Cognitive Behavioural Therapy (CBT)

What is Cognitive Behavioural Therapy?

This is a goal-orientated therapy which looks at problem-solving in a practical way. It has been described as a combination of both psychotherapy and behavioural therapy.

The therapy aims to change a person’s behaviour and by doing so affect their feelings. It focuses on how our thoughts (the cognitive part) affect our behaviour as a means of dealing with emotional difficulties. In other words, it helps an individual manage their problems by changing how they think and act on a daily basis.

CBT therapists believe that it is not the actual incidents that affect us but the way in which we process them ie if we attribute a ‘negative’ meaning to them then we will behaviour differently than if that meaning were positive. We learn to attribute meaning through past behaviour and therapists attempt to reshape this into more positive perceptions and therefore behaviour.

Unlike many other talking therapies, CBT focuses on the ‘here and now’ rather than looking back constantly and analysing past events in childhood which later shaped adult life.

By breaking down problems into smaller more manageable parts, CBT shows the client how they connect (ie the past with present feelings) and what kind of effect this has both in physically and emotional terms.

The therapy aims to break those vicious circles of unhelpful behaviour and feelings and replace the negative feelings and action with more positive and purposeful affects.

The ultimate aim of the therapy is that eventually the client will be able to work out for themselves the connections between events, feelings and actions and become their own therapist when it comes to current and future situations which in the past would have caused them difficulties.

What to expect

Sessions in CBT are very much structured unlike in traditional therapy where you usually talk to your therapist about what is bothering you at that particular time.

Initially, with CBT, you will be asked to describe a current issue – or issues – which brought you their surgery. You will both then set goals you want to work towards. This could involve finding a better job, having more friends even getting more sleep or being able to step onto an aeroplane. These goals will then form the basis of future sessions.

During future sessions you may analyse the previous session. Both you and the therapist will decide on what new or existing topics you should cover that week.

You will always leave the therapist’s room with homework to do. This will normally involve looking at particular situations, your reaction to them, and what you can do to make that reaction a more positive or pleasant experience. This will go on to look at your behaviour or action which your emotion caused you to carry out.

At other times you may be asked to keep a diary and record situations and your emotional reaction to them.

The initial phase of CBT counselling is focused on relieving the symptoms that brought you there originally by speaking about – and looking at – what is causing them. The second phase is to reinforce improvements and connections.

As the number of sessions continue you will find that you are structuring the sessions and choosing the topics rather than your therapist. This is deliberate so that when the therapy ends you will have learned the techniques involved and have the confidence to set yourself tasks and work on your own initiative.

Most CBT is on a confidential one-to-one basis with a therapist. However, CBT groups also exist where others can provide mutual support for shared difficulties by providing input of a personal nature.

Sessions for both individual and group CBT tend to last around sixty minutes and can be weekly or fortnightly. They can go on for anything from six weeks to six months depending on the severity of the problem and how you find the therapy is working.

Effects and benefits

CBT is considered effective for a number of emotional disorders. The therapy can work on many ages from adults, to teenagers, children and the elderly.

In terms of mild depression and anxiety it is considered as good as chemical treatments and believed, in some instances, to be better in terms in relapse.

However the therapy does not benefit everyone who receives it. It very much depends on how much of an input the client himself is prepared to make. It can also prove difficult for individuals whose mood is too low for them to be able to motivate themselves. Clients must also have a certain level of intelligence so they can work out the connections between feelings and actions for themselves and understand what they are being asked to do.

Because it involves confronting anxiety, the patient will often ‘get worse before they get better.’

Conditions it is said to be good at helping include: anxiety, depression, post-traumatic stress disorder, panic attacks, obsessive compulsive disorder, eating disorders, gambling, phobias (including agoraphobia and claustrophobia), insomnia and drug misuse (including alcohol and smoking).

It is used in more serious depressive disorders such as clinical depression, bipolar and even psychosis and schizophrenia. It can also help with anger management, low self esteem, fatigue, marital difficulties, work problems and attention deficit disorder.

Fascinating facts about Cognitive Behavioural Therapy

  • Behavioural therapy was developed in early 20th century (Pavlov being a major proponent as well as Skinner in later years in the States)
  • CBT was a blending of behavioural and cognitive therapy (the latter developed in the 1960s)
  • The founder of CBT was Aaron T Beck who noticed there was an ‘internal dialogue’ occurring in patients during analysis
  • It was Aaron T Beck who coined the phrase ‘automatic thoughts’ to describe those involving an emotional response
  • Arnold Lazarus developed CBT further by introducing physical sensations, visual images and biology
  • Studies have shown CBT to be as effective as antidepressants in treating cases of mild to moderate depression.
  • CBT is believed to reduce the risk of relapse in people who have experienced at least one episode of depression.
  • CBT was developed as a treatment in the early 1970s
  • The therapy is especially recommended for treating a variety of phobias
  • National Institute of Clinical Excellence (NICE – the government body responsible for providing national health care guidance on the promotion of good health and the prevention and treatment of ill health) recommends CBT  as the treatment of choice for a range of mental health problems such as Anxiety, Depression, Obsessive Compulsive Disorder, Post Traumatic Stress Disorder and Eating Disorders
  • The average CBT sessions lasts 15 to 20 sessions. Other psychological therapies can go on for years
  • Nowadays CBT sessions are available online where the client interacts with a software programme rather than face-to-face with a therapist
  • In 2006 the National Institute for Health and Clinical Excellence recommended CBT be used in the first instance (rather than anti-depressant medication) for patients in England and Wales perceived as suffering from mild to moderate depression
  • The therapy is increasingly being used to help those suffering from a stutter and other speech disorders where anxiety is involved. Speech Bloom is an online programme which has been hailed very successful in this field
  • The World Health organisation recognised a group CBT programme in the States called the Friends Programme as best practice for the treatment of anxiety in children

Professional Organisations

British Association for Behavioural and Cognitive Therapies

For those interested in both the practice and theory of behavioural and cognitive psychotherapy. Members are from a wide-ranging variety of background such as clinical psychology, occupational therapy, general practice, academic research, nursing and educational psychology. The Association aims to promote a range of Behavioural and Cognitive Psychotherapies in accordance with its standards and ethics, provide a discussion forum, information and standards for the discipline, and deliver training. Accredits members and publishes an academic journal, newsletter and other publications. In 2007 its membership had reached 6400.

The British Psychological Society

Promotes excellence in psychology, whether in education, training or practical application. Insists on a code of practice and ethics for members. Attempts to make psychology accessible to the public and act as a spokesperson for its members. Supports professional development of members and provides information on new research and the subject in general to the public through news articles, conferences and events.

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