Cognitive Behaviour Therapy

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Cognitive Behaviour Therapy (CBT) is a combination of cognitive and behavioural therapeutic approaches. It focuses on breaking down overwhelming problems into smaller manageable  ones.This approach suggests that thoughts, feelings and behaviours are interconnected. Specifically, our thoughts influence our feelings and behaviour.

CBT suggests that the meaning we prescribe to an event, and not the event itself contributes to our emotional and behavioural reactions. When an event occurs, thoughts (interpretation) are formed based on that event. For example, Molly is passed over for a promotion. She thinks that she is useless and dumb, because she did not get promoted. Subsequently, feelings based on the situation are formed. Molly feels disappointed in herself. Then, more thoughts are triggered and behaviours are influenced. With negative thoughts, the person can experience distressing feelings and display unhelpful behaviours. Molly then cries in the toilet, and blames herself for being dumb. Molly begins to ruminate on how she thinks she is a useless employee to the point of being late for work, and also missing deadlines. 

From that example, we clearly see that automatic thoughts contribute to emotional difficulties. It has been suggested that these thinking patterns were set up in childhood and are generally fixed and true. Hence, CBT focuses on changing these dysfunctional thoughts into more helpful ones. 

The behaviour component of CBT includes teaching clients skills or techniques to alter behaviour. It is suggested that helpful behaviours can allow people to relieve their distress. Clients can rehearse and practice new coping skills, either in therapy or planned situations. Therefore, clients are taught to identify thoughts, behaviours and situations that elicit negative emotions. 

CBT is an active short term therapy that focuses on the present. People with depression, anxiety, sleeping problems, eating disorders, post traumatic stress disorder and addictions can greatly benefit from this therapy. It is also suited for those preferring a structured and focused approach in counselling.

History

CBT has its direct roots from Aaron Beck’s Cognitive Therapy. Beck believed that unhelpful automatic thoughts about self are the reason people are upset, as these thoughts are neither helpful nor realistic. He realised the importance of the link between thoughts and behaviours. However, Beck noted that clients were sometimes unaware of such thoughts. Therefore, Beck believed that a therapy used to change clients’  negative thinking styles could be helpful. Later on, behavioural techniques were employed, thus cognitive behavioural therapy was formed. Rational Emotive Behavior Therapy also contributed to CBT.

Goals

Specific goals are set collaboratively by the therapist and client. The therapist and client discuss behaviours associated with goals, circumstances required for change, and the plan of action for achieving those goals.

Techniques

Reframing

Clients learn about their cognitive errors for example personalisation (relating external events to themselves), or overgeneralisation (holding extreme beliefs about a single event and inappropriately applying them to other non related situations). They then develop awareness into the type of cognitive distortions they have. Through this, clients begin to broaden their perspectives and comprehend better the reasons for the actions of others. Clients begin to challenge their faulty beliefs and replace them with more helpful ones. A more positive way of analysing situations is developed.

Back to the previous example through CBT, Molly begins to realise that she took the passing over of the promotion too personally. After analysing the situation, she realised that her colleague did do more for the company than her. Molly also realised that she does not have to base her self-worth on the promotion at work. She begins to feel better about herself, and have healthier thought patterns.

Homework

Doing homework between sessions is common for CBT. Homework refers to exercises done outside counselling sessions. This could be take home worksheets, experiments, or keeping a diary. Homework allows clients to practise what has been learnt during therapy sessions, or note incidents that have provoked feelings of anxiety, depression, or the like. Reactions based on homework are discussed during sessions. Furthermore, faster progress is made for clients that practise new skills, in comparison to those who just talk about their difficulties.

Thought Records

Thought records allow clients to identify unhelpful automatic thoughts and test them. Clients are supposed to look for evidence supporting their claims. When clients are unable to justify their thoughts, they learn to generate alternative explanations. Through this, clients learn to think in more helpful ways.

Behavioural Experiment 

Behavioural experiments are used to test automatic thoughts and beliefs. CBT suggests that some thought patterns are irrational and lack evidence, yet we choose to believe them. Thus, behavioural experiments are designed to allow clients to challenge these thoughts outside the counselling sessions. Behavioural experiments include clients identifying irrational thoughts, planning and executing an experiment to test the validity of those thoughts. Subsequently, thoughts and feelings related to the experiment are discussed in the counselling session. Their automatic thoughts might be altered as a result of the experiment. They could lead to more balanced thoughts about the event, or themselves.

What to Expect

The therapist takes an active role in CBT, by structuring the sessions. The therapeutic journey starts with the therapist and client establishing goals. Clients’ challenges are discussed during the sessions. Cognitive behavioural therapists assist clients to identify their automatic thoughts. Together, they come up with topics that are needed for discussion. Homework is also given to the client to complete between sessions. Clients practise these skills  that promote positive change. Time is also allocated to discuss the outcomes of homework assignments and to plan for the next one. As more progress is made by clients, they begin to assume more responsibility for the sessions.

Criticisms

CBT may not be suitable for people with complex mental health needs or learning difficulties. Furthermore, symptoms are treated, rather than causes. Clients may not gain insight into the reasons for their maladaptive behaviours and thoughts. This therapy approach might not be suitable for clients who prefer to remain more passive during therapy sessions.

To see therapists specialised in this field, visit thetherapy.co 

Janna was our in-house blog writer and therapy specialist. She has supported The Therapy Platform users towards successful therapy experience. She is about to complete Master of Counselling. 

Janna Lim

Therapy Specialist

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