What is Cognitive Behavioural Therapy?

Cognitive Behavioural Therapy, commonly referred to as CBT, is a form of talking therapy developed in the 1950s by Aaron T. Beck. Over the years, it became one of the world’s most researched, effective, and widely practised psychotherapies.

This therapy is based on the awareness that our thoughts, beliefs and physical sensations impact how we feel and behave towards ourselves, others, and the world around us. The research shows that CBT can be very effective in treating a range of mental health problems.

CBT can be delivered via individual sessions, group therapy, online therapy or self-help materials. CBT aims to teach new ways of coping with distress by changing how we behave and think about ourselves and the world around us.

Whom can CBT help?

CBT is a relatively flexible therapy that can be adapted to meet 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, a person works with a therapist to identify and challenge any negative thinking patterns and behaviours that may be causing them difficulties. This can change the way they feel about situations and help them change future behaviour.

CBT teaches a person coping skills for dealing with different problems to become equipped with psychological tools to become ‘your own therapist’.

A CBT therapist, such as a Clinical Psychologist, can help someone understand why they are feeling the way they are and teach them how to deal with difficult emotions and how to cope with different situations, thoughts, feelings, and behaviours.

An important part of CBT is ‘take-home exercises’. The exercises aim to help put to practice the skills learnt during sessions. They also help someone build new thinking and behavioural habits.

Those who decide to try CBT are most likely to be invited to have weekly sessions lasting approximately 1 hour. In the first few sessions, a therapist may ask some questions about the past, reasons for coming to therapy and discuss ultimate end goals and plans for the sessions.

However, the focus of sessions will be on what is going on in a person’s life right now and how past experiences impact the way they see the world around them. CBT sessions tend to be quite structured and focus on changing unhelpful behaviours or thinking patterns.

One of the critical 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 that may be covered during a CBT session include behavioural activation, which is thought challenging and relaxation techniques. A therapist will usually start with the most straightforward techniques and progress steadily to the more complex strategies.

An individual and their therapist can decide together what emotional problems are most difficult for them to cope with and tailor the therapy accordingly. Some CBT techniques will vary depending on whether a problem is Depression, Anxiety, anger or trauma (PTSD).

CBT for Depression

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 walk through life, our stress container fills with difficult experiences and events, bigger (e.g., bereavements, getting a new job, or getting redundant) and smaller (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.

Sometimes those strategies are not enough, and our buckets start to overfill. We begin to have negative thoughts about ourselves, others, 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 maybe 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 helps those suffering from the thoughts and feelings that Depression may bring about by teaching techniques to help manage them.

Here are some strategies that a therapist might work through help overcome Depression:

  • Behavioural activation

A lack of drive and motivation is a significant feature in Depression (both a symptom and a coping mechanism when feeling overwhelmed). Keeping a record of activities can be the first step towards getting motivation back. A therapist can help identify activities that give a person the most pleasure and those that can provide them with a sense of accomplishment.

A balance between these may be most helpful to getting 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 negative thoughts. A therapist can help identify negative thoughts (using worksheets and exercises) and help challenge them by creating thought diaries and testing those negative assumptions through behavioural experiments.

  • Problem-solving

When we are depressed, we may avoid solving problems; a therapist can teach problem-solving strategies.

CBT for Anxiety

Those who suffer from anxiety are likely to experience heart palpitations, faster breathing, sweaty palms, or nausea in stressful situations.

They may also experience thoughts or images about danger or bad things happening, ideas that they cannot cope with, and various other worries.

When those suffering start thinking and worrying about the challenges in their life, they tend to put things off or avoid them altogether, as this can ease the stress and help them feel better for a while.

Avoidance is a prominent feature of anxiety, being both a symptom and a coping mechanism. 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 a person decides to try CBT for anxiety, these are some of the strategies that a therapist may go through:

  • Gradual exposure

When we’re anxious, we can feel 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, a therapist will help identify situations, order them from least to most stressful, and ask a person to remain in each situation until their anxiety comes down.

  • Problem-solving

When we’re anxious, we may avoid solving problems. A therapist can teach problem-solving strategies.

  • Thought challenging

When anxious, it can be very easy to ‘run away’ with our thoughts. To help with that, a therapist may suggest keeping a worry diary (where someone will write down all their anxious thoughts) and scheduling ‘worry time’ (a specific amount of time a person would use to think about all the worries they have).

