Cognitive behavioural therapy is a short-term therapeutic treatment, normally lasting between 6-20 sessions. CBT looks at the connection between thoughts, feelings, physical sensations and actions. CBT is one of the most widely used therapeutic techniques, being 72% of therapy provided by the NHS in 2021-22 and has proven to be effective for a wide range of mental health problems and conditions.
CBT can be very helpful for overcoming and managing issues as it aims to deal with problems in a more positive way. CBT focuses mainly on current issues and potential solutions rather than the past. CBT breaks down problems into smaller parts, making them more manageable to process and think about. Furthermore, CBT teaches techniques to deal with these issues so they will feel easier to deal with in the future.
Understanding Cognitive Behaviour Therapy
CBT is a very behavioural-focused therapy, CBT looks to understand the conscious and unconscious reasons behind a client’s behaviour. CBT looks at many aspects of someone’s behaviour and how their thinking or unconscious may have affected that. The core principle of CBT is looking at behaviour through interconnectedness. This is the concept that thoughts, feelings, physical sensations and actions are all connected, meaning changing one affects all of the others. An example of this is changing the way your body responds to stress or anxiety will change the way you think and feel about it.
Looking at negative thoughts and feelings is a very important aspect of CBT. People tend to get into cycles when it comes to negative emotions and thoughts and by addressing these negative processes, it can break the cycle and encourage positive change. In addition, when the client learns how to break these negative patterns, if they have negative thoughts or feelings again, it will be easier for them to address the thoughts using the skills they have already learned.
Main Goals of Cognitive Behaviour Therapy
Often, people can have negative automatic thoughts (NATs), which can cause a lot of emotional distress. In CBT, a therapist will help a client identify and challenge these thoughts. Doing this will allow someone to re-evaluate the validity of these negative thoughts and this can help someone start to overcome negative patterns. CBT helps people to cope with problems. One way in which it does this is by teaching individuals skills to respond to problems in healthier ways. An example of this is reframing negative thoughts in a positive light or using relaxation techniques to cope with anxieties.
An important aspect of CBT is problem-solving, which can help with a wide range of complex mental health issues. Clients will work with their therapist to learn one of the key problem-solving techniques which is breaking down complex issues into less intimidating, more approachable steps. Another main aspect of CBT which goes hand in hand with problem-solving is confidence building. CBT helps clients gradually face challenges allowing them to build their confidence over time. This is the concept of graded exposure which takes challenges step by step, slowly building confidence and learning to deal with these problems.
The last aspect of CBT which we will touch on here is the technique of replacing dysfunctional thought patterns and behaviours with adaptive ones. CBT aims to replace negative patterns with rational, positive thinking and behaviour. One example of this is changing a thought like “I will never overcome this problem” to “This is a difficult problem but I will deal with it”.
Practical Implementation of CBT
Cognitive restructuring is a technique which is at the heart of CBT. One main aspect of this technique is breaking down overwhelming problems into more manageable parts. By breaking down larger issues, clients and therapists can more easily identify the negative thoughts and then reframe them in a more positive way.
Many common therapeutic techniques focus on exploring the past, whereas CBT treatment mainly explores current challenges. This gives immediate relief and also gives ways of dealing with these issues in the future. Although CBT does mainly focus on the specific problems in the present, a therapist may explore the past if it is directly influencing negative thought patterns in the present.
CBT is a very active therapeutic technique, meaning the client has to actively use and practice techniques which they have learned in the sessions. The therapist acts as a guide but the client will have to actively participate to develop skills. CBT may also include ‘homework’ or an action plan. This may include practising techniques or journalling certain thoughts or thought processes.
Techniques and Strategies in CBT
Cognitive Restructuring:
Cognitive restructuring is fundamental to CBT therapy and is critical to the therapeutic process of CBT. Cognitive restructuring is a way the client addresses negative thinking patterns by changing the way they process negative thoughts. This changes their emotional response to negative thoughts and therefore their behaviour. The first step of cognitive restructuring is identifying negative or irrational thoughts. The next step is challenging these thoughts; do they really reflect reality, is there proof behind the negative thought. The client will then think from alternative perspectives, for example, instead of “I fail at everything” they may think “I do not succeed all the time but I have had successes in the past and failure is part of learning”. The final step is replacing the negative thought with a balanced rational thought and practising this technique with different thoughts.
Behavioural Activation:
Behavioural activation is a common technique used in CBT, this is a therapeutic technique in which the client is encouraged to participate in activities that they enjoy, which bring pleasure or a feeling of achievement. This technique is used most commonly for cases of depression as depression can cause a lack of motivation and withdrawal from things someone used to enjoy. This withdrawal can then cause a cycle of avoidance and further withdrawal. Behavioural activation is a technique which can break this cycle by planning meaningful activities. Behavioural activation could include activities like re-engaging in previously enjoyed hobbies or meaningful social interactions with loved ones. The main aim of behavioural activation is to get the client re-involved with the things they previously enjoyed in order to reignite motivation.
Exposure Therapy:
Exposure therapy is a key technique for anxiety disorders such as Generalised Anxiety Disorder (GAD), social anxiety, Obsessive Compulsive Disorder (OCD), Post Traumatic Stress Disorder (PTSD) and fears and phobias. Exposure therapy includes slowly, gradually and safely exposing clients to the triggers of their anxieties. Exposure therapy may look a bit different for the different types of anxiety disorders. However, the overall aim is to expose clients to reduce anxiety as they learn that the outcomes which they fear are less likely or less catastrophic than they imagine.
