Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is one of the most common and well-studied forms of psychotherapy. It combines two therapeutic approaches: cognitive therapy and behavioral therapy .

Which treatment methods are used depends on what the problem, disease or disorder is. But the basic idea of the therapy is always the same: What we think, how we behave and what feelings others trigger in us are closely interrelated – and are crucial to our well-being.

Graphic: The basic idea of cognitive behavioral therapy: thoughts, feelings and behavior are closely related

What is cognitive therapy? Information about $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

The term "cognitive" is derived from the Latin "cognoscere" and means "to recognize". Cognitive therapy is about getting clear about your thoughts, attitudes and expectations. The goal is to identify false and stressful beliefs and then change them. Because it is often not only the things and situations themselves that cause problems, but also the perhaps far too great importance that one gives them.

A stressful thinking pattern is, for example, to immediately draw negative conclusions from an incident, to generalize them and to transfer them to similar situations. Generalizing thought patterns are called "overgeneralization" in psychology. Another stressful thinking error is "catastrophizing": something disturbing happens, and exaggerated worries promptly arise that disaster may be imminent.

Such thought patterns sometimes develop into a "self-fulfilling prophecy" and make life difficult for the person concerned. For example, if you believe that other people have something against you, you act dismissively. And thereby triggers oneself to make others more unkind.

However, with the help of cognitive therapy, one can learn to replace false thought patterns with more realistic and less harmful thoughts. KVT helps to think more clearly and to better control one’s own thoughts.

How does cognitive behavioral therapy work? Information about $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

Behavior therapy has its origins in behaviorism. This theory assumes that human behavior (engl. = behavior) is learned and therefore can be changed or re-learned again. Behavioral therapy is about finding out if there are certain behaviors that make your life more difficult or exacerbate problems. The second step is to work on changing such behaviors.

For example, people with depressive thoughts often tend to withdraw and stop pursuing their hobbies. This leads them to feel even more unhappy and isolated. In behavioral therapy, this mechanism can be recognized and ways sought to become more active again.

For anxiety disorders, part of behavioral therapy often involves learning calming behaviors. For example, you can learn to reduce your anxiety by consciously breathing deeply in and out so that your body and breathing become calm. This focuses on the breathing rather than the trigger of the fear. Such techniques can help to calm down and not to get into anxiety.

Most psychotherapists trained in cognitive behavioral therapy call themselves behavioral therapists in Germany.

Which thought and behavior patterns are harmful, which are neutral? Information about $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

Harmful thoughts or behaviors can make you feel bad about yourself. An example: you meet an acquaintance on the street and greet him, but the acquaintance does not greet you back. One’s own reaction to it depends very much on how one evaluates the situation:

Table: Example of harmful and neutral thought and behavior patterns Reaction harmful neutral Thoughts Feelings Behavior
"He ignored me – he doesn’t like me anymore." "He hasn’t noticed me at all – maybe something is bothering him. I should call him again sometime and hear how he is doing."
Those who think this way feel down, sad, and rejected. No negative feelings arise from this thought.
This thought has the effect of making you avoid the person you know in the future, even though your guess could be completely wrong. This idea leads to contacting the person with whom one is acquainted and asking whether everything is all right.

What distinguishes behavioral therapy from other psychotherapies?? Information about $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

Cognitive behavioral therapy (CBT) is problem-oriented. It is about working on concrete current problems and finding solutions for them. In contrast to psychoanalysis, for example, it deals little with the past. The goal of CBT is to address problems in the here and now. The focus is on "helping people to help themselves": they should be able to cope with their lives again as quickly as possible without therapeutic help. This does not mean that the influence of past events is completely hidden in cognitive behavioral therapy. However, the main goal is to recognize and change currently stressful thought patterns and behaviors.

In analytical psychotherapy, which has its origin in classical psychoanalysis according to Freud, other methods are used. Here, the therapist helps to uncover and understand problems and their deeper causes.

When is behavioral therapy appropriate?? Information about $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

Cognitive behavioral therapy is used to treat depression, anxiety, obsessive-compulsive disorder, and addiction, among other conditions. It can also be used for physical illnesses such as chronic pain, tinnitus and rheumatism: it can help to cope better with the symptoms.

