CBT - Cognitive Behavioural Therapy
What is CBT?
Cognitive Behavioural Therapy or “CBT” is a form of talking therapy that focuses on your patterns of thought and how these affect your behaviours and abilities to cope with emotional situations. CBT primarily focuses on the present and looks to see how we can cope better in the current life circumstances we face but it may be useful at times to look into our past in order to understand our current patterns of thought and behaviour.
Like other talking therapies, it relies on a good relationship between client and therapist involving confidentiality, a supportive environment and empathic listening and understanding of issues. CBT also relies on a collaborative working relationship, supported behaviour change, a goal-driven nature and a motivated client willing to do some work outside of the therapy room.
It tends to be short in duration, taking between 6 weeks and 6 months, this varies depending on the level of difficulties faced.
What is a session like?
The first session is an assessment session, an hour long where the therapist will develop an understanding of the client’s issues and together goals may be discussed, short, medium and long-term.
CBT is structured with both parties bringing items to the agenda each week to discuss in the hour long session. It is important that both parties get to discuss items on their agenda each week. Of course the therapist will wish to discuss issues the client may have had this week and together come up with methods to improve this situation should it occur again. However, after analysing a few individual situations that have caused issue, it will start to become apparent that there are overarching patterns of thought and behaviour having a negative impact on the client’s life. Discussion of these patterns and teaching of CBT skills and techniques will then be the focus of the therapist's agenda for following weeks.
With sessions being only one hour long and sessions being weekly or fortnightly it is important that agreed potential behavioural change or skills taught are practiced outside of the therapy room. For this reason “homework” will usually be assigned each week. These tasks will not be tedious and will be collaboratively discussed and assigned. Clients who work the hardest outside of the therapy room will progress considerably quicker.
In CBT, symptoms will be measured weekly on one or two easy to fill in inventory forms. These give an objective numerical measure of how the client is progressing.
Is CBT effective?
The National Institute for Health and Clinical Excellence (NICE) is an organisation tasked with providing evidence-based guidance and information to the NHS on the most effective ways to treat disease and ill health. NICE recommends CBT for the treatment of Depression where it has found it to be highly effective and also Anxiety Disorders.
CBT - The Cognitive Triangle
CBT is based on the idea that the way we feel is not brought on by the situation itself but by how we perceive or understand the situation - the meaning we give to it. Imagine two people in a room and a dog wanders in - one may feel happy while the other may feel afraid. This proves that it is not the entrance of the dog that has caused the emotional response but rather the meaning each person has attributed. While one person thinks "a playful dog is here", another may think "Ah! I am going to be attacked!"
"We see the world not as it is but as we are"
- Anais Nin
You can imagine how these different thoughts and emotions then influence the action or behaviour of each person. While one moves to play with the dog, the other's "fight or flight" response is stimulated and they will likely move to avoid this threat.
When we engage in situations we have the opportunity to learn more about them, updating our belief systems and therefore changing how we may think about them in the future. However avoidance means beliefs remain fixed and avoidant behaviour likely maintains thought patterns, or with the perceived reward of "safety" even increased the frequency of anxious thoughts in the future.
You might notice that how you perceive situations in your life is not necessarily fixed and this is because how we think about or understand things in any moment is influenced by how we feel at the time. When you feel anxious, your mind is more inclined to see dangers, we tend to worry more. When you feel low, you will think more negatively and perhaps ruminate a lot.
What we do also feeds back into how we are feeling. Think about the days when you could go to the gym but simply can't find the motivation or energy. Again we see feeling impact on emotion here - but... if you go, don't you always feel better and more energised after.
What you think influences and is influenced by how you feel
What you feel influences and is influenced by what you do.
What you do influences and is influenced by what you think.
I always encourage people to note two things about this model.
Firstly: If nothing changes, nothing changes.
People to not speak to their GP about feeling sad for a few hours or anxious for a day or two. Rather we seek out help and support whenever a problem has persisted for a longer period of time and is showing little sign of changing. If a feeling is consistent over a period of time, CBT recognises that there are likely patterns of behaviour and thought that are also not changing. Therefore the first task in therapy will be to better understand your thoughts and behaviour and how they are perhaps maintaining your emotional state.
The second thing to note is:
That if one thing changes - everything changes.
So, the good news is that small changes can have huge impacts. A change in one are of the model has potential infinite knock on effects on the other areas. Therefore, just as mental health can spiral downwards quickly, we can recover quickly too. However it does require change. CBT is an active process where we will be identifying new behaviours that you will be tasked to try out. CBT involves homework tasks and outcomes in therapy will be massively impacted by the effort you put in, inside the therapy room and more importantly, outside the therapy environment.