What is Cognitive Behaviour Therapy?
Cognitive Behaviour Therapy (CBT) is a general term, which refers to a group of therapies.
These therapies are present-focused, short-term, talk therapies and, as the name suggests, combine cognitive therapy (examining the things we think) with behaviour therapy (examining the things we do).
The underlying principle in CBT is that our thoughts, feelings, physical sensations and actions/behaviours are all interconnected – that our thought patterns (and associated emotions) inform our behaviours. When mental health problems arise, it is frequently as a result of dysfunctional thought patterns.
The goal in CBT then is to work closely with a therapist to identify and change any destructive or disturbing thought patterns that are having a negative effect on our lives. By identifying these thoughts, and developing alternative ways of thinking, we can reduce our psychological distress, resulting in an increase in positive feelings and healthy, helpful behaviours.
There are several ways to approach CBT, depending on the issues we’re dealing with and our personal goals. Whichever approach is taken, therapy will include:
- identifying specific problems or difficulties in our daily life
- becoming aware of negative thought patterns and how they impact our life
- identifying unhelpful thinking and reshaping it in a way that changes how we feel
- learning new behaviours and putting them into practice.
Unlike some talk therapies, CBT focuses on our current problems rather than an in-depth analysis of issues from our past. A key benefit is that our thought processes are constantly being examined, modified and improved during therapy sessions, equipping us with effective coping skills we can continue to apply in the future.
What are the different types of CBT?
Cognitive behaviour therapy is not a distinct treatment technique, but rather an umbrella term that encompasses a range of approaches, each addressing specific needs.
Characteristics shared by many types of CBT include: emphasis on the present, goal setting and understanding the connection between thoughts, emotions and behaviours.
Some of the therapeutic approaches that apply CBT techniques include:
- Behaviour therapy (BT)
- Cognitive therapy (CT)
- Dialectical behaviour therapy (DBT)
- Rational emotive behaviour therapy (REMT)
- Self-instructional training
BT is an action-based therapy that focuses on the idea that all behaviours are learned, and therefore, unhealthy behaviours can be unlearned/changed. By becoming aware of potentially self-destructive or unhealthy behaviours, and seeing how our environment influences them, we can begin to modify and change them. The goal is to reinforce desirable behaviours and remove unwanted or maladaptive ones.
CT assumes that inappropriate or negative thought patterns (automatic thoughts) trigger maladaptive emotional and behavioural responses. It focuses on present thinking and is oriented towards problem-solving. The treatment helps us to identify and change distorted thinking patterns in order to adjust our responses.
DBT combines cognitive therapy, skills training, behavioural strategies and exposure therapy to help us manage dysfunctional and distressing emotions. DBT emphasises acceptance and validation, recognising how difficult it can be to change. This variation can significantly help people stay committed to the process of change.
REMT is an approach that helps to identify irrational beliefs that lead to emotional or behavioural issues. It helps us to identify self-defeating, irrational thoughts and feelings (about ourselves or the world), challenge their rationality and then replace them with healthier, more productive beliefs.
Self-instructional training teaches the use of positive, self-enhancing statements to replace negative or maladaptive thoughts. Internal dialogues are explored during therapy sessions. Coping strategies are developed to reframe them – including relaxation, guided ‘self-talk’ and role-playing. As we practise and reinforce positive self-talk, we learn to successfully self-regulate our behaviour.
Whilst each type of CBT takes a slightly different approach, they all work towards addressing the underlying thought patterns that can contribute to our psychological distress.
Which type of CBT is the best fit for us, will need to be discussed in detail with a therapist. It will be determined by our specific problems, results of previous therapies, our background, personality and our own strengths and weaknesses.
What is CBT used to treat?
CBT was originally developed in the 1960s, by psychologist Aaron Beck, following his dissatisfaction with Freudian psychoanalysis – specifically that it was not sufficiently goal-oriented.
