What does CBT target?

This article is part of our introductory series on cognitive-behaviour therapy.

Almost all individuals who present for psychotherapy, present with some sort of an emotional or behavioural problem. Even those individuals who think that their greatest problem is a practical one (disciplining their children/making a decision/dealing with difficult people) are typically prevented from managing their practical dilemma as a result of their emotional disturbance about it.

One of the primary goals of CBT is thus to assist individuals in reducing emotional distress, thereby experiencing more appropriate, healthy emotional reactions. Those who seek ‘happiness’ continuously are essentially misguided in the sense that positive emotions such as happiness, joy or calmness, whilst pleasurable, are typically short-lived and unsustainable for longer periods of time. CBT therapists prefer to consider emotional reactions as either helpful and functional or unhelpful and dysfunctional. The goal is to assist clients in shifting from unhelpful emotional states to more appropriate, manageable ones.

As an example, many individuals who struggle with assertiveness are often inhibited by intense guilt about the way in which others may feel in response to their decisions. While having sensitivity to other’s feelings is certainly admirable and quite appropriate, feeling intense guilt about others’ feelings is often unhealthily inhibiting.

In such a situation, one would typically want to reduce the likelihood of feeling guilt and shift such an emotional response to something more moderate and tolerable such as regret or disappointment. Guilt in such a situation would typically be fueled  by beliefs such as “I must never do anything that others may not like” or that “I am personally responsible for others’ feelings”.

Regret on the other hand, would be based on more flexible, realistic beliefs such as “while I’d prefer to always make decisions that others are happy with, there is no rule that states that I have to always place others’ satisfaction above my own and I am not personally responsible for others’ happiness”. Such a shift in belief allows one to be sensitive to others’ feelings, but not see their reactions as always more important than what may be in one’s own best interest. Such a restructuring of one’s thinking would thus help to reduce the presence of unnecessary guilt and enable one to then act in a more assertive manner, thereby also addressing the practical problem.

Below is a table of positive emotions, healthy negative emotions and unhealthy negative emotions:

Simultaneously, behaviour may often also be targeted during intervention, but this is often (but not always) secondary to the initial emotional goal. Many behavioural interventions target specific behaviours without any initial emotional goals. This would typically be the case with substance-related problems, procrastination, habit-related disorders like tics, skin picking or trichotillomania, and insomnia.

Behavioural reactions associated with depression or anxiety-related problems may often also be targeted directly, with a change in one’s emotional state being seen as secondary to this. For instance, prolonged exposure to feared situations tends to result in a decrease in anxiety and becoming more actively involved in pleasurable activities tends to reduce feelings of depression.

Written by Bradley Drake and Jaco Rossouw, Centre for Cognitive-Behaviour Therapy, Cape Town, South-Africa. For further details visit: www.cognitive-behaviour-therapy.co.za. (September 2011)

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