Cognitive-Behavioural Therapy (CBT) is a practical and goal-directed therapeutic approach. It is based on the premise that it is not our situation, but how we think about our situation, that determines our emotional well-being. Often we cannot change our situation (or the people around us), but we can always change the way we think about that situation and how we choose to respond!
The following summary of CBT is adapted from Dr Philip Timms (Series Editor for the Royal College of Psychiatrists’ Public Education Editorial Board):
CBT is a way of talking about:
- How you think about yourself, the world and other people
- How what you do affects your thoughts and feelings
CBT can help you to change how you think (“Cognitive”) and what you do (“Behaviour”). These changes can help you to feel better. Unlike some of the other talking treatments, it focuses on the “here and now” problems and difficulties. Instead of focusing on the causes of your distress or symptoms in the past, it looks for ways to improve your state of mind now.
CBT has been found to be helpful in:
- Agoraphobia and other phobias
- Social phobia
- Obsessive compulsive disorder
- Post-traumatic stress disorder
How does CBT work?
CBT can help you to make sense of overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you.
These parts are:
- A Situation – a problem, event or difficult situation
From this can follow:
- Physical feelings
Each of these areas can affect the others. How you think about a problem can affect how you feel physically and emotionally. It can also alter what you do about it. There are helpful and unhelpful ways of reacting to most situations, depending on how you think about them.
Situation: You’ve had a bad day, feel fed up, so you go out shopping. As you walk down the road, someone you know walks by and, apparently, ignores you.
|Thoughts||He/she ignored me – they don’t like me||He/she looks a bit wrapped up in themselves – I wonder what is wrong?|
|Emotions/feelings||Low, sad and rejected||Concerned for the other person|
|Physical||Stomach cramps, low energy, feel sick||None – they feel comfortable|
|Action/behaviour||Go home and avoid them||Get in touch to make sure they are ok|
The same situation has led to two very different results, depending on how you thought about the situation. How you think has affected how you felt and what you did. In the example in the left hand column, you’ve jumped to a conclusion without very much evidence for it – and this matters, because it’s led to:
- a number of uncomfortable feelings
- an unhelpful behavior
If you go home feeling depressed, you’ll probably brood on what has happened and feel worse. If you get in touch with the other person, there’s a good chance you’ll feel better about yourself. If you don’t, you won’t have the chance to correct any misunderstandings about what they think of you – and you will probably feel worse.
This is a simplified way of looking at what happens. The whole sequence, and parts of it, can also feedback like this:
This “vicious circle” can make you feel worse. It can even create new situations that make you feel worse. You can start to believe quite unrealistic (and unpleasant) things about yourself. This happens because, when we are distressed, we are more likely to jump to conclusions and to interpret things in extreme and unhelpful ways.
CBT can help you to break this vicious circle of altered thinking, feelings and behaviour. When you see the parts of the sequence clearly, you can change them – and so change the way you feel. CBT aims to get you to a point where you can “do it yourself”, and work out your own ways of tackling these problems.
What does CBT involve?
CBT can be done individually or with a group of people. If you have individual therapy:
You will usually meet with a therapist for between 5 and 20, weekly, or fortnightly, sessions. Each session will last 60 minutes. In the first 2-4 sessions, the therapist will check that you can use this sort of treatment and you will check that you feel comfortable with it.
The therapist will also ask you questions about your past life and background. Although CBT concentrates on the here and now, at times you may need to talk about the past to understand how it is affecting you now. You decide what you want to deal with in the short, medium and long term. You and the therapist will usually start by agreeing on what to discuss that day.
With the therapist, you break each problem down into its separate parts, as in the example above. To help this process, your therapist may ask you to keep a diary. This will help you to identify your individual patterns of thoughts, emotions, bodily feelings and actions.
Together you will look at your thoughts, feelings and behaviours to work out:
- if they are unrealistic or unhelpful
- how they affect each other, and you
The therapist will then help you to work out how to change unhelpful thoughts and behaviours. It’s easy to talk about doing something, much harder to actually do it. So, after you have identified what you can change, your therapist will recommend “homework” – you practice these changes in your everyday life.
The therapist will not ask you to do things you don’t want to do – you decide the pace of the treatment and what you will and won’t try. The strength of CBT is that you can continue to practice and develop your skills even after the sessions have finished. This makes it less likely that your symptoms or problems will return.
How long will the treatment last?
CBT may be from 6 weeks to 6 months. It will depend on the type of problem and how it is working for you.