What is Cognitive Behavioural Therapy?
Cognitive Behavioural Therapy, commonly referred to as CBT, is a form of talking therapy. It was developed in the 1950s by Aaron T. Beck and over the years it became one of the most effective and widely practised psychotherapies in the world.
It is based on the idea that our thoughts, beliefs and physical sensations impact how we feel and behave in relation to ourselves and the world around us. The research shows that CBT can be very effective in the treatment of a range of mental health problems.
CBT can be delivered via individual sessions, group therapy, online therapy or self-help materials. The aim of CBT is to teach new ways of coping with distress by changing the way we behave and think about ourselves and the world around us.
Who can CBT help?
CBT is a relatively flexible therapy that can be adapted to meet your particular needs. The National Institute for Health and Care Excellence (NICE) particularly recommends CBT for depression and anxiety.
However, evidence suggests it can be an effective treatment for a range of mental health problems, such as:
What to expect during CBT therapy?
In CBT, you work with a therapist to identify and challenge any negative thinking patterns, and behaviours that may be causing you difficulties. In turn, this can change the way you feel about situations, and help you to change your behaviour in the future.
CBT teaches coping skills for dealing with different problems so that you become equipped with psychological tools to become ‘your own therapist’.
A CBT therapist, such as a Clinical Psychologist, can help you understand why you are feeling the way you are and teach you how to deal with difficult emotions. You may learn ways of coping with different situations, thoughts, feelings and behaviours.
An important part of CBT is ‘take-home exercises’ – these are what makes CBT so effective! The aim of the exercises is to help you put to practice the skills that you will learn during sessions. They help you build new thinking and behavioural habits.
If you decide to try CBT, you would most likely be invited to have weekly sessions lasting approximately 1 hour. In the first few sessions, your therapist may ask you some questions about your past, your reasons for coming to therapy and discuss your goals and plans for the sessions.
However, the focus of your sessions would be on what is going on in your life right now and how your past experiences impact the way you see the world now. CBT sessions tend to be quite structured and focus on changing unhelpful behaviours or thinking patterns.
One of the key parts of CBT involves exploring a person’s core beliefs. Core beliefs are all-or-nothing statements about ourselves, other people, or the world. They are the roots of our underlying assumptions and automatic thoughts, which in turn impact how we feel and behave.
Some of the techniques you may cover during your CBT sessions include behavioural activation, thought challenging and relaxation techniques, and your therapist would usually start with the simplest ones and progress steadily to the more complex strategies.
You and your therapist can decide together what emotional problems are most difficult for you to cope with and tailor your therapy accordingly, as some CBT techniques will vary depending on whether your problem is depression, anxiety, anger or trauma (PTSD).
CBT for Depression
Let’s for a moment imagine that we all have a stress container, which has a few pebbles in it to start with. These pebbles signify our personality and genes.
However, as we’re walking through life our stress container fills up with difficult experiences and events, big (e.g., bereavements, getting a new job, or getting redundant) and small (e.g., misplaced keys, car breakdowns, arguments, everyday worries).
We all have ways of dealing with life challenges, which help us remove pebbles from our stress container.
However, sometimes those strategies are not enough, and our buckets start to overfill. We start to have negative thoughts about ourselves and the world around us.
We begin to feel low in mood and Depression. We have very little motivation to do even the simplest things, like getting out of bed or taking a shower. We can find it difficult to enjoy things that we used to enjoy, feel tired and/or tearful. Some people can also feel hopeless and experience suicidal thoughts, such as ‘life is not worth living’.
Depression can mean different things for different people and can develop suddenly or very slowly.
CBT can help you cope with thoughts and feelings brought about by depression by teaching techniques to help manage them.
Here are some strategies that your therapist might work through with you to help you overcome depression:
- Behavioural activation – as a lack of drive is a significant feature in depression (both a symptom and a coping mechanism when we feel overwhelmed), keeping a record of your activities can be the first step towards getting your motivation back. Your therapist can help you identify activities that give you the most pleasure, as well as those which can give you a sense of accomplishment. A balance between these may be most helpful to get your life back on track.
- Identifying and challenging negative thoughts – negative thinking patterns are at the core of depression and so the most powerful way of breaking these patterns is to challenge your negative thoughts. Your therapist can help you identify your negative thoughts (using worksheets and exercises) and help you challenge them by creating thought diaries and testing out those negative assumptions through behavioural experiments.
- Problem-solving – when we are depressed, we may avoid solving problems; your therapist can teach you problem-solving strategies.
