Cognitive-Behavior Therapy 

What is Cognitive-Behavior Therapy?

Cognitive therapy is the opposite of behavior therapy. Cognitive therapy focuses primarily on the thoughts and emotions that lead to certain behaviors, while behavioral therapy deals with changing and eliminating those unwanted behaviors. However, some therapists practice a type of psychotherapy that focuses on both thoughts and behavior. This type of treatment is called cognitive-behavior therapy.

Cognitive-behavior therapy (CBT) helps improve a child’s moods, anxiety and behavior by examining confused or distorted patterns of thinking. CBT therapists teach children that thoughts cause feelings and moods which can influence behavior. During CBT, a child learns to identify harmful thought patterns. The therapist then helps the child replace this thinking with thoughts that result in more appropriate feelings and behaviors.

For example, a child with depression has often developed automatic negative responses to life events. The child may call a friend to play and the child (named John) might say “I can’t play right now.” The child with adaptive thought patterns will say to himself “John can’t play right now. He must be busy. Maybe I should call a different friend and call him tomorrow.” The child with negative patterns of thinking and tendency toward depression may think “Johnny can’t play right now. He doesn’t like me anymore. No one likes me. I don’t have any friends.” Same life event, very different response. One goal of cognitive therapy is to help the child understand that he is interpreting the same life event in a very negative way due to assumptions that may not be true and that he is also generalizing the event to his whole life. The therapist will try to help the child recognize when he/she is doing this and redirect his/her thinking to a more adaptive approach.

Who Performs Cognitive-Behavior Therapy?

Cognitive-behavior therapy may be performed by a variety of mental health professionals such as licensed psychologists, social workers and counselors. The minimum education requirement is a master’s degree in a related field and adequate preparation to provide CBT as evidenced by both coursework and supervised clinical experience.

Several methods of CBT may be used, depending on the particular problem. CBT is considered short-term therapy, with anywhere from 8-16 sessions needed in general. Some of the techniques used include:

  • Guiding self-statements (“Stop, Think, Act”)
  • Positive self-statements (“You can solve this problem”)
  • Verbal self-instructions (“What are all of my options to solve this problem?”)
  • Relaxation training (controlled breathing, progressive muscle relaxation)
  • Recognition of faulty cognition (“I know she didn’t mean it; it was an accident”)
  • Modeling, role playing and reinforcement for using CBT skills

Finding a Qualified Therapist or Program

Parents may receive a referral from their doctor to a qualified mental health professional that is on their health insurer’s provider panel. Parents may then want to follow up with the therapist with questions about specific training experiences, what specific types of problems the provider treats, what types of disorders are treated and how frequently, and what interventions are used can provide useful information. Finally, parents should ask about communication policies between the mental health provider and referring physician to enhance coordination of care.

Who Usually Receives Cognitive-Behavior Therapy Treatment?

Children as young as 6 or 7 may benefit from cognitive-behavior therapy. A child must have the ability to understand concepts such as self-talk and self-instruction, which may be more likely in older children.

What are the Benefits of Cognitive-Behavior Therapy?

The benefits of CBT are similar to the benefits of behavior therapy and may include:

  • Receiving emotional support
  • Resolving conflicts with others
  • Understanding how feelings impact thoughts and actions
  • Reversing negative patterns of thinking, addressing bad habits
  • Appropriately dealing with stress and frustration
  • Participating positively in a variety of activities
  • Setting goals to replace negative patterns of behavior with positive ones
  • New ways of learning and self-help techniques are reinforced
  • Increase in self-esteem
  • Improved performance at school, at home and in social situations

Cognitive behavioral therapy can be used to treat anxiety and depression and to prevent relapse of anxiety or depression in children who have been treated with medications.

Drawbacks of Cognitive-Behavior Therapy

One of the main drawbacks of CBT is that it depends on the child’s willingness to learn new skills and practice them for it to be effective. This can be a treatment barrier when CBT is being used to address an issue that the child is not necessarily interested in resolving, or one that may requires too much effort to overcome. Parents, too, must be willing to encourage the child to practice new skills and use positive reinforcement for cooperation and successful outcomes. This may be difficult to do in the context of a larger therapy program or just as part of the daily family routine. For some conditions, CBT has also been found to be more effective when medication is added than when practiced alone.

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