Cognitive Behavioural Therapy

Many people who have sought treatment for their mental health difficulties would have heard of CBT. It’s widely available, both on the NHS (although waiting lists vary) and privately.

Modern CBT has its roots in behaviour therapy developed in the 1950s and 1960s and cognitive therapy from the 1960s onward. CBT is the most heavily researched and proven (evidence-based) form of psychological therapy available. This is not to say it doesn’t have its critics.

Many sufferers have been helped to overcome their problems with CBT, but there are also inevitably many who have not found it helpful and prefer other approaches.

CBT – Basic principles

The cognitive principle (the C)

This is about your thoughts, beliefs and interpretations and the meaning we give to them.

The behavioural principle (the B)

Our actions, responses and what we do.

The ‘interacting systems’ principle

CBT stresses that psychological problems are a result of the interaction between not only our C’s and B’s, but also our emotions, and at times our physical reactions (such as increased heart-rate and altered breathing pattern).

The ‘vicious cycle’ principle

Linked to the above principle is that in CBT there is a strong emphasis on one problem of the ‘interacting system’ causing a direct and often immediate problem in another. For example, our cognitions triggering unhelpful behaviour or vice-versa.

The ‘virtuous cycle’ principle

On a more positive note, CBT stresses that by making positive changes in any one element of the ‘interacting system’ can lead to positive change in other elements thus helping overcome psychological problems or at least reducing symptom severity.

The ‘here and now’ principle

CBT generally focuses more on what’s maintaining the current problems rather than what might have originally caused them. However, please see the below ‘myths’ section.

CBT – Common techniques used

Cognitive restructuring

This is also sometimes referred to as ‘thought challenging’ and ‘cognitive distortions’. It means identifying patterns of thinking or beliefs that are inaccurate based on the available evidence. This also might include making assumptions, jumping to conclusions or mind reading among other things. Once such thoughts and patterns of thinking are identified, the crucial next step is to work on actively challenging and disputing such thoughts and assumptions by looking at the available evidence again and trying to form a more balanced view of the situation.

Behavioural activation (BA)

Although not technically belonging to CBT it fits well with the CBT model in specifically working on the “B” element of the problem. BA works on the theory that depression is linked to people not experiencing enough ‘positive reinforcement’ within their environment. Thus BA aims to support people in gradually experimenting in introducing behaviours and activities that might result in positive reinforcement (basically a sense of accomplishment and/or pleasure that will make it more likely the person repeats the behaviour). BA specifically targets the issue of ‘avoidance’ which it argues is a key factor in maintaining depression

Graded exposure

Typically used for anxiety and panic. The idea is to formulate a ‘hierarchy’ of fears that are tackled in a structured way. The key being to push yourself enough to make progress, but not so much to expect unrealistic and fast gains that lead to a worsening of symptoms and becoming disheartened. The theory holds that our feelings of anxiety lessen as we gradually become more accustomed (habituated) to them. It is especially useful to help overcome safety behaviours that have resulted in us placing great restrictions on what we can and cannot do.

Some common myths

The relationship between therapist and client is not as important as in other models of therapy It is a mistaken view that CBT is impersonal and not concerned with the relationship. If this has been experienced by the client it’s more likely to be specific to an individual therapist rather than CBT as a whole. CBT therapists view warmth, empathy and unconditional positive regard as important elements of the therapy process.

CBT is about positive thinking This does not tell the whole story. CBT is about developing realistic ways of thinking and viewing problems in order to help break the “vicious cycle” as identified above.

CBT doesn’t care about your past, or help you come to terms with past events Although there is a ‘here and now’ focus as discussed above, that does not mean CBT ignores the past. If past events are clearly helping to maintain current problems, the CBT therapist will aim to skilfully work with the client in addressing these issues with a view to helping interrupt the ‘vicious cycle’ that may have developed. An example of how it is inaccurate to say that CBT doesn’t care about the past, is that trauma-focused CBT is becoming more and more widely available now. {/gspeech}

References and further reading

An introduction to Cognitive Behavioural therapy – Skills and applications
Westbrook, Kennerley and Kirk (2007)

The complete CBT guide for anxiety
Shafran, Brosan and Cooper (2013)

Overcoming depression and low mood – A five areas approach, 4th edition
Chris Williams (2014)