CBT for Anxiety
If you suffer from anxiety, you are likely to experience heart palpitations, faster breathing, sweaty palms, or feeling nauseous in stressful situations.
You may also experience thoughts or images about danger or bad things happening, thoughts that you won’t be able to cope with, and various other worries.
When you start thinking and worrying about the challenges in your life, you probably tend to put things off or avoid them altogether as this can ease the stress and help you feel better for a while.
Avoidance is a main feature of anxiety, being both a symptom and a coping mechanism, and although it can provide some relief from worry, this tends to be short-lived and create more difficulties in the long term.
Some people may use “safety behaviours”, things we do to reduce our sense of risk or keep from being hurt, in situations that make us anxious. If you decide to try CBT for anxiety, these are some of the strategies that your therapist may go through with you:
- Exposure – when we’re anxious, we can feel as if our stress levels will keep rising until we have a heart attack or pass out. The truth is that anxiety follows a normal curve until it hits its peak, after which the stress and worry start to come down. During exposure, your therapist will help you identify situations and order them from least to most stressful and ask you to remain in each situation until your anxiety comes down.
- Problem-solving – when we’re anxious we may avoid solving problems; your therapist can teach you problem-solving strategies.
- Thought challenging – when we feel anxious, it can be very easy to ‘run away’ with our thoughts. To help you with that, your therapist may suggest keeping a worry diary (where you would write down all your anxious thoughts) and scheduling ‘worry time’ (a specific amount of time you would use to think about all the worries you have). Your therapist can also help you identify your anxious thoughts (using worksheets and exercises) and help you challenge them by creating thought diaries and testing out those anxiety-provoking assumptions through behavioural experiments.
- Relaxation – your therapist can teach you some strategies, such as progressive muscle relaxation or diaphragmatic breathing (breathing through your tummy not your chest).
CBT for Anger Management
Everyone gets angry sometimes. They may feel their heart beating faster, fists clenching, muscles tensing or just simply feel hot.
Often, they become irritable, nervous or feel unable to relax and are more likely to shout or lash out at others. Some people may feel humiliated or disrespected and have anger-provoking thoughts, such as ‘It’s not fair!’, ‘This is wrong’, ‘I have to do something about it!’.
However, if you notice that your anger starts to affect your life and your relationships with people, there are CBT strategies that can help you get your anger under control:
- Identify triggers – your therapist can help you identify situations or circumstances, where you’re more likely to become angry and suggest strategies to help you manage your emotions.
- Relaxation – your therapist can teach you some strategies, such as progressive muscle relaxation or diaphragmatic breathing (breathing through your tummy not your chest) to help you feel less stressed and anxious.
- Thought challenging – thoughts are often at the starting point of the anger cycle, and your therapist can teach you strategies to manage them, such as helping you distinguish between facts and opinions, teaching you how to take a ‘helicopter view’ of the situation and teaching you techniques to challenge your angry thoughts.
- Timeouts – when you notice becoming angry, it may be helpful to take yourself out of the situation to calm down. Your therapist can help you identify early warning signs of your anger getting out of control.
CBT for Trauma (PTSD) or Trauma CBT
Most people become stressed after experiencing a traumatic event, however, this usually passes after a few weeks. If you suffer from PTSD, you have probably experienced flashbacks (traumatic re-living of the event, including images, sounds, emotions and physical sensations) and nightmares, resulting in severe anxiety and/or angry reactions.
As a result, you are likely to do your best to avoid any triggers, such as physical objects, surroundings, other people, that may remind you of the incident in some way.
Although this approach can provide some relief, it is likely to create more difficulties in the long-term as flashbacks and nightmares are part of the brain’s way of processing the trauma so that the traumatic experience can be filed away as a past memory (rather than a current threat) to enable your healing.
Some of the strategies that your therapist may go through with you to help you process those traumatic memories are:
- Exposure (Dealing with the memory) – your therapist will help you to think about or imagine the traumatic event in a safe environment, bit by bit, so that you gradually expose yourself to those situations that remind you of the event. Inevitably, thinking and talking about the trauma may be upsetting at the time, but it will reduce the overall distress and help you move on with your life.
- Grounding and soothing techniques – these can be very useful when we feel really distressed, particularly when the distress makes us feel detached, or it feels like we are in a different situation from where we really are. Your therapist may teach you breathing techniques and could also suggest mindfulness-based strategies to help you stay in the moment (rather than get carried away with your distressing thoughts).
- Relaxation – your therapist can teach you some strategies, such as progressive muscle relaxation or diaphragmatic breathing (breathing through your tummy, not your upper chest) to help you feel less stressed and anxious.