Cognitive-Behavioral Therapy (CBT)

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A scientifically proven form of psychotherapy that involves identifying distorted, maladaptive patterns of thinking and behaviors and replacing them with more pragmatic, problem-solving ways of thinking and acting. Cognitive-behavioral therapy (CBT) has been shown to effectively treat a number of issues and disorders, including depression, anxiety, eating disorders, substance abuse, anger, and attention deficit disorder. It also appears to help improve symptoms of medical conditions with a psychological component, such as chronic pain, migraines, fibromyalgia, erectile dysfunction, and sleep disorders.

CBT, with or without the concurrent use of antidepressant medicines, has proved extremely effective in treating depression. People with diabetes have roughly twice the risk of depression as those without diabetes and, by some estimates, depression affects some 15% to 30% of individuals with diabetes at any given time. Depression in turn may worsen diabetes control, since the depressed person is less likely to stay active and to take all the steps necessary to ensure good blood glucose control.

The basic tenet of cognitive-behavioral therapy is that the way a person perceives an event, situation, or another person influences how he reacts to it and how he feels about it. In some cases, a negative reaction may stem from distorted thinking. For example, a person may engage in “all-or-nothing” thinking, perceiving people or things that are not totally perfect as totally defective. A person might also overgeneralize, using one aspect of an experience or situation to “sum up” their entire character rather than considering its many facets. Another example of distorted thinking is magnification, in which the thinker blows a small event or characteristic way out of proportion. The opposite is also possible: minimizing an event or characteristic that is actually quite important.

A person with diabetes might react to a very high blood glucose reading by thinking “Another bad blood glucose reading. Why can’t I ever keep my blood sugar under control? I’m a failure!” This person would be engaging in magnification, overgeneralization, and all-or-nothing thinking by overemphasizing the importance of one blood glucose reading, deciding that it sums up his blood glucose control in general, and deciding that it reflects a lifetime of incompetence. This type of thinking not only wreaks havoc on self-esteem, but it also undermines a person’s motivation to control his diabetes.
CBT is designed to identify these types of negative thoughts and actions and replace them with more realistic, more constructive ones. For example, one could react to a high blood glucose reading by thinking, “Boy, that was a high blood glucose reading. I wonder what caused it. Was it that orange juice I had with breakfast?”

For more information about CBT or to find a cognitive-behavioral therapist, contact the National Association of Cognitive-Behavioral Therapists at

Originally Published November 19, 2009

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