Cognitive behavioural therapy, or CBT, is a method of psychotherapy that decades of research has shown to be effective in treating many conditions, including depression, anxiety disorders, PTSD, OCD, and even schizophrenia, among others. It is widely used by therapists and treatment programmes. CBT also forms the basis for a number of other treatment methods, including dialectical behavioural therapy, or DBT, acceptance and commitment therapy, or ACT, cognitive-behavioural family therapy, and mindfulness-based cognitive therapy, or MBCT.
CBT is based on the insight that our emotions are a result of our thoughts. When our thinking is faulty or distorted, we have negative emotional reactions. So for example, if two people fail to get a promotion at work, both will naturally be disappointed, but what each person thinks about the situation will affect her emotional state going forward. One person may think something like, “I failed again. I can’t do anything right. My career is pretty much finished.” The other person might think something like, “I would have preferred to get that promotion, but I know I’ll have other chances. It’s hard to know what factors made the difference. Maybe this is an opportunity to get some feedback so I can improve my work.”
The first person’s reaction is much more likely to lead to feelings of helplessness, depression, despair, and more negative outcomes, whereas the second person’s reaction is more likely to to lead to a quick recovery and more perseverance. The main goal of CBT is to take the former and turn it into the latter. A CBT therapist helps you become aware of the distorted thinking and replace it with more rational, constructive ways of thinking. This process is called cognitive restructuring. CBT is typically done in individual sessions. It’s typically very focused on one or two specific issues and therefore is relatively short compared to other forms of talk therapy. A typical course of CBT might last as little as eight weeks, meeting once per week.
MBCT also works on the insight that our thoughts cause our emotions, but the way MBCT teaches you to deal with those thoughts is slightly different. Instead of challenging distorted thinking and replacing those thoughts with more rational ones, MBCT teaches you to separate yourself from your thoughts, a process called “decentering.” According to MBCT, the problem is not so much with the thoughts themselves as our believing the thoughts. MBCT teaches you to hold your thoughts at arm’s length, to experience them nonjudgmentally rather than reacting to them automatically as if they were objectively true. This way, you break the automatic cycle of a challenging event leading to a distorted thought, which leads to negative emotions.
MBCT can be delivered individually, as with CBT, and it’s also used for a limited number of sessions like CBT and both methods involve homework. However, MBCT can also be delivered in a group setting, more like a class, lasting about eight weeks. MBCT is based on mindfulness meditation, specifically the mindfulness-based stress reduction method, or MBSR, developed by Jon Kabat-Zinn. The classes teach you about how the brain functions during depressive episodes and guides you through meditation techniques designed to increase your mindful attention. Then, you do homework assignments and practice mindfulness meditation daily between sessions. Studies have found that just eight weeks of mindfulness meditation is enough to change the structure of the brain and start causing positive changes in emotions and behaviour. The MBCT intervention is intended to teach you the skills so you can keep practicing on your own. People generally find that the longer they practice, the better they feel.
The major benefit of MBCT and mindfulness meditation is that you gradually develop metacognitive awareness, or the ability to know what you’re thinking and feeling. The difference is subtle but profound. It turns “I’m such a loser” into “I’m feeling discouraged right now.” The first thought makes you feel worse, while the second is simply acknowledging your emotions without reacting. It even opens a little space where you can extend some compassion to yourself.
Because of this emphasis on metacognitive awareness, MBCT is especially good for people who struggle with addiction and people who have had several episodes of major depression. Automatic thinking is common to both addiction and depression. In addiction, automatic thinking prompts you to reach for drugs or alcohol whenever you’re triggered. In depression, automatic thinking leads you into a spiral of negative thoughts and emotions. And, of course, many people who suffer from depression also struggle with substance use. MBCT makes you more aware of automatic thinking and allows you to respond rather than react.
Although MBCT and CBT are both effective, which is right for you depends on your particular situation. People who have had several episodes of major depression have about a 50 percent chance of relapsing a year or two after discontinuing CBT because those automatic thoughts start creeping back in. MBCT makes you more aware of those thoughts so you can deal with them more skillfully. People who have had at least three episodes of major depression get the most benefit from MBCT. On the other hand, if you are struggling with a mental health issue other than addiction or recurring depression, CBT is probably better. Even people who have depression caused by a life event, such as loss of a loved one, do better with CBT. If you think MBCT might be a good fit for you, talk to your therapist about how you might integrate it into a treatment plan.
If you or someone you love is struggling with addiction or mental illness, The Dawn Medical Rehab and Wellness center can help. We are one of Thailand’s most respected addiction treatment and wellness centers. We use established, research-backed treatment modalities such as CBT and MBCT, as well as cutting-edge treatment modalities to provide personalized care to treat addiction, depression, anxiety, bipolar disorder, personality disorders, PTSD, and executive burnout. See our contact page to reach us by phone or email.