What Is Cognitive Behavioural Psychotherapy?

Cognitive Behavioural Therapy

This post is for anyone who wants to learn more about Cognitive Behavioural Therapy (CBT). In this post we will discuss how CBT works, why and when it is used, and alternative approaches to therapy. If you struggle to find what you want in this post, there are sources of further information at the end of this post.

What is CBT?

CBT is really two therapies in one. It is a mixture of cognitive and behavioural approaches to therapy. Cognitive approach explores people’s thinking and attitudes. It helps you change how you think. Behavioural approaches focus on things that we do, or avoid doing that perpetuate our unhappiness. So, CBT works with:

how you think about yourself, the world and other people,
how what you do affects your thoughts and feelings.

Unlike some of the other talking treatments, it focuses on the ‘here and now’ problems and difficulties. It does not focus on the causes of your mental health problem or symptoms in the past. Instead, it looks at what you do, and how you think now in order to find ways to improve your state of mind now.

When does CBT help?

CBT has been shown to help with many different types of problems. Initially, it has been designed to help people suffering from anxiety and depression. For the last 50 years it has proved to be very successful. Other mental health problems that can be treated by CBT include: panic, phobias (including agoraphobia and social phobia), stress, bulimia, obsessive compulsive disorder, post-traumatic stress disorder, bipolar disorder and psychosis. CBT may also help with difficulties with anger, regardless of whether you tend to bottle it up, or over-express it. Finally, CBT has been proven very effective with a low opinion of yourself (self-esteem), or physical health problems, like pain or fatigue.

How does it work?

CBT works best when people start with a high motivation to change. It typically starts from creating a formulation of a problem. If it is big and feels overwhelming the therapist will help you to break it down into smaller parts. This will make it easier to understand how the smaller parts are interconnected and how they affect your mental state. It will enable you to make progress in your recovery. When your problem is broken down into these smaller parts, the therapist usually focusses on:

Specific Situations when a problem occurs,
Your thoughts,
your emotions,
your physical sensations,
your actions.

In therapy these different aspects of a problems are known as the 5 Areas Model (look at the diagram below). It is common that each of these five areas affect the others. How you think about a problem can affect how you feel physically and emotionally. These interrelationships are analysed in the process of therapy.

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In CBT we identify helpful and unhelpful ways of reacting to different situations in our lives. Your reactions depend on how you think about it. The way you think can help you, or it can lead you to experiencing difficult and unpleasant emotions.

The example of a situation of an unhelpful pattern:

You’re at home at your little baby won’t stop crying. This starts a cascade of negative THOUGHTS, such as, “I’m a useless dad/mum”, “I never know what my child needs”, “I’m doing something wrong”. You begin to ruminate and worry about these thoughts. As a result, your mood drops and you FEEL sad. PHYSICAL SENSATIONS of low motivation, feeling deflated, and even problems with sleep may occur if this pattern of thinking occurs regularly. Further, you may engage in avoidance BEHAVIOURS, such as, you may try and avoid spending time with your child. This is likely to strengthen your feelings of inadequacy when it comes to being a dad.

The example of a situation of an helpful pattern:

You’re at home at your little baby won’t stop crying. You choose to THINK positively even though you are distressed: “All babies cry sometimes”, “It’s nobody’s fault”, “It is ok to not to always know what my child needs”. You recognise that there is no need to and worry about what happens. This empowers you to FEEL positively about yourself. It uplifts your mood. IT It is very unlikely that there would be any unpleasant PHYSICAL SENSATIONS. Positive and realistic thinking about what happens will boost your motivation. Your BEHAVIOUR is likely to be one of wanting to be closer to your child, which will strengthen your sense of being a good and responsible dad/mum.

As you can see, the same situation has led to two very different outcomes, depending on how you thought about what happened.

This example shows that how you think has affected how you felt and what you did. In this example in the left hand column, you’ve jumped to a conclusion even though there wasn’t much evidence for it. As a result you 1) had a number of uncomfortable feelings, and 2) you behaved in a way that made you feel worse.

If you follow your unhelpful thoughts and go home feeling low in mood, you’ll probably ruminate on what has happened and make yourself feel even worse. Further, avoiding the other person, will not allow you to correct and clarify on whether what was going through your mind was right or not. On the other hand, if you do get in touch with the other person, there’s a good chance you’ll end up feeling better about yourself.

It often happens that when we are distressed, we are more likely to jump to conclusions and to interpret things in extreme and unhelpful ways. You can start to believe in unpleasant and unrealistic things about yourself. This can create a ‘vicious circle’ which can potentially lead to developing symptoms of depression and anxiety.

CBT is a way of breaking this vicious circle of irrational thinking, feelings and behaviour. It is a way of mental health hygiene, whereby you focus on your rational self and you allow it to inform your feelings and behaviours. During CBT therapy we aim to get you to a point where you can ‘do it yourself’, without being assisted by a therapist. Initially you need to be guided through the process, but after a while you will be able to work out your own ways of tackling your problems.

