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Cognitive Behaviour Therapy (CBT)

Cognitive Behaviour Therapy (CBT) is a form of evidence-based psychotherapy that emphasises the importance of ‘thinking’ in how we feel and what we do. Simply put, the cognitive – the thinking part of our experience – very much affects the behavioural – the action part of our experience. Indeed there is a causal relationship between our thinking and our feelings and behaviours. It is possible, in a practical and constructive way, to change the way we think in order to feel and behave more comfortably and acceptably, even if the situation has not changed. It is a logical and practical approach to help people with their emotional problems; as such it can be extremely empowering and can bring lasting relief after short term treatment.

Cognitive Behaviour Therapy (CBT) is a short-term form of psychotherapy directed at present-time issues and based on the idea that the way an individual thinks and feels affects the way he or she behaves.  A CBT approach can be applied to a wide range of mental health issues and conditions. The focus is on problem solving, and the goal is to change patients thought patterns in order to change their responses to difficult situations.

Cognitive Behaviour Therapy is one of the most established and researched psychological therapies for emotional, psychological and psychiatric dysfunction. For some problems, such as anxiety and depression, CBT is as effective as medication and can also enhance the effects of medication. The results of CBT are long-term, and you can keep using what you have learned in therapy to approach other problems in your life… The application of CBT varies according to the problem being addressed, but is essentially a collaborative and individualised program that helps individuals to identify unhelpful thoughts and behaviours and learn or relearn healthier skills and habits. Research shows considerable evidence that cognitive behaviour therapy provides effective relief across the lifespan for many anxieties, depressive and behavioural difficulties. Research also indicates that for some problems it is actually the treatment of choice. In practice, the cognitive behaviour therapist helps the client identify thoughts and beliefs that lead to distress, then explores and re-evaluates those thoughts, before helping the client develop more constructive and helpful emotions and behaviour.

When Is Cognitive Behaviour Therapy (CBT) Used?

CBT has been extensively investigated in rigorous clinical trials and has empirical support.CBT is structured; goal oriented, and focuses on immediate difficulties as well as long term strategies and requires active involvement by the client.CBT is flexible, individualised, and can be adapted to a wide range of individuals and a variety of settings.

What can I expect from Cognitive Behaviour Therapy (CBT)?

In a broad sense, as its name suggests, CBT involves both ‘cognitive therapy’ and ‘behaviour therapy’. Cognitive therapy focuses on an individual’s pattern of thinking while behaviour therapy looks at associated actions. When combined skilfully, these two approaches provide a very powerful method to help overcome a wide range of emotional and behavioural problems in children, adolescents and adults. Depending on the problem, CBT may involve a mix of both therapeutic modalities, so some issues are better treated with more behavioural methods and some with more cognitive methods. One of the strengths of CBT is that it aims not just to help people overcome the symptoms that they are currently experiencing, but it also aims to teach the person new skills and strategies that they can apply to future problems. It focuses on the ‘here and now’ whilst developing an understanding of past styles of thinking and behaviour that have developed over time.

CBT examines all elements that maintain a problem, including our thoughts (cognitions), feelings, behaviour and the environment. It is a structured therapy, which involves a partnership between you and your therapist. You are fully involved in planning your treatment and the therapist will always let you know what is happening. Usually you will have a thorough assessment in the first session or two. Each session will involve discussion, explanation and practice of skills and techniques. Often you will be required to practice those techniques in between sessions.

In CBT you will first learn to identify painful and upsetting thoughts you have about current problems and to determine whether or not these thoughts are realistic. If these thoughts are deemed unrealistic, you will learn skills that help you change your thinking patterns so they are more accurate with respect to a given situation. Once your perspective is more realistic, the therapist can help you determine an appropriate course of action. You will probably get “homework” to do between sessions. That work may include exercises that will help you learn to apply the skills and solutions you come up with in therapy to the way you think and act in your day-to-day life.

How does Cognitive Behaviour Therapy (CBT) Work?

  • CBT is appropriate for children, adolescents, and adults and for individuals, families, and couples. CBT has an educational focus. CBT therapists focus on teaching self-counselling skills. When people understand what the thought processes are that are leading to their current situation, they are in a better position to effectively control them. Understanding how and why they are behaving a certain way means they can begin to effect change and progressively have an impact on their own growth and psychological health.
  CBT integrates behavioural theories and cognitive theories to conclude that the way people perceive a situation determines their reaction more than the actual reality of the situation does. When a person is distressed or discouraged, his or her view of an experience may not be realistic. Changing the way clients think and see the world can change their responses to circumstances.
  • CBT is rooted in the present, so the therapist will initially ask clients what is going on in their mind at that moment, so as to identify distressing thoughts and feelings. The therapist will then explore whether or not these thoughts and feelings are productive or even valid. The goal of CBT is to get clients actively involved in their own treatment plan so they understand that the way to improve their lives is to adjust their thinking and their approach to everyday situations.
  • While CBT is a relatively new form of therapy, early philosophers such as Socrates and Epictetus first documented principles on which it is based, centuries ago. Epictetus said “It is not the things of this world that hurt us but what we think about them.” In other words, we can have a powerful effect on our own lives by learning to understand and control our thinking patterns.