A therapist can also help identify anxious thoughts (using worksheets and exercises) and help challenge them by creating thought diaries and testing those anxiety-provoking assumptions through behavioural experiments.

  • Relaxation

A therapist can teach strategies such as progressive muscle relaxation or diaphragmatic breathing (breathing through your tummy, not your chest).

CBT for Anger Management

Everyone gets angry from time to time. It is a natural human emotion. When angry, a person may feel their heart beating faster, fists clenching, muscles tensing, or simply feeling 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’, and ‘I have to do something about it!’

However, if y your anger starts to affect wider life and relationships, there are CBT strategies that can help you get anger under control:

  • Know the triggers

Identify situations or circumstances where a person is more likely to become angry and suggest strategies to help manage emotions.

  • Relaxation

A therapist can teach 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. A therapist can teach strategies to manage them, such as helping someone distinguish between facts and opinions, teaching how to take a ‘helicopter view’ of the situation, and teaching techniques to challenge their angry thoughts.

  • Timeouts

When someone notices they are becoming angry, it may be helpful for them to themselves out of the situation to calm down. A therapist can help you identify early warning signs of 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 someone has PTSD, they have probably experienced flashbacks (traumatic re-living of the event, including images, sounds, emotions and physical sensations) and nightmares, resulting in severe anxiety and angry reactions.

As a result, those who suffer from this are likely to do their best to avoid any triggers, such as physical objects, surroundings, other people that may remind them 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 healing.

Some of the strategies that therapists may go through to help process those traumatic memories are:

  • Exposure (processing the memory)

A therapist will help think about or imagine the traumatic event in a safe environment, bit by bit so that a person can gradually expose themselves to those situations that remind them of the event. Inevitably, thinking and talking about the trauma may be upsetting at first, but it will reduce the overall distress and help those suffering move on with their lives.

  • Grounding and soothing techniques

These can be very useful when we feel really distressed, particularly when the distress makes us feel detached or feel like we are in a different situation from where we really are. A therapist may teach breathing techniques and suggest mindfulness-based strategies to help someone stay in the moment (rather than get carried away with your distressing thoughts).

  • Relaxation

A therapist can teach strategies such as progressive muscle relaxation or diaphragmatic breathing (breathing through your tummy, not your upper chest) to help those suffering feel less stressed and anxious.

What is Cognitive Behavioural Therapy?

Cognitive Behavioural Therapy, commonly referred to as CBT, is a form of talking therapy developed in the 1950s by Aaron T. Beck. Over the years, it became one of the world’s most researched, effective, and widely practised psychotherapies.

This therapy is based on the awareness that our thoughts, beliefs and physical sensations impact how we feel and behave towards ourselves, others, and the world around us. The research shows that CBT can be very effective in treating a range of mental health problems.

CBT can be delivered via individual sessions, group therapy, online therapy or self-help materials. CBT aims to teach new ways of coping with distress by changing how we behave and think about ourselves and the world around us.

Whom can CBT help?

CBT is a relatively flexible therapy that can be adapted to meet 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, a person works with a therapist to identify and challenge any negative thinking patterns and behaviours that may be causing them difficulties. This can change the way they feel about situations and help them change future behaviour.

CBT teaches a person coping skills for dealing with different problems to become equipped with psychological tools to become ‘your own therapist’.

A CBT therapist, such as a Clinical Psychologist, can help someone understand why they are feeling the way they are and teach them how to deal with difficult emotions and how to cope with different situations, thoughts, feelings, and behaviours.

An important part of CBT is ‘take-home exercises’. The exercises aim to help put to practice the skills learnt during sessions. They also help someone build new thinking and behavioural habits.

Those who decide to try CBT are most likely to be invited to have weekly sessions lasting approximately 1 hour. In the first few sessions, a therapist may ask some questions about the past, reasons for coming to therapy and discuss ultimate end goals and plans for the sessions.

However, the focus of sessions will be on what is going on in a person’s life right now and how past experiences impact the way they see the world around them. CBT sessions tend to be quite structured and focus on changing unhelpful behaviours or thinking patterns.

One of the critical 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 that may be covered during a CBT session include behavioural activation, which is thought challenging and relaxation techniques. A therapist will usually start with the most straightforward techniques and progress steadily to the more complex strategies.

An individual and their therapist can decide together what emotional problems are most difficult for them to cope with and tailor the therapy accordingly. Some CBT techniques will vary depending on whether a problem is Depression, Anxiety, anger or trauma (PTSD).