Behavioral therapy requires a lot of personal initiative. It can only be successful if you talk actively and openly with the therapists during the sessions and also work on your own problems between sessions. Especially in the case of severe mental illness, such as a pronounced depression or anxiety disorder, this can require a lot of strength. Sometimes, therefore, medications are first used to alleviate the strongest symptoms in the short term and thus make psychotherapy possible in the first place.

The decision for a certain type of psychotherapy also depends on what goals you have. If there is a need to gain deep insights into the causes of one’s own problems, behavioral therapy is probably not the right choice. It is useful when someone wants to deal with concrete problems and is less interested in reasons.

How does behavior therapy work and how long does it last?? Information about $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

In cognitive behavioral therapy, close and trusting cooperation between psychotherapist and client is important. Sometimes it takes a while to find the right therapist.

In the first interview, the patient briefly presents his or her problems and expresses wishes and expectations for the therapy . Then the treatment goals and the therapy plan are agreed upon together. If personal goals change in the course of therapy, they are adjusted accordingly.

Part of the therapy often consists of recording one’s thoughts in a diary over a period of time. Then, together with the therapist, it is examined: Am I realistic about the things I am experiencing?? What happens when I behave differently in a particular situation than I have in the past? Progress made and possible problems are regularly discussed in the sessions.

Within the framework of behavioral therapy, exercises for relaxation, stress or pain management are also applied. In addition, one gets to know procedures that help to solve problems.

Compared to analytical psychotherapy, behavioral therapy is a short-term treatment. However, it is not possible to say in general how long a therapy will take. Some people feel much better after just a few sessions, while others require treatment over several months. This depends, among other things, on the type and severity of the problems. A one-on-one session usually lasts about an hour. Sessions usually take place once a week. Cognitive behavioral therapies are offered in therapeutic practices, clinics, and rehabilitation facilities, sometimes as group therapy or online using digital media.

Can behavior therapy also have undesirable effects? Information on $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

Psychotherapy can also have adverse effects: For example, direct confrontation with one’s own problems or fears can initially be stressful and unsettling or lead to a deterioration in relationships with others. It is important to talk openly about this with the psychotherapist if difficulties arise during therapy.

There has been little scientific research into the adverse effects of psychotherapy.

Who pays the costs? Information on $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

In the case of mental illnesses such as depression, anxiety or obsessive-compulsive disorders and addictive disorders, cognitive behavioral therapy is covered by the statutory health insurance fund. Behavioral therapy can also be paid for if complaints resulting from a chronic illness lead to considerable suffering. However, it can take several weeks or months to get a therapy place or until the health insurance approves the treatment.

A psychotherapeutic practice can initially bill the statutory health insurance for two to four probationary sessions (trial sessions) – with children and adolescents or people with mental disabilities, even up to six. This allows psychotherapists and clients to get to know each other and to determine what problems exist and whether therapy makes sense. After the probationary sessions, we jointly prepare an application for the statutory health insurance, justifying why therapy is necessary. The client must submit this application to his health insurance company before the start of therapy. In addition to the application for therapy, the health insurance company requires a (general) practitioner’s report stating that the present complaints are not physically caused and that there are no medical reasons against psychotherapy. The statutory health insurance then decides whether a therapy is approved on the basis of an expert opinion.

Pschyrembel. Clinical dictionary. Berlin: De Gruyter; 2017.

Schulz H., Barghaan D., Harfst T., Cook U. Psychotherapeutic care . Robert Koch Institute (RKI); 2008. (Federal health reporting).

IQWiG health information is intended to help understand the advantages and disadvantages of important treatment options and health care offerings.

Whether one of the possibilities described by us is actually useful in the individual case can be clarified in a conversation with a doctor. Health can support, but not replace, discussions with physicians and other professionals. We do not offer individual counseling.

Our information is based on the results of high-quality studies. They were prepared by a team of authors from the fields of medicine, science and editing and reviewed by experts outside IQWiG. How we develop our texts and keep them up to date, we describe in detail in our methods .

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