Cognitive Behavioural Therapy

What Is Cognitive Behavioural Therapy?

CBT is a form of talking therapy that works on the relationship between thoughts and beliefs, actions and behaviours.  As we grow and develop, our perception of life becomes our belief system, and our belief system plays a big role in how we drive our lives.  By focusing on how we think about the things going on in our life – our thoughts, images, beliefs and attitudes (cognitive processes) – and how this impacts on the way we behave and deal with emotional problems, CBT can enable us to confront, challenge and change negative patterns of thinking or behaviour that may be causing us difficulties. In turn, this can change the way we feel and behave.

CBT differs from general counselling in that responsibility is gradually passed over to the client. This means that the CBT process tends to take anywhere from six weeks to six months, depending upon the issues of the client and also how motivated he or she is to work towards recovery (see homework below).

Sessions are usually weekly, normally lasting for an hour (although they can be for 90 or even 120 minutes if the situation requires it).  Problems and challenges are explored with your therapist, and then an action plan is developed for resolving them.  Over a period of time, you learn a set of principles that you can apply whenever you need to, and once you have them, you have them for the rest of your life.

CBT is goal-orientated.  The goal(s) is/are identified by the client, with the help of the therapist, which  means that, after the first “fact-finding” session, the focus tends to be on what is going on in the present rather than the past. However, if appropriate, the therapy may also look at your past and how your past experiences impact on how you interpret the world now.

CBT And Negative Thoughts

CBT theory suggests that it isn’t events themselves that upset you, but the meanings you give to them. Your thoughts can block you, causing you to only see the things that fit in with what you believe to be true. There is then a risk of continuing to hold on to these thoughts and being unable to learn anything new.  CBT helps you to clear these negative thinking blocks and see a different perspective.

How Do Negative Thinking Patterns Start?

During our childhood we develop our beliefs about ourselves and our world, and this is when negative thinking patterns are developed. They are known as negative automatic thoughts (NATs) and they affect the way that we think and feel about ourselves and others.  They give us a ‘faulty’ view of a situation since we interpret that situation in line with those negative automatic thoughts.  This is likely to make any difficulty or challenge seem worse than it actually is.

CBT can help you understand what’s going on, by identifying your negative automatic thoughts and helping you  to step outside of them, so you can test them out.  CBT also helps you to understand that if things go wrong or you make a mistake, this does not mean that you are a failure or that others will see you as a failure.

What Types Of Problems Can CBT Help With?

Because of the way that the therapy works, CBT can be an effective therapy for a number of problems:

• anger management
• anxiety and panic attacks
• chronic fatigue syndrome
• chronic pain
• depression
• drug or alcohol problems
• eating problems
• general health problems
• habits, such as facial tics
• mood swings
• obsessive-compulsive disorder (OCD)
• phobias
• Poor self image or low self-esteem
• post-traumatic stress disorder
• sexual and relationship problems
• sleep problems
• Stress

There is also a new and rapidly growing interest in using CBT (together with medication) with people who suffer from hallucinations and delusions, and those with long-term problems in relating to others.

What Are CBT Sessions Like?

CBT sessions are always structured. At the beginning of the therapy, you will meet with the therapist to describe specific problems and to set the goals you want to work towards.

When you have agreed the problems you want to focus on, and what your goals are, you and your therapist can begin to plan the content of your sessions, and discuss how to deal with your problems. Typically, at the beginning of a session, you and the therapist will jointly decide on the main topics you want to work on that week.  You will also be given time to discuss the outcomes from the previous session. With CBT you are always given homework, and you will look at the progress made with the homework you were set last time. At the end of each session, the therapist and client plan another homework assignment to do outside the sessions.

The importance of structure

Structuring the sessions ensures that the therapeutic time is used efficiently. It also makes sure that important information isn’t missed out (the results of the homework, for instance) and that both you and the therapist have a chance to talk about new assignments that naturally follow on from the session.

To begin with, the therapist will be responsible for structuring the sessions, however as you make progress and grasp the tools you find helpful, you will find that you begin to take more and more responsibility for the content of the sessions. By the end of your therapy, a client will conficent to continue working on your own.

Learning coping skills

CBT teaches skills for dealing with different problems. For example:

• If you feel anxious, you would learn that avoiding situations actually increases fears. Confronting fears in a gradual and manageable way can give you faith in your own ability to cope.
• If you feel depressed, you would be encouraged to record your thoughts and, together, we would explore how you can look at them more realistically. This helps to break the downward spiral of your thoughts and your mood.
• If you have long-standing problems in relating to other people, you would learn how to check out your assumptions about other people’s motivation for doing things, rather than always assuming the worst.

The client-therapist relationship

CBT favours an equal relationship. It is focused and practical. One-to-one CBT can bring you into a kind of relationship you may not have had before. The ‘collaborative’ style means that you are actively involved in the therapy. The therapist seeks your views and reactions, which then shape the way the therapy progresses. The therapist will not judge you. The aim of the therapy is to help you feel able to open up and talk about very personal matters. You will learn to make decisions in an more emotionally intelligent  way, as issues are opened up and explained. Some people will value this experience as the most important aspect of therapy.

The importance of doing homework

The sessions provide invaluable support, however most of the life-changing work takes place between sessions. The benefits of the work that you are doing through CBT will become more obvious, more quickly if you are willing to undertake assignments at home. For example, if you are experiencing depression you may feel that you are not able to socialise or be around other people until you feel better. However,  CBT may encourage you to see that by trying even a very small activity that puts you together with other people, it is possible for you to develop an alternative view of the situation.  This may cause you to modify how you think and feel about being around others sooner than if you hadn’t tried the activity.  So by testing out theories in this way, you are likely to make faster progress, compared to somebody who feels unable to take any risks.

Group Sessions

CBT is usually a one-to-one therapy, but it can also be very effective when delivered through group sessions. It is sometimes helpful to share your difficulties with others who have similar problems, even though this may seem unlikely at first. The group can also be a source of valuable support and advice, because it comes from other people with similar personal experience of a problem.

How Effective Is CBT?

Clinical trials have shown that CBT can reduce the symptoms of many emotional disorders. For some people it can work just as well as drug therapies at treating depression and anxiety disorders. The National Institute for Health and Clinical Excellence (NICE) recommends CBT via the NHS for common mental disorders, such as depression and anxiety.  CBT has been applied in both clinical and non-clinical environments to treat disorders such as personality conditions and behavioural problems. (1)   A systematic review of CBT in depression and anxiety disorders concluded that “CBT delivered in primary care, especially including computer- or Internet-based self-help programs, is potentially more effective than usual care and could be delivered effectively by primary care therapists. (2)

Throughout this year, I will be discussing various terms and expressions used in CBT so I recommend checking back regularly.

References:

1. The Cochrane Library. 2010 impact factor. Cochrane Database of Systematic Reviews (CDSR). Frequently asked questions. Retrieved 2011-07-01.
2. ^ ^{a b} Higgins JPT, Green S (editors). Cochrane handbook for systematic reviews of interventions, version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Retrieved 2011-06-17.