Cognitive Behavioural Therapy and Psychotherapy: What is the Difference?
July 29, 2024
Psychotherapy
Psychotherapy, also known as “talk therapy”, is a broad term that refers to the treatment of mental health issues through conversational methods (as opposed to prescribed drugs or other medical interventions).
Psychotherapists are those trained in psychotherapy who use “talk therapy” to help their patients understand past experiences, improve their relationships, develop more self-awareness, heal psychological wounds, and/or change problematic behaviours.
However, psychotherapy is what is known as an umbrella term. It encompasses other areas of therapy such as Cognitive Behavioural Therapy (CBT) psychoanalysis and Gestalt therapy. These are all methods of talk therapy that fall under the rubric of psychotherapy. CBT focuses on negative thought patterns and behaviours, psychoanalysis tries to uncover unconscious feelings, and gestalt therapy goes deep into role-playing situations. There are many other types of psychotherapy, but let us focus here on CBT which has gained in effectiveness and popularity in recent years.
Slightly confusingly there is a difference between psychotherapists and cognitive behavioural therapists. Cognitive behavioural therapists will have specific training within cognitive behavioural therapy whereas psychotherapists will have psychotherapy training, which is similar to counselling training but is longer, more in-depth and covers more therapy approaches. You can be both a CBT therapist and a psychotherapist at the same time, or just one type. Just because someone is a broad psychotherapist though does not mean they have received training in CBT and vice versa.
Cognitive Behavioural Therapy (CBT)
Cognitive Behavioural Therapists attempt to identify and then change negative thought patterns and behaviours. The treatment is based on the theory that thoughts, behaviours and physical feelings a person has all interact with one another. For example, someone will think something, that will lead to a behaviour and result in a physical feeling. This process can start and end with either three of the categories.
Sometimes when people are struggling, these behaviours, thoughts and physical feelings can turn negative and when they interact people can get stuck in a vicious cycle. For example, someone thinks they cannot cope, so they start trying to overachieve, so they feel tired meaning that they think they cannot cope even more and the cycle starts again (see below for an example vicious cycle of a panic attack). CBT tries to break this vicious cycle by trying to alter the thoughts and behaviours using different tools and techniques.
Techniques used in a CBT session include:
- cognitive restructuring (challenging and changing negative thoughts)
- behavioural activation (increasing engagement in positive activities to increase motivation)
- exposure therapy (gradual exposure to fears and phobias)
- mindfulness and relaxation techniques (to tackle physical symptoms such as increased breathing rate)
A patient undergoing treatment with a therapist trained in CBT can expect to be given various worksheets and exercises that help them understand and change their thinking patterns and behaviours. You can also expect homework outside of therapy sessions which is a crucial part of cognitive behavioural therapy as this is where you will use the techniques to break out of your vicious cycle.
CBT is effective for a wide range of mental health issues:
The Anglo-American roots of CBT
CBT originates in behavioural psychology which is known to privilege actions, reactions, behaviours, and muscle memory. For example, a “behaviourist” intervention to treat a child with a fear of pets is to give him sweets when he is with that specific pet. If timed properly, the sweet will become inextricably linked with animals in the child’s mind. Fear at the sight of a cat or dog will be replaced by the opposite emotions: pleasure and anticipation due to the link with the sweet.
In the 1950s, British psychologist Hans Eysenck first proposed behaviour therapy as an alternative to psychoanalysis for the treatment of fears and neuroses. Eysenck’s methods were effective with fears and phobias but less so for treating depression.
At about the same time, an American psychoanalyst named Aaron Beck was successfully using free association exercises with his depressed patients. He noticed that many distressing thoughts were coming up. Furthermore, these thoughts were easy to elicit and describe. They were not as deeply buried in the unconscious as Sigmund Freud and the psychoanalysts had insisted they were. In 1967, Beck published a method for dealing with these “automatic thoughts”. It involved techniques drawn from both cognitive therapy (thought modification) and behaviourism (behaviour modification). Beck is now known as the “father of Cognitive Behavioural Therapy”.
The British psychological profession adopted CBT enthusiastically. Treatments for panic disorder, anxiety, and obsessive-compulsive disorder using CBT were successfully pioneered at Oxford and later Kings College London in the 1990s and 2000s. As a result, Cognitive Behavioural Therapy is now used to treat a wide range of mental health problems in this country, including depression, panics, phobias, PTSD, and eating disorders; in and out of the UK and is considered the gold standard of treatment within the NHS for many disorders.
Further reading
NHS
Explains how CBT is delivered within the NHS and the types of disorders it is useful for. It also discusses how to access CBT and the pros and cons.
Royal College of Psychiatrists
Discusses the myths and types of CBT.