brain? A Systematic Review of Neuroimaging in Anxiety Disorders Published Online:1 Apr 2009
David Hosier BSc Hons; MSc; PGDE(FAHE).