As a short-term, goal-oriented psychotherapy treatment, CBT is most beneficial for people who have a clearly defined problem in their life that they want to address. It is ideally suited to people who prefer a more practical, problem-solving approach – where gaining deep insights is not the main aim.
CBT is highly effective in addressing a wide range of mental health conditions, including:
- Anger management
- Anxiety attacks
- Chronic fatigue syndrome (CFS)
- Eating disorders
- Obsessive-compulsive disorder (OCD)
- Panic attacks
- Post-traumatic stress disorder (PTSD)
- Sleep disorders (including insomnia).
CBT is increasingly being used to treat people with long-term health conditions, such as:
- Irritable bowel syndrome (IBS)
- Chronic fatigue syndrome (CFS)
Although it cannot cure the physical symptoms of these chronic conditions, CBT can significantly help people cope better with their symptoms and improve their quality of life.
As cognitive behaviour therapy is highly goal-oriented, the treatments are personalised and customised to meet each individual’s specific needs, circumstances and personality type. All treatments will help in developing effective coping strategies to better manage problems, so they no longer have a negative impact on our life.
What does CBT involve? / What can I expect?
Undergoing CBT usually involves individual therapy sessions with a trained therapist.
The emphasis in CBT is on the importance of a collaborative approach with our therapist, to discuss specific problems and set goals to work towards. These problems and goals then become the focus for planning the content of future therapy sessions and practical homework assignments.
By talking through each problem in turn, breaking it down into smaller, more manageable chunks, we begin to identify and challenge any destructive, negative thought patterns associated with them. We learn to explore and evaluate our problems in much healthier ways and work towards changing the way we think, behave and respond to them.
Typically, sessions will involve identifying negative thoughts, setting manageable goals, problem-solving, practising new skills and learning to self-monitor.
CBT introduces us to a set of principles and key strategies that, once learned, can be applied whenever they are needed. These key strategies include:
- Cognitive reframing
- Activity scheduling and behaviour activation
- Relaxation and stress reduction techniques
- Role playing
- Mental distractions.
For the best results, we must be willing to spend time and effort outside of the therapy setting to complete homework tasks and continue practising the new techniques in our daily life.
An important advantage of cognitive behavioural therapy is that it tends to be short, taking five to ten months to address and resolve problems.
How effective is CBT?
CBT is one of the most researched types of therapy, perhaps because the approach is focused on specific goals and results can be more easily measured than in many other treatments.
As a result of their success, CBTs are becoming more and more popular and diverse in their application.
Furthermore, it has been found to be an effective approach with people of all ages, including children, adolescents and adults.
Some advantages of CBT:
- Can be completed in a short time frame, compared with other talking therapies (depending on the type and number of issues to be addressed).
- Empowers us to take control, with our therapist in a more advisory and supportive role.
- Deals directly with current problems, without the need to examine our past.
- Can be helpful in cases where medication has not worked or is not possible.
- Can be delivered in different formats, such as group, self-help books and apps (due to its very structured approach) and progress can be paced to meet individual needs.
- Provides long-term solutions and practical strategies that we can continue using in everyday life, once treatment is complete.
- Is often more affordable than some other types of therapy.
Some disadvantages of CBT:
- Underlying mental health conditions may not be identified or addressed, as the main focus is on current problems and specific issues.
- Requires commitment to the process to succeed – the therapist is there to guide and support us, but ultimately we have to do the work for ourselves. We must be ready and willing to invest the time and effort needed to bring about change.
- Is less suitable for people with more complex mental health needs or learning difficulties.
- Involves confronting our emotions and anxieties, which may initially cause a heightened state of anxiety and emotional distress (for a short time).
- Focuses on empowering us to change our thoughts, feelings and behaviours, which may not address problems caused by external factors impacting on our wellbeing.
If you, or a loved one, would like to explore how CBT can help you with any issues you are currently experiencing, please contact us for further support and assistance.