Can cognitive behavioural therapy really change our brains?

Open navigator

1. The power of talking

Cognitive behavioural therapy (CBT) is a type of talking therapy which is used to treat a wide range of mental health problems, from depression and eating disorders to phobias and obsessive-compulsive disorder (OCD).

CBT works by encouraging new perspectives of ourselves and the world around us that could be useful for everyone in day-to-day life. But does the brain physically change when we have this talking therapy?

2. How does CBT work?

CBT is based on the idea that problems aren't caused by situations themselves but by how we interpret them in our thoughts. These interpretations have an impact on our feelings and actions.

For example, if someone you know walks by without saying hello, what's your reaction?

You might think that they ignored you because they don't like you, which could make you feel rejected. So you might be tempted to avoid them the next time you meet. This could increase the bad feeling between you both and generate more "rejections", until eventually you believe that you are an unlikeable person. If this happened with enough people, you might start to socially withdraw.

But how well did you interpret the situation in the first place?

CBT aims to break negative thought cycles by helping people to spot problematic ways of reacting and replacing unhelpful thoughts with more useful or realistic ones. For example, did the person who just "ignored" you actually see you? Were they really just in a hurry?

Making sure your reaction is based on the evidence can be a challenge for people with mental health problems, as their thinking styles can be well-established. When someone is depressed or anxious, negative thoughts often persist, but more positive thoughts are easily forgotten.

3. Common mistakes in the way we think

Do you recognise any of these thinking styles?

Jumping to conclusions

You selected

Jumping to conclusions

Predicting something negative will happen without evidence; for example, you might assume that going into work when you’re feeling low will make you feel worse.

All-or-nothing thinking

You selected

All-or-nothing thinking

Seeing things purely in black and white; for example, if you’ve not done something perfectly, you think it's absolutely useless.

Mental filtering

You selected

Mental filtering

Noticing the negatives more than the positives; for example, you may gloss over the 95% of feedback that was positive and dwell on the 5% that was negative.

Over-generalising

You selected

Over-generalising

Seeing one negative incident as a sign of everything being wrong; for example if you have a bad day, you think that nothing ever goes well for you or ever will.

4. Breaking negative habits

CBT is not just about changing how we think – it's about doing things differently too.

Some psychological theories suggest we learn negative ways of thinking and behaving through a process called negative reinforcement.

For example, if you have a fear of spiders, by avoiding them you learn that your anxiety levels can be reduced. So you're rewarded with less anxiety in the short term, but this reinforces the fear.

To unlearn these patterns, people with phobias and anxiety disorders often use a CBT technique called graded exposure. By gradually confronting what frightens them while practising relaxation strategies and observing that nothing bad happens, it's possible to retrain their brains to not fear it.

5. Rewiring the brain

Primitive survival instincts like fear are processed in a part of the brain called the limbic system. This includes the amygdala, a region involved in the processing of emotion, and the hippocampus, a region involved in reliving traumatic memories.

Brain scan studies have shown that overactivity in these two regions returns to normal after a course of CBT in people with phobias.

What's more, studies have found that CBT can also change the prefrontal cortex, a part of the brain responsible for higher-level thinking.

So it seems that CBT might be able to make real, physical changes to both our "emotional brain" (instincts) and our "logical brain" (thoughts).

Intriguingly, similar patterns of brain changes have been seen with CBT and with drug treatments, suggesting that psychotherapies and medications might work on the brain in parallel ways.

6. When is CBT used?

The principles of CBT can be applied to many real-life situations. Which of these is it effective in?

Anxiety

Image: Getty Images

You selected

Anxiety

CBT is widely used as a treatment of choice, often ahead of medication, for many anxiety conditions from social phobia to post-traumatic stress disorder.

Dementia

Image: Getty Images

You selected

Dementia

CBT may be less helpful in people who have severe dementia and memory loss, as it requires them to learn and practise new habits and ways of thinking.

Cancer

Image: Getty Images

You selected

Cancer

While CBT can’t cure people of physical conditions such as cancer, it is often used effectively to help them adjust to life with their illness.

Eating disorders

Image: Getty Images

You selected

Eating disorders

CBT is an effective talking therapy for many people with bulimia, but is less effective in anorexia – a more difficult-to-treat eating disorder.