What does CBT involve?

The sessions

You can do CBT individually with a therapist, or with a group of people. In cases of some mild mental heath difficulties you can do your work with a self-help book, or computer programme.

If you start an individual therapy you may expect the following:

Depending on your problem, you will meet with a therapist for between 5 and 20, weekly, or fortnightly sessions. Each session will last 60 minutes.
In the first 2-4 sessions, the therapist will make sure that CBT is the best treatment option for your problem, discuss whether you feel comfortable with it, and they will conduct further assessments.
The therapist will ask you questions about your past life and background. Even though CBT concentrates on the here and now, it may be the case that you will be invited into discussing your past to understand how it is affecting you now.
The short, medium and long term goal for treatment will be formulated.
There will be a sense of continuation in the process of therapy. You will build on the progress achieved in previous sessions. Some in-between session work can be suggested by a therapist in order to allow you to practice what you discovered in therapy in the real life setting.

The work

In order to help the therapy process, your therapist may ask you to keep a diary. This is a good way of helping you to identify your individual patterns of thoughts, emotions, bodily feelings and actions. These patterns will then be looked at in sessions. The therapist will help you to establish whether 1) they are unrealistic or unhelpful, and 2) how they affect each other, and you.
In further work the therapist will help you to find out how to change your unhelpful thoughts and behaviours.
After you have identified the irrational parts of your thinking and behaviour, the therapist will help you to plan a process of what, how and when you can change. There is an array of methods that can be utilised in sessions to practice the more rational responses (i.e role-play exercises), and to challenge negative thinking (cognitive restructuring). Your therapist may recommend ‘homework’ – when you practise what you have achieved in sessions in your everyday life.
In time you will 1) become more skilled in questioning your self-critical or upsetting thoughts and replace them with a more helpful (and more realistic) ones, and 2) you will be more able to recognise that you are about to do something that will make you feel worse and, instead, do something more helpful.
The process and progress of therapy will be monitored. During each session you will discuss how you’ve got on since the last session. If some task have proven to be too difficult, the therapist will, again, help you to break it down into smaller, and less challenging bits to allow a steady progress in therapy.
It is very important to say that the therapist will not ask you to do things you don’t want to do. It is common that task are challenging, but it is for you to decide on the pace of the treatment and what you will and won’t try. Making steady progress will give you a sense of achievement, and will empower you to make further efforts. The strength of CBT is that, at some point in therapy, you can continue to practise and develop your skills without the assistance of a therapist. This makes it more likely that you will be able to avoid relapsing into the old unhelpful patterns of thinking and behaviour.

Is CBT Effective?

CBT has been designed specifically, and is one of the most effective treatments for conditions where anxiety or depression is the main problem.
Scientific studies have shown is the most effective psychological treatment for moderate and severe depression.
CBT is as effective as antidepressants for many types of depression.

What are other psychological treatments are there and how do they work?

CBT isn’t for everyone. Depending on the nature of the problem, more general psychotherapy may be indicated. This often is the case when old childhood patterns are so deeply ingrained that they affect a person personality and functioning. Further, in cases of traumatic events in the past general psychotherapy may be suggested. This will allow to focus on the troubling emotions. bring them to the fore, and work them through. In the Ark Psychotherapy Service we provide Gestalt Therapy which enables work with difficult emotions, and their meetings for a person.

What are the problems with CBT?

CBT is not a quick fix. It does rely on a person motivation to treatment. As any other therapy approach it encourages you to challenges you believes about yourself and the world around you and, as such, may temporarily make you feel uncomfortable. Your therapist cannot ‘do’ it for you, but will act like a personal trainer that guides and encourages you –
If you are feel very low, it may be difficult for you to concentrate and get motivated. here the process of therapy can be augmented with medications.
As mentioned above, to overcome anxiety, you will need to confront it on several occasions. This may lead you to feel more anxious in the short term, but is designed to meme you better in the long term.
Your sessions will be paced to allow you to stay in control of the whole process.

How long does CBT usually last?

Depending on the problem, a course of CBT therapy may take from 6 weeks to 6 months. In the Ark Psychotherapy we provide CBT for individuals who are self-funded , and those with health insurance.

Is it possible for the symptoms to come back?

It is possible that your anxiety or depression may return. If this happens you can use your CBT skills to control them. Therapists usually encourage clients to keep practising newly acquired CBT skills, even after you are feeling better. If necessary, you can attend more sessions of CBT to work through the symptoms.

Further materials:

The ‘Overcoming’ series, Constable and Robinson

This is a series of popular self-help books which use the theories and concepts of CBT to help people overcome many common problems. Titles include: overcoming social anxiety and shyness, overcoming depression and overcoming low self-esteem.

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