What is CBT?
Cognitive-Behavioural Therapy (CBT) is a highly effective evidence-based, solution-focused therapy that can help you overcome emotional problems, like depression and anxiety. Although CBT is called a “talking therapy”, emotional change very much depends on behavioural change. As such, CBT involves more than just talking about solutions-you will actively work toward behavioural change.
The Cognitive element of CBT refers to the thoughts, images or memories you have. Sometimes thoughts can be helpful, such as “I am doing my best” and “I am coping.” But sometimes the thoughts we have are less helpful, i.e., “I am not coping,” or “I am going to fail.” These are called negative thoughts, because they have a negative effect on how you feel.
The Behavioural component of CBT refers to behaviours and strategies you engage in to cope with how you feel, i.e., procrastination, avoidance, setting unrealistic standards.
The goal of CBT is to help you identify which behaviours and thoughts may be impacting your emotions and getting in the way of you reaching your goals, and to help you develop new ways of coping.
Causal factors and maintaining factors
Causal factors are those events or situations that precipitate an emotional response, i.e., the loss of a job, the break-down of a relationship, difficulty conceiving, several stressors occurring all at once. One or more of these events may contribute to the development of anxiety or depression, but it is the maintaining factors above that actually keep the anxiety or depression going, and this is why the focus of our CBT sessions will be on the maintaining factors.
Unlike other talking therapies that focus mainly on the past (specifically, your early relationship with your parents, for example), cognitive-behavioural therapy is more present-focused, and is more concerned with what keeps your current problems going today (i.e., what beliefs and behaviours are holding you back from achieving your goals today), rather than on what caused the problems in the first place. The beliefs and behaviours that keep your problems going are called maintaining factors.
Maintaining factors consist of negative thoughts and behaviours.
- I am a fraud
- I can’t cope
- Things will never get better
- Nothing ever goes as planned
- I am not valued
- I am wasting my time
- Excessive drinking
- Withdrawing from family/friends
- Avoiding important tasks
- Sleeping more than usual
These are all maintaining factors because they maintain your anxiety and depression and keep you stuck. The thoughts have a negative effect on how you feel, and when you feel bad, you engage in behaviours that are unhelpful-they prevent you from moving closer to your goals. Therefore, they maintain your problems.
CBT-a practical therapy
CBT brings logic to emotional problems; when everything may seem overwhelming and nonsensical, CBT can bring logic and sense to your problems. One way we achieve this is by breaking down your problems into various parts (thoughts, feelings, behaviours).
The ABC of CBT
One of the principles of CBT is that the way you think (Cognitive) about a situation, influences how you feel and behave (Behavioural). Our thoughts play a key role in the way we feel, and they also influence how we behave towards ourselves and others.
Let’s take a look at an example using the ABC model of emotional problems:
A=activating event (trigger)
B=beliefs and thoughts
C=consequences (emotional and behavioural)
Example: Mike and Sam have both lost their jobs. Let’s call “loss of job” the “activating event” or “trigger”. Now let’s look at how they both think about and respond, to this activating event.
|A(Activating Event/Trigger)||Beliefs (Thoughts)||Consequences (emotional and behavioural)|
|Loss of job||“I’ll never find a good job again; this was the ideal job; what if I can’t find another job”.||Depression, worry, withdrawal from people, stay in bed far too long each day, avoid getting on with tasks.|
|A(Activating Event/Trigger)||Beliefs (Thoughts)||Consequences (emotional and behavioural)|
|Loss of job||“It’s too bad I lost this job, I really enjoyed it and liked my colleagues but it’s not the end of the world; I know I am employable so I’ll just spend some time putting my CV together and send it out to prospective employers.”||Upset, not depressed, takes proactive steps to finding new job.|
Can you spot any differences in the way these two people think? How about how they each responded to their thoughts? Did you notice that Mike behaved in a “depressed” way whilst Sam responded in a more proactive way to the same situation?
CBT will help you to identify and evaluate the validity of your negative thoughts; negative thoughts are the thoughts that make you feel bad and prevent you from reaching your goals.
“Marla was supportive, committed, patient and a good listener- she was well prepared prior to our sessions, which ensured that our meetings were focused and result oriented”. RS from the City
Cognitive-Behavioural Therapy and Early Experiences
CBT is present-focused, and most of our work will focus on your present situation. During our initial sessions, however, we will complete a CBT assessment to explore your history and early experiences. By taking time to think about where your beliefs come from, and how they may be negatively impacting your life and relationships today, you can gain distance from them, in order to develop healthier and more helpful self beliefs.
It’s often difficult to know how much the past is contributing to your present distress and problems, but you may find some of these clues helpful:
- Long-standing anger towards one or both parents about the past
- Seeking approval from your parents (as an adult)
- Blaming yourself for something that has happened in the past
- Difficulty letting go of something that has happened in the past
- Difficulty remaining present-focused in session and instead feeling the need to talk about the past
If you relate to any of the above, it may be important for us to spend some time exploring how your past is affecting you now. However, if you are interested in spending all of your time in therapy exploring your past, it may be that you need a different therapy, one that focuses mainly on your past relationships.