CBT for Depression

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 walk through life, our stress container fills with difficult experiences and events, bigger (e.g., bereavements, getting a new job, or getting redundant) and smaller (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.

Sometimes those strategies are not enough, and our buckets start to overfill. We begin to have negative thoughts about ourselves, others, 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 be 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 helps those suffering from the thoughts and feelings that Depression may bring about by teaching techniques to help manage them.

Here are some strategies that a therapist might work through help overcome Depression:

  • Behavioural activation

A lack of drive and motivation is a significant feature in Depression (both a symptom and a coping mechanism when feeling overwhelmed). Keeping a record of activities can be the first step towards getting motivation back. A therapist can help identify activities that give a person the most pleasure and those that can provide them with a sense of accomplishment.

A balance between these may be most helpful to getting 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 negative thoughts. A therapist can help identify negative thoughts (using worksheets and exercises) and help challenge them by creating thought diaries and testing those negative assumptions through behavioural experiments.

  • Problem-solving

When we are depressed, we may avoid solving problems; a therapist can teach problem-solving strategies.

CBT for Anxiety

Those who suffer from anxiety are likely to experience heart palpitations, faster breathing, sweaty palms, or nausea in stressful situations.

They may also experience thoughts or images about danger or bad things happening, ideas that they cannot cope with, and various other worries.

When those suffering start thinking and worrying about the challenges in their life, they tend to put things off or avoid them altogether, as this can ease the stress and help them feel better for a while.

Avoidance is a prominent feature of anxiety, being both a symptom and a coping mechanism. 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 a person decides to try CBT for anxiety, these are some of the strategies that a therapist may go through:

  • Gradual exposure

When we’re anxious, we can feel 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, a therapist will help identify situations, order them from least to most stressful, and ask a person to remain in each situation until their anxiety comes down.

  • Problem-solving

When we’re anxious, we may avoid solving problems. A therapist can teach problem-solving strategies.

  • Thought challenging

When anxious, it can be very easy to ‘run away’ with our thoughts. To help with that, a therapist may suggest keeping a worry diary (where someone will write down all their anxious thoughts) and scheduling ‘worry time’ (a specific amount of time a person would use to think about all the worries they have).

A therapist can also help identify anxious thoughts (using worksheets and exercises) and help challenge them by creating thought diaries and testing those anxiety-provoking assumptions through behavioural experiments.

  • Relaxation

A therapist can teach strategies such as progressive muscle relaxation or diaphragmatic breathing (breathing through your tummy, not your chest).

CBT for Anger Management

Everyone gets angry from time to time. It is a natural human emotion. When angry, a person may feel their heart beating faster, fists clenching, muscles tensing, or simply feeling 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’, and ‘I have to do something about it!’

However, if y your anger starts to affect wider life and relationships, there are CBT strategies that can help you get anger under control:

  • Know the triggers

Identify situations or circumstances where a person is more likely to become angry and suggest strategies to help manage emotions.

  • Relaxation

A therapist can teach 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. A therapist can teach strategies to manage them, such as helping someone distinguish between facts and opinions, teaching how to take a ‘helicopter view’ of the situation, and teaching techniques to challenge them angry thoughts.

  • Timeouts

When someone notices they are becoming angry, it may be helpful for them to themselves out of the situation to calm down. A therapist can help you identify early warning signs of 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 someone has PTSD, they have probably experienced flashbacks (traumatic re-living of the event, including images, sounds, emotions and physical sensations) and nightmares, resulting in severe anxiety and angry reactions.

As a result, those who suffer from this are likely to do their best to avoid any triggers, such as physical objects, surroundings, other people that may remind them 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 healing.

Some of the strategies that therapists may go through to help process those traumatic memories are:

  • Exposure (processing the memory)

A therapist will help think about or imagine the traumatic event in a safe environment, bit by bit so that a person can gradually expose themselves to those situations that remind them of the event. Inevitably, thinking and talking about the trauma may be upsetting at first, but it will reduce the overall distress and help those suffering move on with their lives.

  • Grounding and soothing techniques

These can be very useful when we feel really distressed, particularly when the distress makes us feel detached or feel like we are in a different situation from where we really are. A therapist may teach breathing techniques and suggest mindfulness-based strategies to help someone stay in the moment (rather than get carried away with your distressing thoughts).

  • Relaxation

A therapist can teach strategies such as progressive muscle relaxation or diaphragmatic breathing (breathing through your tummy, not your upper chest) to help those suffering feel less stressed and anxious.

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