What You Should Know About Cognitive Therapy


With the lessening stigma surrounding mental disorders and the growing understanding of the financial burden on those living with a mental disorder, both individually and collectively, a vast amount of research has been undertaken over the last few decades into not only the origins (what the scientific community terms etiology) of these disorders, but treatments and their effectiveness. Truthfully, how can we treat diseases we don’t know anything about? Beyond that, how do we know if a treatment works until we see what it does on a physiological and neurological level?

Yes, I’m talking nerd, but bear with me. I won’t disappoint. So, what is cognitive therapy? Everyone seems to be buzzing about this. What truly is cognition? Well, to put it bluntly, it’s how we think and how we construct our reality. It’s our thoughts and how those thoughts carry us from day to day in our decision making, perspective and relationships. And it’s how those, in turn, impact our thoughts.

Some researchers argue (a rather valid argument I might add), that a component of mental disorders is based in our cognition, our thoughts and how these affect our view of ourselves and the world. More importantly, it is largely about how we interact with the world and how that interaction affects our perception. This becomes our template of sorts and it starts from the moment we are born.

Psychologists like to call this template our cognitive schema. I love that term. It sounds awesome at parties. Babies are born with pretty much a blank canvass. As they absorb their world, their cognitive schemas build, laying down the foundations as they experience the world, to be used over and over again as they grow older. Every time a cognitive schema is accessed, it is revamped and refiled.

This has even been seen in neurobiology in something called Hebbian Law, which basically states neurons that fire together, wire together. So, the more you use it, the stronger these brain connections become.

How awesome is that? Once we have these schemas (and keep in mind, we have many schemas from which we draw, school, work, relationships and even how we do laundry or make coffee), we can then efficiently place any new situation within these schemas without even thinking about it. This is not only adaptive (think Darwin), but makes total sense. I mean, how exhausting would it be if we had to start from scratch every time we met a new friend:

OK, this is a person. A person is a human, like me. Now this person is talking to me. Does this conversation make me feel good? Yes, OK then we like this person… and so forth.

It would take us ages to simply get to the point that this new person is even cool! We don’t have time for that. So our brains go rifling through the files of “friends,” “humans” and “conversations.” As we do so, our brains are firing in areas like our frontal lobes and medial temporal lobes, which associate these concepts with memories, emotions and actions previously experienced.

I don’t know about you, but my brain just exploded. However, these schemas can also be maladaptive and this is where, cognitively speaking, mental disorders can come from. Take someone with generalized anxiety disorder (GAD). A cognitive approach to this disorder would encompass how this individual (let’s call him “Bob”) perceives the world and interacts with the world. Bob wakes up one morning and might feel a little out of sorts. Because Bob’s schema is one of heightened arousal and intolerance for uncertainty (pretty much ubiquitous with GAD), he may begin to feel worry over his current mood. This might increase his heart rate slightly, leading him to feel more worry about his health, which then further increases arousal and precipitates further negative thoughts. And down the rabbit hole Bob goes. It’s a vicious cycle and not one that is entirely controllable without help.

What we can understand from cognitive psychology is that Bob’s schema of that particular moment can be deconstructed (taken apart and analyzed for its individual components). This is where therapy comes in, specifically, cognitive behavioral therapy and mindfulness-based cognitive therapy. In a nutshell, cognitive behavioral therapy (CBT) helps people living with mental disorders learn to recognize certain maladaptive schemas. (“My heart is racing, so I must be having a heart attack,” “Everyone will laugh at me,” or “I’m going to fail my classes.”) Once someone is able to effectively recognize those thoughts as they happen, they are then guided into more realistic and positive thoughts. (“My heart is racing, so I must be feeling anxiety,” “If someone laughs at me, then it’s because I said something funny,” or “I won’t fail my courses because I never have in the past.”)

This takes effort, a lot of effort. I won’t lie. However, once those thoughts start to change, schemas start to change. What is amazing is our brain wiring (remember Hebbian Law?) starts to change.

Once Bob starts to retrain those maladaptive thoughts through CBT, his prefrontal cortex actually grows more efficient in telling the amygdala to calm down. The more he trains his brain, the more efficient this calming process becomes. In fact, one study conducted in Montreal, Canada examined people with phobias (another form of anxiety under the DSM-5) both before and after CBT. Before CBT, these individuals had overly active hippocampi and prefrontal cortices in relation to the feared object. After CBT, brain scans showed a significant decrease in activation in these brain areas when exposed to the feared object, showing that cognitive reframing actually rewired their brains.

Mind blown, right?

So, if you haven’t got the point by now, I’ll give you a Coles Notes version. Mental disorders are multimodal disorders, meaning they don’t have a single cause. They have origins in many different systems (genetic, biological, neurological and environmental,) which are primarily out of our control. What is in our control is harnessing the power of our own thoughts to retrain our brains, (better yet) rewire, our brains, into a healthier, more adaptive way of thinking.

This may not work in all situations, of course, and will take time, patience and self-acceptance. But isn’t that the point? To learn patience and acceptance of ourselves and to enjoy the time we have? Maybe by even just writing these words, my neurons are firing in ways they haven’t before, introducing themselves to new pathways that could lead me to a more accepting, positive and patient way thinking.

Image via Thinkstock.


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