When a child, teen, or young adult develops a mental health disorder, parents who seek treatment often find the search overwhelming, and wonder – between approaches like cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), motivational interviewing (MI), and others – which type of therapy works best, and which can offer the most help and hope for the children, teens, and/or young adults in their family.
The three therapeutic approaches we mention above are proven effective for children, teens, and young adults diagnosed with various mental health disorders. They can offer significant symptom relief. They can help patients manage emotion, tolerate stress, and modify the types of behavior associated with mental health disorders that makes participating in essential daily activities – including school, work, and maintaining family/peer relationships – a real challenge, and in some severe cases, nearly impossible.
It’s important for parents to understand that recovery and healing is within reach. When their child, teen, or young adult commits to evidence-based treatment with skilled, experienced therapists at a high-quality treatment center, it’s possible for them to regain agency. They can develop the skills needed to effectively and productively process the patterns of thought and behavior that make living with a mental health disorder difficult.
In this article, we’ll focus on one of the three modalities we introduce above: cognitive behavioral therapy (CBT). We’ll discuss its origin and core principles. Then we’ll describe how CBT can help children, teens, and young adults learn to manage their mental health disorder and live full and productive lives based on their vision of happiness.
History of Cognitive Behavioral Therapy (CBT)
The article “Cognitive Behavioral Therapy” published by the National Library of Medicine (NLB) in partnership with the National Center for Biotechnology Information (NCBI) and the National Institutes of Health (NIH) offers a concise history and helpful overview of CBT. We’ll draw on that publication and others over the course of this article.
First, we’ll provide a brief summary of the origin and application of CBT.
Dr. Aaron Beck, an American psychiatrist, developed the first iteration of cognitive behavioral therapy (CBT) around 60 years ago. First called cognitive therapy, he developed CBT to support his patients diagnosed with depression. Since then, over the half-century since the 1960s, volumes of peer-reviewed research shows CBT is effective for depression and a wide range of mental and behavioral disorders, including:
- Anxiety disorders
- Eating disorders
- Substance use disorders
- Personality disorders
In addition, research shows CBT is effective as a supplemental therapeutic approach for complex mental health disorders such as bipolar disorder and schizophrenia. Although Dr. Beck developed CBT in his work with adults, mental health providers have adapted CBT for various groups, including:
- Families
- Couples
- Children
- Adolescents
Dr. Beck’s concept of depression evolved over time. He theorized that depression, in addition to being a mood disorder, was also a cognitive disorder, based on the observation that his patients with depression shared something in common. The vast majority showed what he labeled cognitive distortions. He realized these basic errors in logic contributed to their ongoing depressive states. He published his theory and observations in the groundbreaking book, “Cognitive Therapy of Depression” in 1979.
Cognitive Behavioral Therapy (CBT): Basic Concepts That Help Teens Develop Coping Skills
One thing about CBT that attracts providers and patients is that it makes sense. At first blush, sounds logical and it seems like it can work. CBT connects thought and emotion to behavior in a straightforward and simple manner. The National Alliance on Mental Illness (NAMI) explains the organizing principle behind CBT:
“CBT focuses on exploring the relationships between thought, feeling, and behavior. Therapist and patient collaborate to uncover non-productive patterns of thought and learn how they cause non-productive behaviors and beliefs. By addressing these patterns, patients can develop constructive ways of thinking that will produce healthy, productive behaviors and beliefs.”
The idea is that thoughts and emotions are both connected to influence behavior. During cognitive behavioral therapy – for children, teens, or young adults – a therapist and patient focus on three types of thought, or cognition:
- Automatic thoughts
- Cognitive distortions
- Underlying beliefs
We’ll define and break down how spending time working through these three types of cognition during CBT sessions can help patients develop the skills essential for healing and recovery, starting with automatic thoughts.
What are Automatic Thoughts?
CBT therapists define automatic thoughts as “our immediate, unpremeditated interpretations of events in our lives, which shape our emotional and behavioral responses to those events.”
Examples of automatic negative thoughts – which some therapists label ANTS – include:
“They don’t like me,” when someone doesn’t say hello in a social situation, for instance.
“I did something wrong, that’s why they didn’t say hello,” in response to the non-hello.
“I guess I’m not likable anyway,” in further response to the situation.
Thoughts like those can lead to feelings that in turn influence behavior. A core concept of CBT is that automatic thoughts like these are often exaggerations, mistakes, or unrealistic, and contribute to the negative symptoms associated with mental health disorders.
When a CBT therapist and patient work to identify automatic thoughts, they can then work to identify how they influence behavior. Next they move on to the goal of replacing automatic negative thoughts with positive and productive thoughts.
What are Cognitive Distortions?
CBT therapists define cognitive distortions as “errors in logic that lead to erroneous conclusions.” When a person with a mental health disorder believes their cognitive distortions are true, their emotional and behavioral responses to events – based on those erroneous conclusions – can cause problems, and disrupt their full and effective participation in basic daily activities.
Here are examples of five common cognitive distortions:
Dichotomous, all-or-nothing, black and white thinking:
A person who engages in this type of thought sees the world in immovable absolutes. A situation can only be good or bad. Events can only be positive or negative. Any outcome of their behavior can only be a success or a failure. In this type of thinking, there’s no in-between and no gray area. Clouds – and events – don’t have silver linings. Black and white thinking precludes understanding nuance in situations and in life, which makes emotional and psychological balance difficult to maintain.
Overgeneralization:
This is the psychological/emotional equivalent of the logical fallacy of generalization, in which a person makes a conclusion about all related events based on one single event. Think about a carpenter and a bag of nails: if they assume all the nails in a bag are bad because the first nail is bad, they’re engaging in overgeneralization.
