CBT is a form of talking therapy that combines cognitive therapy and behaviour therapy. It focuses on how you think about the things going on in your life – your thoughts, images, beliefs and attitudes and how this impacts the way you behave and deal with emotional problems. It follows this through with looking at how you can change negative patterns of thinking or behaviour that may be causing you difficulties. In turn, this can change the way you feel.
CBT tends to be short, taking six weeks to six months. You will usually attend a session once a week, each session lasting either 50 minutes or an hour. Together with the therapist you will explore what your concerns are and develop a plan for tackling them. You will learn a set of principles that you can apply whenever you need to. You may find them useful long after you have left therapy.
CBT may focus on what is going on in the present rather than the past. However, the therapy may also look at your past and how your past experiences impact on how you interpret the world now.
CBT and negative thoughts
CBT theory suggests that it isn’t events themselves that upset you, but the meanings you give to them. Your thoughts can block you seeing things that don’t fit in with what you believe to be true. You may continue to hold on to these thoughts and not learn anything new.
CBT can help you understand that this is what’s going on and can help you to step outside of your automatic thoughts so you can test them out. For example, if you explain to your CBT therapist that you sometimes call in sick because you feel depressed, the therapist will encourage you to examine this experience to see what happens to you, or to others, in similar situations. You may agree to set up an experiment where you will agree to go to work one day when you feel depressed and would rather stay at home. If you go to work, you may discover that your predictions were wrong. In the light of this new experience, you may feel able to take the chance of testing out other automatic thoughts and predictions you make. You may also find it easier to trust your friends, colleagues or family.
What type of concerns can CBT help with?
CBT can be an effective therapy for a number of problems:
anger management anxiety and panic attacks, chronic fatigue syndrome, chronic pain, depression, drug or alcohol concerns, eating problems, general health concerns, habits, such as facial tics, mood swings, obsessive-compulsive disorder (OCD), phobias, post-traumatic stress disorder sexual and relationship problems sleep problems
What happens in a CBT session?
CBT sessions have a structure. At the beginning of the therapy, you will meet with the therapist to describe specific problems and to set goals you want to work towards.
When you have agreed what problems you want to focus on and what your goals are, you start planning the content of sessions and discuss how to deal with your problems. Typically, at the beginning of a session, you and the therapist will jointly decide on the main topics you want to work on that week. You will also be given time to discuss the conclusions from the previous session. With CBT you are also given homework, and you will look at the progress made with the homework you were set last time. At the end of the session, you will plan another homework assignment to do outside the sessions.
The importance of structure
This structure helps to use the therapeutic time efficiently. It also makes sure that important information isn’t missed out (the results of the homework, for instance) and that both you and the therapist have a chance to think about new assignments that naturally follow on from the session.
To begin with, the therapist takes an active part in structuring the sessions. As you make progress and grasp the ideas you find helpful, you will take more and more responsibility for the content of the sessions. By the end, you should feel able to continue working on your own.
Learning coping skills
CBT teaches skills for dealing with different problems. For example:
If you feel anxious, you may learn that avoiding situations actually increases fears. Confronting fears in a gradual and manageable way can give you faith in your own ability to cope.
If you feel depressed, you may be encouraged to record your thoughts and explore how you can look at them more realistically. This helps to break the downward spiral of your mood.
If you have long-standing problems in relating to other people, you may learn to check out your assumptions about other people’s motivation for doing things, rather than always assuming the worst.
The client-therapist relationship
CBT favours an equal relationship. It is focused and practical. One-to-one CBT can bring you into a kind of relationship you may not have had before. The ‘collaborative’ style means that you are actively involved in the therapy. The therapist seeks your views and reactions, which then shape the way the therapy progresses. The therapist will not judge you. This may help you feel able to open up and talk about very personal matters. You will learn to make decisions in an adult way, as issues are opened up and explained. Some people will value this experience as the most important aspect of therapy.
How effective is CBT?
Clinical trials have shown that CBT can reduce the symptoms of many emo8onal disorders. For some people it can work just as well as drug therapies at trea8ng depression and anxiety disorders. The National Institute for Health and Clinical Excellence (NICE) recommends CBT for common mental disorders, such as depression and anxiety.
Is CBT for me?
CBT is more likely to be helpful to you if can relate to its ideas around thought and behaviour patterns, its problem-solving approach and the need for homework. People tend to prefer CBT if they want a more prac8cal treatment – where gaining insight isn’t the main aim.
The importance of doing homework
The sessions provide invaluable support. But most of the life-changing work takes place between sessions. You are most likely to benefit from CBT if you are willing to do assignments at home. For example, if you experience depression you may feel that you are not able to take on social or work activities until you feel better. CBT may introduce you to an alternative viewpoint – that trying some activity of this kind, however small-scale to begin with, will help you feel better. If you are open to tes8ng this out, you could agree to do a homework assignment, say to go to the cinema with a friend.
(This extract is taken from ‘Making sense of cognitive behaviour therapy’ at Mind)