Does Cognitive Behaviour Therapy (CBT) work?

Cognitive Behaviour Therapy (CBT) has In particular demonstrated effectiveness with individuals experiencing the following problems:

  • Generalised Anxiety
  • Panic
  • Obsessive Compulsive Disorder
  • Phobias
  • Post-traumatic Stress Disorder
  • Depression
  • Eating Disorders
  • Brain Injury
  • Sexual Dysfunction
  • Couples/Marital problems
  • Social Anxiety
  • Anger & Stress Management
  • Child Anxiety Disorders and Child Depression
  • Child Behaviour Problems

Cognitive Behaviour Therapy (CBT) is particularly useful in treating the problems listed above where you request a practical method of treatment for a specific problem rather than “wanting to understand yourself better”; are able to consider psychological causes of problems; and are able to be actively involved in the therapy process and will practice skills between sessions.

CBT has been extensively investigated in rigorous clinical trials and has empirical support. Broadly, CBT has evidenced the following outcomes:

  • CBT is compatible with a range other treatments that you might receive such as medication or supportive counselling.
  • Because the individual is actively involved in their treatment they are more likely to stick with it.
  • Because CBT is flexible and individualised, it can be adapted to a wide range of individuals and a variety of settings.
  • The client can keep using what they have learned in therapy to approach other problems in life.

What can I expect at my first session?

In the first session, your cognitive behaviour therapist should:

  • Undertake a thorough assessment – you will be asked about past experiences and treatment to better understand the nature of the difficulties for which treatment is being sought.
  • Give you an opportunity to tell them anything you think is relevant to your issue.
  • Explain the basis of cognitive behaviour therapy and how it works
  • Explain what you can expect from therapy
  • Give you an idea of how long you will need to see them – the number of sessions varies with the type of difficulties being treated.
  • Discuss the treatment plan with you including goals and ways to monitor progress.

What can I expect in future sessions?

CBT is a well-planned therapy focused on outcomes. There are a range of techniques and styles in CBT, but regardless of their approach, each session your therapist should:

Give you an opportunity to tell them what has happened since you last saw them   Explain what will happen during that session   Measure and keep you informed about your progress   Give you time to practise any new skills and ask any questions during the session.  

What can I expect in between sessions?

CBT is an active therapy – sometimes described as a ‘doing therapy’ rather than a ‘talking therapy’. So, individuals will be expected to be active participants in their own therapy. This means that you can expect to be fully involved in your sessions and to develop with your therapist some tasks to practice in between sessions. Sometimes these tasks are called ‘homework’

Cognitive Behaviour Therapy and Mindfulness Strategies

The application of mindfulness concepts in Cognitive Behaviour Therapy started in 1970 when Mindfulness Based Stress Reduction (MBSR) was introduced by Jon Kabat-Zinn, to teach patients with chronic medical conditions how to live fuller, healthier more adaptive lives and to cope with stress, pain and illness. Mindfulness is defined as moment-to-moment non-judgemental awareness. For those of us who meditate, this definition sounds familiar, and indeed a theme that is found throughout many of the Eastern philosophies.

The practice of mindfulness begins with considering the following:

  • Anxiety, tension, and stress arise from worrying about the future. Similarly, guilt, regret, resentment, sadness, and bitterness arise from focusing on the past.
  • Mindfulness strategies combined with CBT provide a powerful therapeutic tool that enables us to reside fully in the present and to live our lives in a satisfying and productive way.
  • Cognitive Behaviour Therapy is an effective form of treatment for people with mild to moderate depression, anxiety and panic disorders, agoraphobia, eating disorders, and personality disorders.

A basic example of CBT in action

Let us assume we look at the way you act when a friend says they ‘cannot go out with you because they are busy’. You might think they actually don’t like you and that’s the real reason they always say no to you lately, which leads to the more negative thought that ‘people almost never like me’, which leads to you feeling sad and a bit tired and paranoid or anxious. The result is you don’t go out at all and spend another Friday night in feeling bad about yourself.

  • CBT would encourage you to not accept this negative thought pattern, but to look at the ways your friend really might be busy, and to then identify the people who do like you. The idea is to question all negative assumptions. You might remember that the last time you went out with your colleagues from the office everyone said they enjoyed your company. This might make you feel more energetic, so you call up a workmate and go out with them, or bravely go to an open social gathering and meet new friends entirely. So by changing your thought to one of possibilities, you changed your feelings and physical energy for the better, and this changed your actions and thus your mood.
CBT aims to help you begin to think in open-minded over negative thought loops more and more, until it becomes habitual to think with a wider and more positive perspective over always thinking the worst, or always indulging in the extremes of ‘black and white thinking’.