Cognitive Behavioural Therapy

My Experience of Cognitive Behavioural Therapy

Cognitive Behavioural Therapy (CBT) in my experience is a very popular and well-known therapy due to the exposure it has gained in the media and through NHS commissioning. I regularly get asked over the phone by a client if I provide CBT and it’s not often that people know exactly why they want CBT, but they have heard a lot about it. CBT is often recommended as a first line treatment for a variety of mental health problems such as anxiety, depression, post-traumatic stress disorder, eating disorders, bi-polar, borderline personality disorder, obsessive-compulsive disorder (OCD), phobias, psychosis and schizophrenia. This comes from the National Institute of Clinical Excellence (NICE) which as an organisation evaluates research and develops the policies and pathways that the NHS follows. It is not uncommon for CBT to now be the primary or second taught orientation on most counselling and psychology training courses.

CBT rose in popularly and fame because as a method of counselling it was one that could be standardised (counsellors providing this could offer it in one manualised way so everyone does it the same) and therefore researched. This does not mean that CBT is always the best treatment for the above problems, but research has shown that it can be effective when used with these problems. The benefit being that CBT is an evidence-based therapy meaning that your therapist should only be using what empirically works.

The History of Cognitive Behavioural Therapy

 CBT comes as a second wave of treatment from combining cognitive therapy and behaviourism. People who subscribe to cognitive theory believe that changing thoughts, images and cognitions impact on feelings and as a result a change in behaviour follows. From this perspective people’s emotional reactions and behaviour are strongly influenced by the individualised meaning that they assign to events that they experience. Whereas behaviourists believe that a change in behaviour or environment results in a change in thoughts and feelings. From this perspective it is believed that what we do is the crux of what is maintaining our psychological distress.

When we combine the two perspectives, we get CBT. This theoretical orientation suggests that mental health problems are an extreme or exaggerated version of normal processes. This focus of this therapy is what is happening in the present, with the main concern being the processes that continue the problem rather than what caused it, whether this is thoughts, emotions, bodily sensations or behaviour. 

Now CBT has also evolved further to have alternative models for different problems and this includes Acceptance and Commitment Therapy, Mindfulness Based Cognitive Therapy and Dialectical Behaviour Therapy.

What Does CBT Involve?

In CBT you will first learn to identify painful and upsetting thoughts you have about your problem and then look to evaluate whether these thoughts are realistic. If they are deemed to be unrealistic, therapy will help you learn skills that can challenge the pattern of thinking so that you can accurately evaluate the situation. One way of doing this is to look at the ABC (or more recently the ABCDE) which stands for…

A – Activating event. This is what has triggered the place you now find yourself in. 

B – Belief. This looks at both the inference about the trigger, a person’s core beliefs and the evaluation of the situation.

C – Consequence. This looks at how you react because of these beliefs.

D – Dispute. Then you are encouraged to find evidence and learn new skills to dispute the beliefs.

E – Effective New Belief. Following this space is made so that you can learn a new, realistic and effective belief.

It is also likely together that both you and your therapist will create a formulation such as the example below that highlights the relationship between your thoughts, emotions, bodily sensations and behaviour.When we combine the two perspectives, we get CBT. This theoretical orientation suggests that mental health problems are an extreme or exaggerated version of normal processes. This focus of this therapy is what is happening in the present, with the main concern being the processes that continue the problem rather than what caused it, whether this is thoughts, emotions, bodily sensations or behaviour.

Following this, is it likely that you and your therapist will spend some time trying to build a robust therapeutic alliance as you start to challenge the thought patterns through active participation in therapeutic activities that are tailored to your individual problem and reinforcing these new skills with ‘homework’. 

CBT can be delivered in a range of ways such as one to one or group therapy, or even through self-help materials. 

How Many Sessions of CBT Will I Need?

CBT is often considered a short-term therapy and it is common to be delivered in a block of 12 sessions for one hour a week, over 12 weeks. This can vary with the type of problem that you are coming to therapy for and what you need. Some people need a bit more time, some people need less. 

Is CBT For Me?

 CBT can help with a range of problems such as:

Anxiety

Depression

Post-traumatic stress disorder

Eating disorders

Bi-polar

Borderline personality disorder

Obsessive-compulsive disorder (OCD)

Phobias

Psychosis 

Schizophrenia

It helps many people. For it to work you need to be ready, willing and able to engage with your counsellor. Your practitioner is not there to give you the answers and tell you how to fix the problem but help you learn ways of coping and challenging your current thoughts, feelings and behaviour. This can be hard at times but worthwhile and it will be done in a non-judgemental and caring way.