As children, we receive messages about ourselves through our interactions with the adults in our lives. Over time, these messages become so ingrained that they develop into self-beliefs. It is not unusual to carry these beliefs into adulthood. Unfortunately, some of the beliefs we first developed as children can be quite negative and unhelpful, such as:
- I am fat
- I am ugly
- I am different
- I am incompetent
- I am worthless
Through our CBT sessions, we will explore together the messages you received about yourself when you were young—i.e., “I am lovable” or “I am unlovable”; “I am competent” or “I am stupid”; “I am fat” or “I am too skinny”. We will also discuss where these messages came from and whether they came from a reliable source. When we are young, we do not have the know-how to stand back and question how true these messages are. We are told that a parent is always right, so we believe the things that adults tell us, even if it makes us feel bad about ourselves.
However, now that you are an adult, you can learn to stand back and question the validity of these messages and even question the source of the messages. For example, you may realize that a parent, teacher, sibling, or classmate used to call you “thick” or “stupid” because they felt like a failure, they may have been depressed or they were repeating behaviour they experienced growing up. The treatment you received had nothing to do with you, but it’s easy to personalize negative experiences and create your own meaning—i.e., “it is my fault” “I really am bad”—when you are too young to know or understand differently.
Together, we will consider:
- Were these beliefs helpful to you as a child?
- Are they helpful to you today, now that you are an adult?
- Are they holding you back from reaching your goals?
- Do they prevent from you feeling good about yourself?
Principles of CBT
Cognitive Behavioural Therapy is based on the following principles which set it apart from other therapies:
CBT involves setting specific, measurable and achievable goals. We will clearly identify the main problems you are experiencing and work collaboratively to develop effective, tailored strategies.
Unlike other talking therapies, CBT treatment is more concerned with the present than the past. We are less concerned with what caused your problems, and more concerned with what keeps them going, i.e., the thoughts and behaviours that are holding you back from achieving your goals. These are called maintaining factors because they are maintaining your problems.
While it can be helpful to understand what has contributed to the development of your distress or dissatisfaction, it isn’t a requisite. We don’t need to understand what caused a problem in order to resolve it. One of the obvious reasons for this is because we cannot change the past, we can only learn from it.
Take a physical analogy: if you broke your leg, would you need to know how you broke it, in order to mend it? Of course not. Similarly, we don’t need to know why you became depressed in order to help you overcome your depression. It can, however, be helpful to understand what has contributed to the development of your depression, but it isn’t a requisite to know that in order to overcome it.
It is possible to be so invested in knowing why you became depressed, that you get stuck and are unable to get yourself well. It is more important to know what steps to take to get well, than to know how you got here in the first place. We will work together to understand and address the thoughts and behaviours that may be impacting your emotions and getting in the way of reaching your goals.
CBT sessions are structured and focused. CBT differs from other therapeutic approaches where clients are often encouraged to talk about “whatever is on your mind”. At the start of each session we will set an agenda for the session which will keep us on track and ensure we address the areas most important to you.
CBT typically lasts between 5-20 sessions. The length of therapy depends on the nature of your problems and how long-standing they are. For long-standing problems, CBT may last longer than 20 sessions.
Whilst the CBT therapist has advanced knowledge and training in formulation-driven CBT, psychological theories and treatment models, you are the expert on yourself. Together, you and I will form a collaborative working relationship to help you find fast, meaningful change.
We will regularly monitor progress through the use of questionnaires, which will measure your symptoms, as well as regular feedback during our sessions. This allows us to make any necessary changes to your treatment plan.
The negative beliefs that you hold about yourself and others, as well as many unhelpful behaviours, have been learned. You either learned them through direct messages that were communicated to you—“you are worthless”; “nobody will like you”—or through observation (also known as vicarious learning). You may have seen your older sister or brother getting punished for coming home late or for underperforming at school, for example, and so you learned that you need to do well (behaviour) and be a “good” girl/boy in order to receive praise/love and avoid punishment from your parents. One of the premises of CBT is that any belief or behaviour that has been learned can also be “unlearned”. That means you can learn to think differently about yourself, and behave in ways that will help, rather than hinder, you in reaching your goals.
In our sessions you will play an active role in the therapy process. Your therapist will teach you new skills to help you overcome your current difficulties, whilst your role is to actively put them into practice.
In some talking therapies, the patient (client) is encouraged to talk for most of the therapy hour, while the therapist listens. But, by taking an active approach-noting down important points discussed and practicing new ways of thinking and behaving in everyday life, between sessions-you are more likely to make progress. It takes more than just “talking” to get better; you need to “do” and carry your new learning into your daily life.
The more you practice your CBT skills, the more you will benefit from your sessions. Research has shown that those who practice their new thinking skills and behaviours between sessions, get better faster.
Willingness to Change
The success of CBT in helping you address current challenges is largely dependent on your willingness to have your current style of thinking challenged and your willingness to experiment with new ways of behaving.
Fosters Independence and Self-Help
An important aim of CBT is to help you become your own therapist. By providing you with the tools and skills necessary to cope with your current problems, you will be able to apply these same skills, to other areas of your life, long after your therapy experience is over.