May 11 • 5M

93. Is This CBT?

Clearing up a bit of confusion.

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DISCLAIMER: I have to remind you that this newsletter/podcast is not therapy or a substitute for therapy. This is not a peer reviewed journal article. It is merely a fast overview designed to clear up some basic points of confusion in the community. When in doubt, ask your mental health care provider.

If you’ve listened to me for any length of time, you’d have heard me say over and over that cognitive behavioral therapy (CBT) is the “gold standard” for treating issues like panic disorder, agoraphobia, and other anxiety disorders. I stand by this statement, but I see questions about CBT enough in the community to know that some clarification is needed, so we’ll look at these questions from time to time.

CBT - Cognitive Behavior(al) Therapy is at this point more of an umbrella term than anything else. There are quite a few different therapies that fall under this umbrella. “CBT” by itself is becoming less of an accurate description of treatment, at least in circles occupied by clinicians that are keeping pace with changes in the field over the last 25+ years. If someone told me they were “doing CBT”, I might ask them for more specifics now, because I’d be curious as to which variant of CBT they were working with.

I get asked quite often if XYZ therapy is CBT or not. So let’s take just a minute or two and do a very cursory review of which well-known and widely practiced therapies fall under that CBT umbrella. Note that this is not an exhaustive list. There are bound to be other therapies that I miss here, especially those that might be in their emergent stages and not widely referenced. Just because I do not include a therapy in this list does not mean it does not belong.

  • ACT - Acceptance and Commitment Therapy

  • DBT - Dialectical Behavior Therapy

  • MCT - Metacognitive Therapy

  • MBCT - Mindfulness Based Cognitive Therapy

  • FAP - Functional Analytic Psychotherapy (not to be confused with psychoanalysis, which is not this)

That’s the beginning of a strong bowl of alphabet soup, isn’t it? I know, this can get confusing. From time to time we’ll dedicate editions of The Anxious Morning to a basic overview of these and maybe other forms of therapy just because being an educated consumer is a good thing.

But why is this so confusing within the context of CBT? Because what many people call CBT is an older type of therapy that emerged to glue the idea of cognition (thinking and inner experience) to the basics of behaviorism (that tended to discount those things). That therapy was based on the idea that we should be able to control thoughts themselves, and therefore change behaviors. “Old school” CBT was concerned with using tools like fact checking, thought records, and thought challenging to use thinking to change thinking. The idea was that if you could get a handle on and transform your thoughts, you would ultimately change your behavior.

That was certainly an improvement over Skinnerian behaviorism, but when talking about that kind of “CBT” keep in mind that you’re talking about a form of therapy that isn’t necessarily being replaced, but augmented and changed over time by the newer more process focused therapies I listed above.

Therapy is an ever changing thing. The more we learn and the more research is performed, the more evidence and data we can use to modify how we approach mental health, including anxiety disorders. It’s natural for things to evolve over time. This is a good thing. We want that.

So if you are asking the question, “Is this CBT?” this short article might be a starting point for answering that. If your therapist or potential therapist is practicing one (or a combination) of the therapies I listed, then yes, this falls under the CBT umbrella. If your therapist is practicing old school CBT full of worksheets designed to catch and change thoughts, that is also CBT, but an older form. Often the older and newer forms will often be combined, which is totally fine, and at this point in time, expected.

So to use a phrase I’m told I use quite often … there ya go. I can’t answer every specific question about CBT in one morning newsletter, but this is a start. If you’d like to see more of this kind of thing, let me know I the comments and I’ll be happy to arrange that. I bet I can even drag some of my super smart therapist friends in to help us with that if we want.

Are you listening, super smart therapist friends? Do you have anything you want to add?