PEN IT. A ‘thought journal’ is part of cognitive behavioural therapy
| Photo Credit:
Dragos Condrea
Vihaan (name changed) sits at his desk, head bent over a textbook. His NEET exam is three days away. “Will I pass?’ he wonders. A notification pops up on his phone. His classmate messages to say he has received a scholarship from a prestigious university. Vihaan views this as his own failure, makes unhelpful comparisons and catastrophises.In cognitive behavioural therapy (CBT), such reactions are described as distortions of perception. “Unhelpful thoughts such as ‘My life is bad because I am not able to write the competitive exams on time, I am a failure, etc’ do not provide any clear solutions,” says Keerthi Pai, Clinical Psychologist, Element H Psychological Support Services, Chennai.Unlike other traditional forms of therapy, such as psychoanalysis, CBT is goal-oriented to solve present-day problems rather than explore the distant past. And it is becoming an avenue of mental health support for the young and elderly alike.“CBT helps the individual first identify such unhelpful thoughts through a thought journal and then, through Socratic questioning, the therapist or psychologist is able to help the individual understand core beliefs; next, through the process of cognitive restructuring, the psychologist is able to help the individual restructure these unhelpful thoughts and core beliefs. This breaks the path of self-destructive thoughts and behaviours,” Pai says.Research shows CBT to be effective in many mental health conditions, making it one of the most evidence-based psychological treatments available, according to several experts. CBT-based interventions are increasingly used to manage stress, burnout, perfectionism and work-life imbalance.According to another CBT therapist, “There is an acceptance of this form of therapy in India today because the concept is ‘goal-oriented’, focusing on the ‘here and now’.”“Awareness of CBT has increased substantially over the past decade due to greater public discussion of mental health, online resources, and its inclusion in treatment guidelines worldwide,” says Dr OT Sabari Sridhar, Professor and Head of the Department of Psychiatry, Sri Ramachandra Medical College and Research Institute, Chennai.Adaptive thinkingThere are misconceptions about CBT as mere “positive thinking” when, in fact, it is a “structured, evidence-based therapy”, says Dr Sridhar. It focuses on examining the current problem and the factors leading to it, and requires the individual to be committed to the treatment plan.CBT has been shown to be effective in helping teenagers deal with emotional and physical health challenges. For instance, it has helped reduce the frequency and severity of migraine headaches in adolescents.And in a time of all-pervading social media, it can address the ‘fear of missing out’ (FOMO) syndrome, as also the fallout of digital overexposure. By teaching coping strategies, stress management techniques, healthier digital habits and adaptive thinking patterns, CBT aims to improve both psychological well-being and the overall quality of life.Among middle-aged people and the elderly, CBT helps with illness acceptance and lowering the anxiety associated with chronic illnesses such as Parkinson’s disease, stroke and cancer. It works alongside complementary therapies such as existential therapy, gestalt therapy, acceptance commitment therapy, and solution-focused brief therapy, among others. CBT also helps adults accept the diagnosis without judgment and achieve a qualitatively healthy lifestyle in accordance with their values, says Pai.For instance, a person anxious about attending social gatherings is given not just reassurance or affirmation but also assistance with identifying and reframing the thought and behaviour that sustain the anxiety. The individual may be encouraged to attend a party for a limited period — perhaps just an hour. This small, manageable step serves as a behavioural experiment designed to challenge anxious assumptions in a real-world setting, says a CBT therapist.This could be followed up with reflective questions in the next session. How many people spoke to you? Did any situation make you uncomfortable? How did you feel when you got home?By examining the responses, the individual can reassess their fears and develop a more balanced, realistic perspective about social situations.The therapy duration depends on individual condition and severity. Typically, it involves eight to 20 sessions and follow-ups, as needed. Each session lasts 45-60 minutes, usually weekly, and there is some “homework” to be reviewed in subsequent sessions.“Research over the last few decades indicates that at least 30 per cent of those who received combined CBT and a course of medical treatment have had good improvement in their occupational skills and self-care,” the therapist says, adding that greater personalisation of CBT is anticipated with the growth in digital technologies and artificial intelligence-assisted intervention.Published on July 13, 2026