Likewise, if one thing happens – like a bad grade on a math test – a person may overgeneralize and think, “I never do good on any tests, and I never will.”
This type of thinking can reinforce patterns of thought and emotion associated with depression, anxiety, and other mental health disorders, while helping patients temper overgeneralizations with thoughts like, “I didn’t do great on this test, but I’ve done fine before, and if I study, I can do better next time,” is an important step toward correcting cognitive distortions caused by generalization.
Mind reading and fortune telling:
These are cognitive distortions that CBT therapists call jumping to conclusions. When a person engages in mind reading, they believe they know with one hundred percent certainty exactly what another person is thinking and what their intentions are. And when a person engages in fortune telling, they’re certain they can accurately predict – with one hundred percent certainty – how future events will unfold. Both these habits/patterns can contribute to negative moods associated with depression, and reinforce fear associated with anxiety, as well as disruptive patterns associated with other mental health disorders.
Catastrophizing:
This cognitive distortion is often related to fortune telling. When a person catastrophizes, they focus on only the most negative/worst outcome possible for any future event, whether that outcome is realistic or not. In addition, catastrophizing may involve the present. For instance, a person may characterize things happening right now as horrible and awful, even if an outside observer can plainly see they’re not. Or they may say something like, “This is the worst day ever,” when, objectively speaking, that’s not true.
Emotional reasoning:
Emotional reasoning is exactly what it sounds like. It’s when a person makes decisions based on how they feel about something rather than provable, demonstrable, objective reality. CBT therapists don’t teach people to ignore their gut feelings, but rather check those gut feelings against observable facts. If the feelings and reality don’t match, they teach patients to adjust their thoughts to match reality, which helps them recalibrate their behavior.
What are Underlying Beliefs?
In CBT, underlying beliefs are foundational ideas people have about themselves and the world that shape how they perceive events in their lives. Underlying beliefs develop over time, and when they become distorted or divorced from reality, they form the substrate that exists beneath their automatic thoughts. There are two levels of underlying beliefs: core beliefs and intermediate beliefs.
Core beliefs are our most fundamental ideas about ourselves and the world. An example of a self-related core belief is “I’m not lovable,” while and example of a core belief about the world is “The world is harsh and unforgiving.”
Intermediate beliefs follow from core beliefs and shape our overall attitudes and default behaviors. Examples of intermediate beliefs include “I have to please others in order to be loved and accepted,” or ideas like “If I don’t ask for help, people will never know I’m really bad at everything.”
During CBT therapy, a therapist helps a patient replace a core belief life “I’m not lovable,” with one such as “I am enough, and people like me,” which helps them replace an intermediate belief like “If I don’t ask for help…” with one more like “If I ask for help from a friend, maybe I can solve this problem.”
Based on the examples we provide above, it’s easy to understand how cognitive behavioral therapy (CBT) can help children, teens, and young adults. CBT is an organized, empathetic, and compassionate way of realigning a person with objective reality and basic facts. When they see their automatic thoughts are based on faulty core beliefs that result in cognitive distortions, and that those distorted thoughts lead to negative emotions that create problems in their daily lives, they can begin to create positive change – with the help of an experienced, intuitive therapist – through the CBT process.
The Benefits of CBT
We describe the primary benefit above. When a person gets off-track, and the symptoms of a mental health disorder impair their daily lives, cognitive behavioral therapy can help children, teens, and/or young adutls resolve maladaptive thoughts and replace them with self-generated productive thoughts that support, rather than detract from, overall quality of life an wellbeing.
The Beck Institute, founded by Dr. Aaron Beck – the creator of CBT – indicates cognitive behavioral therapy (CBT) can help children, teens, and young adults:
- Recognize and evaluate thoughts as positive or negative, sound or distorted
- Identify personal goals and values
- Engage in meaningful activities that align with their values and help them reach their goals
- Create achievable goals
- Solve problems
- Make decisions
- Improve communication skills
- Develop mindfulness
- Manage stress
- Tolerate painful and distressing emotions and situations
Most importantly, however, is what happens after therapy, whether that’s between sessions or when an induvial steps down to less frequent care. CBT gives people lifelong, durable skills that enable them to engage in ongoing self-reflection, self-awareness, and self-healing. In other words, CBT gives people the skills to engage in what the Beck Institute calls self-therapy.
What Does an Effective CBT Program Look Like?
We’ll close this article with more helpful information from the Beck Institute. While treatment for each person is based on their individual needs, goals, and the level of severity of their disorder, CBT-based therapy should involve the following components.
Beck Institute: The Tenets of Good CBT
- A continuous process of cognitive evaluation
- A positive and productive relationship between therapist and patient, i.e. a trusting and health therapeutic alliance.
- Ongoing evaluation of progress in relation to patient-directed goals
- Cultural sensitivity, individually tailored to patient history
- A focus on the positive
- Collaboration, mutuality, and active patient engagement
- A foundation in aspirations, goals, and values identified by the patient
- An initial focus on resolving acute distress
- Education and learning
- An awareness that time matters, and patients need help healing sooner rather than later
- Structure
- Empowerment, and giving patients effective tools to identify and resolve maladaptive patterns of thought
- Homework
- A diverse array of creative techniques to create positive change in thought, emotion, and behavior
Parents seeking mental health support for their children, teens, and/or young adults can use this list to evaluate potential or current treatment programs. If the therapist or treatment center offers CBT with these components, then they may be a good fit, capable of helping the entire family restore balance and start the healing process.
