Cognitive-Behavioural Therapy CBT

• An introduction to Cognitive Behavioural Therapy (CBT)
• What is CBT?
• How Does CBT Work?
• What Does CBT Involve?
• Benefits of CBT
• Limitations of CBT
• Effectiveness of CBT
• Examples of CBT

An introduction to Cognitive Behavioural Therapy (CBT)

Cognitive Behavioural Therapy (CBT) is a type of therapy used to treat many different problems, especially psychiatric problems such as depression and anxiety. CBT has its roots in the late 1950s and was officially formed in the late seventies. Since then it has been shown to be a very effective way to help people overcome a variety of problems. CBT is an umbrella term that encompasses many different types of therapy that are all based on the same ideas. The principle is that first there is a thought, this triggers a feeling and this changes a person’s actions. The problem is that in many people these thoughts are based on ‘incorrect beliefs’. The aim of CBT is to correct these beliefs and this will lead to a change in thoughts leading to a change in feelings and finally a change in behaviour.

What is CBT?

CBT is a relatively short-term form of psychotherapy (a type of counselling) that can be used for the treatment of a wide range of psychological disorders including depression, anxiety, eating disorders such as anorexia nervosa, substance abuse and personality disorders amongst others. It can also be used to help people change their lifestyles. It focuses on working on the ‘incorrect beliefs’ that people have. These ‘incorrect beliefs’ are usually unintentional but they seriously affect how people react to situations.

How Does CBT Work?

CBT is based on the theory a thought or idea must precede a mood, meaning there must be something that a person thinks that leads them to feel a certain way. This, in turn, will lead to the way in which people act. It also says that the way in which people act is heavily influenced by the way that they see themselves and the way that they think others see them.

Below is a simple example.
There are three people (Tom, Dick and Harry) and they all stub their toe on an uneven piece of paving. Tom thinks ‘I am such a fool, everyone must think I’m clumsy and stupid’. Tom feels embarrassed and humiliated and quickly returns home.
Dick thinks ‘I could have hurt myself, why doesn’t the council fix such a hazard’. Dick feels stressed and angry and this reflects on his dealings with everyone he meets that day.
Harry thinks ‘Ouch, I hit my toe, but I’m OK’ Harry doesn’t give it a second thought and it doesn’t affect his day. This is a simple example but it illustrates the point.
Tom and Dick both have ‘incorrect beliefs’ and these beliefs result in thoughts, then feelings (embarrassed and angry) and then actions (Tom goes home while Dick is angry). Only Harry had the right response. He acknowledged that he hurt himself but realised that he was OK and went about his day as normal.

The idea behind CBT is that unwanted behaviours and moods such as depression are often caused by a certain type of thought. These thoughts have usually been held by people for a long time, remaining under the surface. Certain events ‘reactivate’ these types of thoughts and can cause negative moods and behaviours. These thoughts, when pulled apart and examined, are often based on the illogical ideas and ‘false’ beliefs that CBT aims to correct. If CBT can correct these false thoughts then in that situation in the future, the person will react differently and see things from a point of view that will not lead to a negative mood.

What Does CBT Involve?

CBT is usually a relatively short-term treatment, with therapy lasting for up to 6 months. During individual therapy you will meet with your therapist on a regular basis and during these sessions:

1. At first you will set short, medium and long term goals. The therapist will also spend time on your past life and background.
2. With the therapist, you break each problem down into its separate parts. Your therapist may ask you to keep a diary to help identify your individual thoughts and emotions.
3. Together you will look at your thoughts, feelings and behaviours to work out if they are unrealistic, or unhelpful and how they affect you.
4. The therapist will then help you to work out how to change unhelpful thoughts, feelings and behaviours.
5. It’s easy to talk but much harder to actually change. So, after you have identified what you can change, your therapist will recommend ‘homework’ where you will practise these changes in your everyday life.
6. Then at each meeting you discuss how you’ve managed since the last session.

In CBT people are asked about some situations and their views about the world. They are asked what situations they feel the most negative in and then asked to try and find out exactly why these situations make them feel that way. People are asked to look really hard at these situations and think whether or not the thoughts that lead them to feeling that way are logical or not. Over time it is hoped that people will be able to think in a way that leads to a more positive outlook and behaviour.

There is also a ‘behavioural’ aspect to CBT that is especially important early in the treatment. People are often asked to schedule positive experiences and things that they enjoy so that there is always something to look forward to. They are also encouraged to reward positive thinking with enjoyable experiences. There is now a new form of CBT that is computer based. This Computerized Cognitive Behavioural Therapy has been shown to be effective for anxiety and depression and more work is underway to see where else it could be useful. The advantage of computerized behavioural therapy is that it requires fewer resources and therefore has the potential to become more widely available.

Benefits of CBT

CBT is an effective method of treating various types of problems. It is relatively short-term and gives people many skills that can be applied to every situation, even after treatment has finished. CBT is especially effective when combined with pharmacological (drug) treatments because they both work together to improve the symptoms. It has even been shown that CBT can change the way the brain works in much the same way as medications. Even in the absence of drug therapy, or if someone is hesitant to begin drug therapy, CBT alone often provides a good treatment. The people who get the most out of CBT seem to be those that are thoughtful and have the ability to self-reflect on situations and are open to change.

Limitations of CBT

While CBT is actually one of the shorter types of treatment for some people it may still seem too long. Also, it is not a ‘cure’ for any illness and while it does provide a lot of help, it does not completely remove the symptoms, especially if the person is continually in a stressful environment. There are also some conditions that CBT alone does not work very well for and these may require both drug treatment as well as other types of psychotherapy -of which there are many.

Effectiveness of CBT

CBT has been shown to be effective in the following conditions. However this list is continually growing as more research is done into the use of CBT.

• Clinical Depression
• Bipolar Affective Disorder (BPAD)
• Anxiety (both Adults and Teenagers)
• Panic disorder
• Obsessive Compulsive Disorder (OCD)
• Weight Loss
• Phobic Disorders
• Post-Traumatic Stress Disorder (PTSD)
• Schizophrenia
• Drug abuse / Dependence
• Lifestyle changes in long term illnesses (such as Diabetes)

Examples of CBT

Below are two examples of how CBT can work in certain situations. Although both are greatly simplified they illustrate the principle of CBT.

You’ve had a bad day, feel fed up, and so go out shopping. As you walk down the road, your friend, who seems deep in thought, walks by and, apparently, ignores you.
You think: He ignored me, he must not like me, I will ignore him.
You feel: Low, sad, rejected
You Do: Go home, you start ignoring the person, the friendship is over.
This shows several points. Firstly there is the false belief that because your friend didn’t see you they don’t like you. Then it becomes a ‘self fulfilling prophecy’ because if you ignore your friend they will become upset and eventually stop being your friend.

CBT will work on changing your assumptions. For example, your friend seemed deep in thought, maybe something has just happened to them? It would be good to get in touch with them to find out if everything is OK. Another example. "Overfilling the swimming pool is the last straw in my relationship with my parents. The whole garden will have to be re-landscaped. The footings may need to be replaced." Here the problem is magnification. The trigger was overfilling the swimming pool, this combined with magnification leads to the thought that the garden is ruined, leading to feelings of anger, leading to an argument with the parents. CBT will try to change this view, if the pool is overfilled it does not mean that the whole garden is ruined, there is no need to feel angry and there is really no reason to argue with the parents.

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