CBT was developed as a therapy in the 1950s, and has recently grown significantly in popularity in the UK, with the NHS choosing it as a mainstay in the treatment of depression and anxiety in Primary Care. The reason for this choice is primarily because of the substantial evidence base which demonstrates the effectiveness of CBT. But what is CBT and how does it work? Here are some of the key elements.
1. We feel the way we think
CBT says that our feelings about a particular event are largely determined by our perception of the event rather than the event itself. Obviously, if a bad thing happens you will feel bad, but the intensity and duration of that emotion are dictated by how you perceive the occurrence. For example, if you lose a loved one and believe this to be the end of the world, you may become depressed. The depression itself will then become an issue.
2. Interaction of elements
“We feel the way we think” is actually a vastly simplified version of CBT theory. CBT actually conceptualises emotions as the result of intertwined interactions between thoughts, feelings, behaviours, and physiological responses, in any given context. For example, you might have a fear of British house spiders. Your belief that a spider might hurt you (thought) will cause you to feel anxious (feeling) and your heart to race (physiological response) when you see a spider. These thoughts and feelings might cause you to run from the room (behaviour). Your anxious emotions and physiological responses reinforce your thought, because why would you feel this way if there weren’t some truth to your perception of danger? Your behaviour further reinforces the thought, because you never give yourself the opportunity to realise that the spider isn’t going to hurt you. This example shows how erroneous thoughts trigger a series of interactions which reinforce the original thought.
3. CBT does what it says on the tin
CBT is a practical and easy to grasp therapy. Most people attend therapy because of emotional difficulties. Emotions (and unpleasant physiological responses) are difficult to directly alter. But because these are intertwined with behaviours and thoughts (cognitions), CBT focuses on helping clients change those elements in order to positively impact the emotions and physiological responses. Hence the approach being called “Cognitive Behavioural” therapy.
4. Present focus
Most difficulties have their roots in the past – CBT acknowledges this. However, CBT focuses largely on how a problem is maintained in the present (see 2. above) rather than concerning itself with exploring the past in great depth. For example, following on from the above scenario, it might be interesting to realise that your mother passed on her irrational fear of house spiders to you when she freaked out at the sight of a spider on the ceiling. Yet having this knowledge, or even acknowledging that her fear was indeed irrational, is unlikely to stop you from feeling fear in the presence of a spider. CBT’s focus on the present looks to understand the problem as it currently stands, and then address it by adjusting unhelpful thoughts and behaviours. Because CBT already has guiding ideas about how many difficulties are maintained, and because of its focus on the present, CBT therapy is often reasonably brief.
5. It’s all about teamwork
Unlike some therapies, in which the therapist takes a strong authoritarian, “expert” position, CBT is very much a collaborative effort. That is not to say the CBT therapist won’t have ideas about how to address your difficulties, but you will work together to develop a shared understanding of the problem and goals for therapy, agree on session agendas, and create both in-session and between-session tasks. The therapist will naturally provide more assistance earlier in therapy, but will help you to gain in confidence, eventually taking the reins and becoming your own therapist.
6. Don’t take my word for it…
While CBT has strong ideas about what will help, it never asks clients to blindly believe what the therapist says. In fact, it is quite the opposite! CBT theory was developed from observations in the therapy room, and then tested in “laboratory” conditions before being disseminated to the wider therapeutic community, where it was again tested for effectiveness in “real life.” CBT actively encourages clients to work with the therapist to develop new, more helpful thoughts, beliefs, and behaviours, and then test them out in everyday life during in-session and between-session experiments.
Between-session experiments can be thought of as test laps on a grand prix circuit, testing what works and what doesn’t, while visiting the therapist for regular “pit-stops” to discuss the difficulties, gain understanding and insight, and talk through necessary adjustments before going back out for further between-session “laps.” It is through this testing that you can move from intellectually “getting it” to actually living it and making lasting changes.
7. CBT is transparent
Unlike some other therapeutic approaches, CBT is completely upfront with clients about the concepts being used, how problems are formulated, and how treatment progresses. In effect, the CBT therapist is aiming to work himself out of a job with each client who steadily becomes his or her own therapist. Everything is mutually agreed upon in advance, and the client is absolutely encouraged to question any strategies the therapist introduces, and to test them out independently. No client should ever leave CBT feeling that he or she hasn’t fully understood it.
8. CBT is structured
If you’ve ever had counselling, then you should prepare yourself for the much more structured approach that CBT offers. Overall goals are clearly defined and agendas are agreed upon at the beginning of each session. The therapist will help the client stay on track both inside and outside the therapy room. Regular reviews are encouraged, with both the therapist and the client sharing feedback with each other about their perception of progress.
I hope the outline above helps to clarify your understanding of CBT. If you have any queries, please feel free to contact me.
If you are seeking compassionate, understanding therapy from a highly trained and qualified therapist in London, I invite you to contact Martin Cox at Achieving Balance today on 020 7096 8854 for a free, no-obligation 20 minute consultation. I tailor the therapy specifically to each client in an approach that provides great flexibility in frequency, session length, timing, duration, and even location. Let’s take the first step toward your emotional health and well-being together.