Cognitive Behavioural Therapy

What is Cognitive Behavioural Therapy (CBT)?

Cognitive Behavioural Therapy is one of the most widely used ‘talking therapies’ in the world today. It involves having regular sessions with a qualified therapist in a safe, neutral environment. CBT works by highlighting the relationship between our thoughts, beliefs, feelings and behaviors and how these shape our lives.

Sometimes, major life events such as trauma, illness, job-loss or changes in family structure can generate strong feelings like fear, anxiety, or anger. If these continue, we can get locked into negative thought patterns which can worsen the problem and prevent us from moving past it. CBT helps us to examine these patterns and find new, better ways of coping. Problems that can seem too big to tackle, get broken down into smaller parts making them less overwhelming to deal with.

History of Cognitive Behavioural Therapy (CBT)?

Cognitive Behavioural Therapy incorporates many aspects of both Cognitive Therapy and Behavioral Therapy.

Cognitive Therapy is based on the premise that it is our conscious thoughts and emotions, rather than childhood experiences, that mainly determine our behaviour. Sometimes our thoughts and perceptions of a situation can become distorted and cause us much distress. For example, we may take everything personally or assume the blame for things that may be beyond our control. We could overgeneralise our assumptions; so if we discovered one person did not like something we did or said, we might take that to mean that they were unhappy with everything we did at that time, or even that nobody is happy with us.

Cognitive theory shows that it is not what actually happens to us that affects our subsequent mood and actions, but how we perceive and react to the situation. Once we identify the negative thought patterns behind the unwanted behaviour we can replace them with more helpful and constructive thought patterns, leading to a better outcome.

Behavioural Therapy originated from research done by Ivan Pavlov and B.F. Skinner. Both men focused on behaviour rather than thought as behaviour can be observed and measured. They believed that as behaviour can be learned, it can also be un-learned. Techniques used include positive and negative reinforcement, conditioning and desensitization.

Cognitive Behavioural Therapy uses a combination of both approaches to work on thoughts and behaviours simultaneously. It is a scientifically-proven treatment with specific approaches used for different issues. For example, if you have a phobia, your therapist may focus more on behaviour management, but if suffer from low self-esteem they may take a cognitive approach with you.

What conditions is Cognitive Behavioural Therapy best suited to?

People referred for Cognitive Behavioural Therapy have usually been given a specific diagnosis such as:

• Depression
• Anxiety or Phobias
• Post-Traumatic Stress Disorder (PTSD)
• Addictions
• Eating disorders
• Insomnia
• Personality disorders
• Obsessive-Compulsive Disorder (OCD).

Those dealing with chronic health conditions can also benefit from CBT as it can help them develop ways to cope with their emotions and reduce their stress levels.

How do I begin Cognitive Behavioural Therapy?

You will need a doctor’s referral before meeting with a suitably qualified therapist. You can choose your own therapist so it helps to learn as much as you can about several therapists before making your selection. Call them first and find out if they have experience with the issues you are facing. It is important to find one you are comfortable with and feel you can trust.

What happens in a Cognitive Behavioural Therapy session?

Therapy is normally conducted over 5-20 regular sessions which could be held weekly, fortnightly or monthly depending on your circumstances. Sessions normally last for 60 minutes.

In the first session, your therapist will want to learn a bit about you, your background and the issues that are concerning you at the moment. Together you can decide which of these to focus on first. While past experiences are considered, the main focus will be on helping you tackle the immediate issues and overcoming them quickly and effectively.

Making connections

Your therapist will help you analyse your thoughts, emotions and behaviours connected to your current difficulties, asking questions like “What thoughts are going through your mind right now?” Sometimes, the thoughts may appear unrelated but, on closer examination, they can reveal all sorts of patterns. For example, if you are struggling to find work, you may discover that thoughts like “I am useless” or “I am not good enough” pop up regularly.

You are likely to be asked to pay attention to how often thoughts like these occur as your ‘homework’ between sessions. Then, with your therapist, you can try and work out why they occur. Has someone else said things like that to you? Did something happen that lead you to lose confidence in yourself?

You will learn to question these thoughts and establish if there was ever any truth to them at all. They may have been assumptions or over-reactions that became blown out of proportion in your mind. You’ll also learn how to develop more helpful, alternative thought patterns such as “I am very capable” and “I trust in my own abilities”.

Other approaches

Talking is not the only technique used in CBT. Therapists use a variety of tools to help people develop an understanding of their thoughts and feelings including journaling, relaxation and mindfulness techniques. Sometimes they may direct your attention to what happens to your body during particular emotions. Do you tense up? Does your heartbeat increase? You can learn to see these as warning signs and deal with them appropriately.

You control the pace

During each session, you will have the opportunity to discuss which parts of the therapy are working and which parts did not seem to help. You can suggest solutions yourself and change the pace if you find things too overwhelming. You’ll never be asked to do anything you don’t want to do.

The aim is for you to learn to be your own therapist so CBT teaches you how to develop coping strategies that you can draw on any time. If things become difficult again, there is nothing to stop you returning to therapy for some extra help.

The more you practice replacing unhelpful thoughts with constructive ones, the easier it becomes. While the process can take some time, depending on how ingrained the negative thought was, you can break the cycle and move forward to a more positive future.

Related therapies

• Acceptance and commitment therapy (ACT)
• Behavioural therapy
• Cognitive analytic therapy (CAT)
• Cognitive therapy