Brief cognitive behavioral therapy can still be highly effective.
This post was co-authored by Jade Emery, and published on Psychology Today, updated December 24, 2024.
The effectiveness of short-term therapy is often debated. With the popularity and wide availability of Cognitive Behavioural Therapy (CBT), and the many available online resources and books to support it, it tends to be a therapy modality that many clients have tried. But research suggests that it also may lose some of its effectiveness over time (Johnsen & Friborg, 2015). Large-scale studies suggest that CBT is effective for depression less than half the time (Wiles et al., 2016) and that there is a wide range of effectiveness depending on the type of mental health condition one seeks treatment for, ranging from 38-82% (Hoffman et al, 2013).
When Kate entered therapy, she felt like she wasn't coping or enjoying life. Years of work stress had built up, she had poor sleep, she felt anxious in social situations, she was recently bereaved, and found herself in a high emotional state most of the time, being easily teary and snappy. With encouragement from her husband, she sought therapeutic support.
Box Breathing and Imagery
After shortlisting therapists from her insurance, she really hit it off with her therapist, Joy Wong, with whom she met for just 10 sessions. Feeling listened to and understood, Kate felt open to exploring her struggles and threw herself into practising a variety of CBT techniques. The tools she found particularly helpful focused on deactivating her heightened nervous system, permitting her to feel safe, grounded, and able to act more appropriately to situations. (See diagram below.)
Kate utilised breathing techniques, like box breathing: in for 4, hold for 4 then out for 4, for 10 cycles. At first she practiced this 3 times a day each day, particularly when a reset was needed. Kate found this surprisingly helpful and continued to practice it a year later. Grounding techniques and imagery work invoked calm, allowing her to focus on slowing down and being more conscious in herself and her environment.
Joy also demonstrated effective imagery work, by guiding her through a short meditation that stimulated different senses and visualisations to invoke euphoria and calm. This allowed Kate to get out of her body and release stuck feelings.
Reframing Negative Thoughts
Reframing events also allowed for a constructive emotional shift. With the death of her father, there was a lot of anger, confusion and pain with her grief. Kate’s father had shared things that upset her before passing. Joy was able to help her reframe perceptions and interpretations, allowing her to understand things in a more positive way, allowing for closure. Eg. He must have loved me to share those things, and this helped him to die in more peace. When the filter of anger that tainted her view lifted, she was able to remember lovely times they had together.
Social Anxiety
It’s easy to get stuck in a certain view, and to see things only through a filter that impedes on how events are interpreted. Kate had a speech impediment and was bullied as a child, which impacted her feelings in social situations. She doubted herself, was convinced she was ‘not interesting’, struggled with eye contact, stayed close to her husband for support, and hoped that people wouldn’t talk to her. Kate could feel herself having a physiological response and shake when approached, not wanting to respond.
Joy helped Kate shift the focus from the panic, and boost her value in herself. She made a list of things she’s good at, and things she could talk about, which made her feel more prepared and able to handle a social situation, overriding her self-doubt. This all helped Kate see that she was worth talking to, and allowed her to feel much safer and confident. She now saw that others wanted to listen to her stories and she now actually enjoyed parties.
Sleep Problems
Kate’s built-up work stress also impeded her ability to sleep well: She struggled to get to sleep, or to get back to sleep once awake in the night, and was even doing spreadsheets in her dreams. With her therapist, Kate developed a calming nighttime routine: She’d gently wind down, listen to nice music, avoid screens, and practise her breathing techniques and mindfulness, which helped. She also habituated techniques which allowed her to create boundaries and separate from her work self.
When leaving work, Kate practised physically saying goodbye to her work station, shutting her office door and trusting that she could pick everything up the next morning. Kate was employed for 8 hours a day, so she realised that no more was needed. This helped her to reprogram herself out of a hyperalert state, enabling her to shift her focus from work stressors to realign with other life values. Kate no longer woke up in the middle of night and found it easier to sleep. Overall, she was more able to cope, balanced life and work more effectively, discovered she was even better at her job, and lived a happier life.
Positive Outcomes
Kate’s openness to new ways of thinking, and throwing herself into continually practising the CBT techniques, allowed her to make profound strides in living a happier life over one year later. It’s quite possible CBT will work just as well for you. Have a look at the diagram below and see how the different techniques might work well for symptoms of anxiety or depression that you may be facing. Remember: Statistics don’t determine your individual fate, and being guided by a therapist, in collaboration with CBT tools, is more likely to work for you than self-help alone.
This post is based on Episode 1 of the Breaking Through Therapy podcast by Cole, E. (2024).
Source: Dr Esther Cole: Lifespan Psychology - The Diverse Practice®
References
Hoffman, S. Asnaani, A. Vonk, I., Sawyer, A. & Fang, A. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognit Ther Res. 2012 Jul 31;36(5):427–440. doi: 10.1007/s10608-012-9476-1
Johnsen, T., & Friborg, O. (2015). The Effects of Cognitive Behavioral Therapy as an Anti-Depressive Treatment is Falling: A Meta-Analysis. Psychological Bulletin DOI: 10.1037/bul0000015
Wiles., N, Thomas, L., Turner, N. et al. (2016). Show more Long-term effectiveness and cost-effectiveness of cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: follow-up of the CoBalT randomised controlled trial. DOI: 10.1016/S2215-0366(15)00495-2
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