Cognitive behavioral therapy is a form of psychotherapy that is based on the idea that our thoughts, feeling and behaviors are all linked.
What is CBT?
The most popular type of psychotherapy is CBT. It is a form of psychotherapy that helps individuals to recognise and modify thought patterns and behaviours that are contributing to their psychological difficulties. CBT relies on the idea that our thoughts, feelings and behaviours are all interconnected, and that changing our thinking in certain areas can lead to positive changes in our feelings and behaviours. An example of a CBT intervention for a patient would be to have them identify and challenge any negative thoughts or beliefs that may be contributing to their emotional distress. The patient would learn to recognise irrational thinking and replace it with more balanced and realistic thoughts. The therapist would also help the patient to become more aware of their triggers and how to take more effective action in managing difficult situations. The core principles of CBT are: Cognitive restructuringThis is the process of identifying and changing thinking patterns that may lead to negative thoughts and beliefs.
Exposure and response prevention
This technique focuses on reducing the fear associated with thought patterns and behaviours by gradually exposing an individual to the source of their fear and preventing any reaction from occurring. Behavioural activation This technique encourages individuals to engage in enjoyable activities, even when they may find it difficult to manage their feelings. Relapse prevention This technique helps individuals understand how to maintain their positive changes and prevent a recurrence of old thoughts and behaviours that may contribute to mental health concerns. There are many different types of CBT, including: Cognitive therapy This focuses on identifying and challenging irrational and maladaptive thought patterns to improve emotional regulation. Dialectical behaviour therapy This helps individuals learn to better manage intense emotions, self-harm behaviours and interpersonal relationships. Rational emotive behaviour therapy This helps identify irrational beliefs and replaces them with more adaptive, realistic thought patterns. Acceptance and commitment therapy This helps individuals become more aware of their thoughts and feelings, and encourages them to become more psychologically flexible and accept difficult experiences. Mindfulness-based therapies These help individuals become more aware of the present moment and develop a non-judgmental attitude towards thoughts and feelings.Efficacy of CBT
Behavioural activation encourages individuals to engage in enjoyable activities, even when they may not feel emotionally up to it. — AFP
Several studies have found that CBT is effective in treating a variety of mental health conditions, such as depression, anxiety, insomnia, post-traumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD).
For example, a meta-analysis published in the Journal of Consulting and Clinical Psychology found that CBT was more effective than placebo in reducing symptoms of depression and anxiety.
One assessment review found that CBT was more effective than other forms of psychotherapy in reducing symptoms of anxiety and depression.
Another study published in the American Journal of Psychiatry found that CBT was more effective than antidepressant medications in reducing symptoms of mild depression.
CBT can be used to effectively address a variety of other psychological conditions too, including phobias, substance misuse, eating disorders, personality disorders, anger management, relationship issues and chronic pain.
CBT can also help individuals develop more effective coping strategies for stress, improving self-esteem and enhancing overall psychological well-being.
Limitations of CBT
Mindfulness techniques, where individuals become more aware of the present moment, are part of CBT. — dpa
Although CBT is an effective form of psychotherapy, there are potential limitations and pitfalls to be aware of.
For example, it requires a high degree of commitment and effort from the individual in order to achieve successful outcomes.
Additionally, since CBT primarily focuses on changing thought patterns and behaviours, it may not be as effective in addressing any of the individual’s underlying emotional issues.
Moreover, some individuals may find the cognitive restructuring techniques employed in this therapy to be psychologically challenging.
Also, it may not be as effective for individuals in more severe mental health states, such as those experiencing psychosis.
Some have argued that CBT does not acknowledge the role of biological factors in mental health issues, and that it can be an overly-mechanistic approach.
Biological factors in mental health refer to the brain and body’s physical and chemical processes that contribute to psychological issues.
These include neurological, genetic, endocrine and biochemical pathways, such as neurotransmitters and hormones, which can influence thoughts, feelings and behaviours.
An example of this would be hormonal imbalances in medical conditions like thyroid disorders, causing psychological manifestations.
CBT is not as well understood as some other forms of psychotherapy, in part because it is a relatively new form of treatment.
Additionally, many clinicians lack the knowledge and skills to properly implement CBT, and this can prevent individuals from receiving evidence-based treatment.
