What is cognitive behaviour therapy (CBT)?
How does CBT work?
Cognitive behavioural therapy (CBT) differs from most other types of psychotherapies in a number of ways. These are outlined below.
- Pragmatic. CBT helps identify specific problems and then an attempt is made to solve them.
- Highly structured. Rather than talking freely about your life, you and your therapist will discuss your specific problems and set goals for you to achieve. As part of this, you may be given homework in the form of activities that you should try to complete before your next therapy session.
- Concerned with the present. Unlike some other therapies that attempt to explore and possibly resolve past issues, CBT is mainly concerned with how you think and act now.
- Collaborative. Your CBT therapist will not tell you what to do. They will work with you in order to help you improve your situation.
A course of CBT therapy can comprise of 5-20 weekly sessions, with each session lasting between 30-60 minutes. The initial sessions will be spent breaking down what appears to be an insolvable problem, into smaller parts.
One way to do this is to consider a certain situation, and then see how it affects your thoughts, emotions, physical feelings, and actions.
For example:
- Situation: a man's marriage has recently ended in divorce.
- Thoughts: he believes that he has failed as a husband and will never be capable of establishing a meaningful relationship in the future.
- Emotions: this makes him feel hopeless, lonely, and depressed.
- Physical feelings: his depression makes him feel constantly tired and drained.
- Actions: the man starts to avoid his friends and family and spends most of his free time at home by himself.
It is clear that the man's initial unrealistic and unhelpful belief that he is a failure, and incapable of forming relationships, is threatening to trigger a downward cycle of thought and behaviour that will eventually make the his negative beliefs become self-fulfilling. If the man spends all of his free time alone in his house, he is unlikely to form any new relationships.
The CBT therapist will attempt to stop this downward cycle from occurring by trying to encourage the man to think more realistically about his situation, before using those thoughts as a springboard for a more positive pattern of behaviour.
For example:
- Situation: a man's marriage has recently ended in divorce.
- Thoughts: CBT encourages the man to accept that many marriages end in divorce, that both parties may be equally to blame, and that all he can realistically do now is to try to learn from his past mistakes and move on.
- Emotions: the man starts to feel cautiously optimistic about the future.
- Physical feelings: the man's energy levels begin to return, making him more socially active.
- Actions: as part of his CBT 'homework', the man begins to attend evening classes. This, along with a more outgoing attitude, enables him to find a new circle of friends.
Once your CBT course has finished, there is no reason why you cannot continue to apply the principle of CBT to your daily life. Your therapist should be able to provide self-help material or recommended some suitable CBT self-help books.Our 'cognitive processes' are our thoughts which include our ideas, mental images, beliefs and attitudes. Cognitive therapy is based on the principle that certain ways of thinking can trigger, or 'fuel', certain health problems. For example, anxiety, depression, phobias, etc, but there are others including physical problems. The therapist helps you to understand your current thought patterns. In particular, to identify any harmful, unhelpful, and 'false' ideas or thoughts which you have that can trigger your health problem, or make it worse. The aim is then to change your ways of thinking to avoid these ideas. Also, to help your thought patterns to be more realistic and helpful.
What conditions can be helped by CBT?
CBT has been shown to help people with various condition - both mental health conditions and physical conditions. For example:
- certain anxiety disorders including phobias, panic attacks and panic disorder
- depression
- eating disorders
- obsessive-compulsive disorder
- body dysmorphic disorder
- anger
- post-traumatic-stress disorder
- sexual and relationship problems
- habits such as facial tics
- drug or alcohol abuse
- some sleep problems
- chronic fatigue syndrome / ME
- chronic (persistent) pain
As a rule, the more specific the problem, the more likely CBT may help. This is because it is a practical therapy which focuses on particular problems and aims to overcome them. CBT is sometimes used alone, and sometimes used in addition to medication, depending on the type and severity of the condition being treated.
What is likely to happen during a course of CBT?
The first session of therapy will usually include time for the therapist and you to develop a shared understanding of the problem. This is usually to identify how your thoughts, ideas, feelings, attitudes, and behaviours affect your day-to-day life.
You should then agree a treatment plan and goals to achieve, and the number of sessions likely to be needed. Each session lasts about 50-60 minutes. Typically, a session of therapy is done once a week. Most courses of CBT last for several weeks. It is common to have 10-15 sessions, but a course of CBT can be longer or shorter, depending on the nature and severity of the condition.
You have to take an active part, and are given 'homework' between sessions. For example, if you have social phobia, early in the course of therapy you may be asked to keep a diary of your thoughts which occur when you become anxious before a social event. Later on you may be given homework of trying out ways of coping which you have learned during therapy.
How well does CBT work?
CBT has been shown in clinical trials to help ease symptoms of various health problems. For example, research studies have shown that a course of CBT is just as effective as medication in treating depression and certain anxiety disorders. There may be long-term benefits of CBT as the techniques to combat these problems can be used for the rest of your life to help to keep symptoms away. So, for example, depression or anxiety are less likely to recur in the future.
What are the limitations of CBT?
CBT does not suit everyone and it is not helpful for all conditions. You need to be committed and persistent in tackling and improving your health problem with the help of the therapist. It can be hard work. The 'homework' may be difficult and challenging. You may be taken 'out of your comfort zone' when tackling situations which cause anxiety or distress. However, many people have greatly benefited from a course of CBT.
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