What is Cognitive Behavioural Therapy?
One of the most well known types of therapy, Cognitive Behavioural Therapy (or CBT for short) has been proven to help people with a variety of issues including depression and anxiety. This article looks to give you the basics of CBT and what you can expect from a session with a CBT therapist.
Where did CBT come from?
CBT was created during a period of time around the 60's and 70's when many psychologists started to move away from psychoanalytic theory (article about that to come), that was predominant in the time. Behavioural psychology, which preceded CBT is based on looking at the connection between behaviour and feeling states. For instance, a behavioural therapist may work with someone who feels anxious in social situations and therefore avoids the situation. The therapist may encourage the client to put themselves in social situations in order to break the anxious feelings and normalise the situation.
As you can see, CBT has added Cognitive onto the behavioural part of it's name. Cognitive Behavioural therapists argue that humans are not simply robotic in our ways of doing things and that our cognitions (ways of thinking about and seeing the world) factor into this. So to go back to our example, CBT therapist would be interested to look at trying to understand the thoughts the client has about the social situations in order to understand best how the anxiety is created. A plan would then be created around this understanding.
So what does Cognitive Behavioural Therapy aim to do?
Put simply, CBT aims to help clients better understand their feelings and emotions and in turn how these affect one's ability to cope and deal with situations in life. One way to help explain this is by talking about the ABC model:
Activating event: this is something that happens in a person's life. This could be every day things like having a conversation at work or being cut off at the traffic lights when driving. It also includes major life events like a divorce, or the death of a loved one.
Belief: our beliefs about the world and about ourselves influence the way we react to things. Our beliefs therefore affect how we interpret things that happen. This is why one person in a conversation may be happy with an outcome but someone else can feel angry and annoyed - their beliefs are different so they have interpreted the conversation differently.
Consequences: our beliefs make us think in certain ways, have specific opinions and values about us and other people. The way that we think creates certain emotions for us, for instance someone who thinks they have been conned or tricked may feel angry, sad, inadequate or despairing. It is these emotions and thoughts that create a resulting action; some people lash out, others withdraw. Other behaviours such as alcohol and drug use and self-harm are also resulting actions.
This model gives a simple idea of how CBT helps people, by looking at situations in their life and how they respond. By attending therapy, clients are able to recognise patterns of behaviour, thoughts and emotions and look to make changes in order to feel better about themselves and their life.
What does a CBT session look like?
Sessions are typically structured, with the aim to achieve specific goals and make sure that everything is covered adequately. CBT involves homework/activities for clients to do in between sessions, and these take many forms. Following a check-in, a therapist may ask how the homework went since the last session and there would be discussion around that. An agenda would then be set for the session, work done around this and then further homework would be agreed upon. CBT is focused on evaluating progress and client satisfaction so the end of a session is usually spent gaining feedback.
Within the session, therapist and client can work on a variety of things. Some examples are:
behaviour based interventions, which look at the client's behaviour and how to make positive changes to increase their wellbeing, relationships and mental health
biological interventions, which look at things like diet, sleep and exercise - all proven to important contributing factors in maintaining good mental health
cognitive / thinking focused interventions, which look at the ways in which a client thinks about themselves, others and the world.
Homework/activities for between sessions also vary greatly and are agreed collaboratively between therapist and client. These can include keeping journals or diaries about things like exercise or sleep or testing out new ways of thinking and coping with situations. The idea is that the momentum is carried forward after sessions and that clients can put their new learning and beliefs into action.
Where can you find a CBT therapist?
The internet has made it easier than ever to find a therapist. If you live in the UK, the NHS offer CBT in different forms as one of their approved treatments for issues such as depression and anxiety, OCD and phobias. You can look for your local IAPT service here in order to find out more about the amount of sessions offered etc.
If you want to receive private therapy, you can look on websites such as Counselling Directory, Psychology Today or the British Association for Counselling & Psychotherapy.
Adam Rothwell is a registered Person-Centred counsellor, working in private practice, seeing clients online and by phone in the UK.