CBT and Brain Function

How Does CBT Change Brain Function?

What is CBT?

Cognitive behavioural therapy (CBT) is a therapeutic intervention that gives individuals the tools to examine their thoughts, feelings, and behaviours. Dr. Beck and Dr. Ellis, the psychiatrists who developed CBT, looked at the way thoughts are formed and how they shape beliefs and behaviour. Specifically, he categorized different types of thoughts such as the distortion of automatic thoughts, core schemas, beliefs, and underlying assumptions. The first role of the cognitive model was to investigate how negative beliefs maintain symptoms in depressed patients. Since then, CBT has had broad applications in mental health and substance use challenges. The premise of CBT is that many struggles are sustained by biases in thinking.  

Many of the thoughts that we have occur automatically and so part of the goal of CBT is to change unconscious processes to mindful practices. The patient tests the way they see reality against available facts. Part of the process of therapy is learning that negative thoughts have consequences. Individuals learn how to describe their experience with accuracy and to rely on facts as opposed to leaning into generalizations. For instance, a therapist might encourage their client to restructure their automatic thoughts. If the client thinks, “I am a failure,” the therapist will help them reframe their thought to: “I did not achieve my goals on this specific task at this time.”

Here are some ways you can reframe your thoughts: 

• If I go to the grocery store I’ll get sick-> What is the evidence that if I go to the grocery store that I will get sick? 
• I’m always going to be alone-> What actions am I taking to meet someone, connect with friends, or to choose a social activity.
• I’m not good enough-> How would a close friend evaluate and respond to this statement?
• I’m going to die of coronavirus->I have no symptoms of coronavirus, I am vaccinated and taking precautions. 

When you’re experiencing challenging thoughts, it can help to focus on your breathing. There are many apps and tools which can assist you with breathing and different forms of meditation. A simple grounding exercise is to breathe in for the count of four, hold at the top for four, breath out for four, and hold at the bottom for four. You can repeat this simple technique as many times as you need to feel calm and grounded. 

An underlying goal of CBT is to move from fixed to flexible thinking. The therapist helps the individual develop the muscle to find evidence for and against an assumption and to manage uncertainty. This helps the individual with the realization that things can be looked at from different perspectives and behaviour can be modified. CBT interrupts the feedback loop that maintains problems over time. As well, it is collaborative and action oriented. The goal of therapy is not simply to feel better but to develop tools to cope with future problems. 

Scientists are encouraged by the results of neuroimaging which shows that therapeutic treatment has neurobiological effects. This helps us understand the relationship between symptoms, emotional regulation, and behaviour better. 

So How Does CBT Change the Structure of the Brain?

Let’s look at the results of a neuroimaging study examining the effects of CBT on social anxiety which can lead to drinking. 18 individuals were assessed and randomized for treatment with an antidepressant called citalopram, CBT, or a waiting list. CBT focused on cognitive restructuring, bibliotherapy, and exposure. There was no difference between the CBT and citalopram groups. Participants were assessed in a public speaking task, which activates social anxiety. Bilateral regional blood flow was assessed in the amygdala, hippocampus, and the anterior temporal cortex and there were significant reductions in regional blood flow to these areas after treatment with CBT, which meant that the patients had decreased symptoms and showed overall improvement.

CBT changes the structure and pathways of the brain. For instance, the limbic response, which is associated with emotions and triggers, was linked to long-term clinical outcomes. Other studies including phobia, OCD, and panic show promising results related to areas of the brain which become activated by disease, and this strengthens the evidence for treatment in substance use disorder. Behavioural therapies are associated with reductions in substance use and increased cognitive control, management of impulsivity, motivation, and attention.

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