Finally, there is a lack of adequate research and comprehensive training programmes that can help clinicians gain the necessary skills to effectively utilise this therapy.
In my clinical practice, I have often been asked two questions.
Firstly, if CBT can be started together with psychotropic medications.
And secondly, if CBT can be the only form of treatment in place of psychotropic medications.
CBT can indeed be given together with psychotropic medications.
The combination of CBT and medication is often the most effective treatment for many mental health conditions, including depression and anxiety.
Medication can help reduce the symptoms of the condition and CBT can help to address underlying causes of the disorder, such as negative thinking patterns, lifestyle choices and patterns of behaviour.
Because of this, CBT may not be an appropriate sole substitute for psychotropic medications in the vast majority of cases.
It is important that each patient’s individual needs are considered carefully when determining the best treatment plan.
Ultimately, it is best to discuss with one’s mental health therapist the method of treatment that is most suited for an individual’s needs, rather than insisting on a therapy that seems appealing.
The mental health needs of every individual is unique, and therefore, a customised approach should be preferred for the best outcome.
Prof Datuk Dr Andrew Mohanraj is a consultant psychiatrist, the Malaysian Mental Health Association president and Taylor’s University Impact Lab on Mental Health and Well-being director. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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In conjunction with World Obesity Day yesterday, we take a look at how the understanding of this condition of
excess weight has evolved. ...
When men eat wrong
.The idea that obesity is a disease of the brain is gaining traction among scientists as the hypothalamus (in yellow) plays a key role in regulating our appetite and metabolism.>>
This is because obesity is a very complex issue with a lot of interconnected causes.
In the past, it was assumed that as our society became richer, we had to physically work less to get our food and this led to over-nourishment.
However, we now know that it is overly simplistic to think that obesity develops as a result of an individual just “eating too much”.
Instead, there are often multiple factors beyond our control that contribute to an individual developing obesity.
For example, people who come from disadvantaged socioeconomic backgrounds may not have the financial privilege of accessing healthy food options.
They may also not be educated enough to choose better quality food with their available resources.
Children born into these families with a history of obesity have higher chances of developing obesity later on in life.
This is partly contributed by genetic factors, as well as enduring lifestyle habits inculcated from a young age that may be difficult to change.
Obesity is also closely linked to the development of mood disorders such as depression and anxiety.
People suffering from depression also have a higher chance of developing eating disorders that subsequently lead to obesity.
A lot of these factors form vicious cycles that span generations.
On a population scale, we are living in an increasingly “obesogenic environment”.
This refers to the multiple physical, economic and sociocultural factors that collectively contribute to the development of an obese population.
For example, our built environment promotes a sedentary lifestyle.
Our roads are hardly pedestrian or bicycle-friendly.
Our public transportation system is not optimised, as the lack of last-mile connectivity remains a major hindrance for many.
As a result, most Malaysians are heavily dependent on motorised vehicles to get around, rather than walking or cycling.
Globalisation and industrialisation of the food supply chain have made ultra-processed foods more common now than ever.
Ultra-processed foods refer to those that have gone through a series of industrial processes, often with ingredients like high-fructose corn syrup, modified oils, food colouring and other additives to make the final product hyper-palatable.
These foods are commonly high in calories and easily over-consumed.
They are generally mass-produced and marketed by large companies, and are often much cheaper and more readily available compared to whole, nutritious food options.
As we start to understand more about obesity, it has become increasingly clear that it is, in essence, a disease of the brain.
The hypothalamus located in the brain plays a key role in regulating our appetite and metabolism.
The satiety centre in the hypothalamus is largely responsible for controlling our sensation of hunger.
When an individual develops obesity, the accumulation of excessive fat tissue actually leads to a host of hormonal changes within the body.
These hormonal changes not only suppress the satiety centre and increase hunger, but also slow down our metabolism rate.
Essentially, our body has a weight “setpoint”, and will try to revert to this setpoint despite our best efforts.
These underlying biological mechanisms are largely out of our voluntary control.
They also explain why people with obesity who embark on lifestyle changes to lose weight tend to hit a plateau after an initial weight loss.
In fact, after some time, they may regain some of the weight they lost initially.