Benefits of Cognitive Behaviour Therapy
CBT encourages reflection on thoughts and feelings, this allows someone to become more aware of their own thought patterns and how that may affect their emotions. Being able to self-reflect and be self-aware in this way allows someone to monitor and manage their emotions more effectively.
CBT also provides techniques to deal with stress on a daily basis. Learning more effective ways to cope from day to day can be very helpful to deal with stress overall. CBT teaches how to break down problems into smaller parts, learning this technique makes coping and problem-solving much less intimidating.
CBT sessions can help clients have more of a sense of control over their thoughts, feelings, behaviours and their overall mental and emotional states. By challenging and being more aware of negative thoughts, they can become more confident in managing responses these thoughts. This can give a feeling of control and empowerment.
Long-term Impact of Cognitive Behaviour Therapy
CBT provides tools, techniques and strategies that can be indefinitely helpful outside of therapy. Someone having these tools at their disposal can give a feeling of independence for one’s mental health and confidence in dealing with future mental health problems.
Often, the skills learned in CBT can affect not just mental health but all areas of one’s life. Learning better emotional regulation and decision-making can allow maintaining relationships to be easier, it can boost work performance and improve functioning as a whole.
CBT has proven to be effective for a wide range of mental health problems such as anxiety, depression, PTSD, OCD and can also be effective for personality disorders. Cognitive behavioural therapy is one of the most widely used therapeutic treatment. Being such a versatile treatment, CBT can be used to treat someone in many different situations.
Practical Applications of CBT
Personalising Cognitive Behaviour Therapy
CBT is a flexible therapy and because of this, therapists are able to tailor the experience and strategies for not only each situation but also the preferences of each client. Having this flexibility allows CBT to be more relevant and effective for every case.
One key aspect of CBT is continual assessment, this is to ensure that a client is getting what they need out of the therapy and that they are progressing in the therapy. Furthermore, throughout a therapy course, a client’s needs may change and continual assessment is a way of ensuring that the therapist adjusts techniques to the changing needs of a client.
Although CBT is self-help-focused, the client-therapist relationship remains very important. Collaborative work is key to setting meaningful and achievable goals and ensuring that the client is getting the most they can out of the therapy. CBT can be self-guided but a therapist’s guide will allow a client to most effectively understand how to approach their own problems.
Common Challenges and Solutions in CBT
People may feel hesitant to change their thought patterns or behaviour through CBT. This could be because of uncertainty or anxiety, but a therapist will be a guide to introducing these ideas in a safe, controlled way. They may gradually introduce the concepts behind CBT or show the benefits of change in a way that the client may find reassuring.
Oftentimes, clients may want to change, and develop the skills they learn from CBT, but struggle to complete the ‘homework’ provided to them. This could be due to a few factors such as motivation or time. Therapists can find ways to help the client for example making tasks simpler, giving a more manageable amount per session or speaking directly with the client about what they are struggling with. A therapist is there to help in the best way for the client, so they will do what they can to assist and for the client to get the most they can out of CBT.
Due to the self-help nature of CBT, maintaining and reinforcing skills learned from CBT outside of therapy is important. Discussing and thinking about developing strategies to maintain these skills can be helpful. On top of this, finding or maintaining support systems can help with consistency.
The Role of CBT in Various Mental Health Conditions
CBT and Anxiety
Cognitive behavioural therapy has proven to be extremely helpful for anxiety and is one of the most common conditions CBT is used for. CBT is so often used for anxiety as it addresses the common triggers of anxiety such as negative or catastrophic thinking or irrational fears and thoughts. Some of the most useful techniques for anxiety used in CBT are cognitive restructuring and exposure therapy. Cognitive restructuring is helpful as it reframes negative or irrational thoughts into positive or realistic thoughts. Exposure therapy is a technique in which fears are faced in controlled and safe ways, this is a technique which over time reduces anxiety about these feared things or situations. This is a good way to reduce avoidance behaviour. Other techniques which are helpful to reduce physiological symptoms of anxiety are things like relaxation techniques or breathing exercises; a common physical symptom of anxiety is increased heart rate or blood pressure and both of these techniques help to reduce these symptoms.
CBT and Depression
Along with anxiety, depression is one of the most common conditions CBT is used for. The reason behind this is that many of the techniques used in CBT are helpful for symptoms of depression. A couple of examples of these techniques are behavioural activation and again, cognitive restructuring. Behavioural activation targets the loss of interest commonly found in depression. Behavioural activation encourages re-engagement in activities someone may have lost interest in such as once-loved hobbies or seeing loved ones. This can help to break the cycle of avoidance and low mood in depression. Cognitive restructuring targets the negative thoughts in depression, it challenges deeply ingrained negative beliefs about oneself and the world around them, replacing them with more positive or realistic thoughts.
CBT and Obsessive Compulsive Disorder
CBT is one of the most common treatments used for OCD. The main technique used for OCD treatment within CBT is ERP (exposure and response prevention), which is like exposure therapy specifically for OCD. The treatment involves exposing the client to a trigger and preventing them from doing a compulsion. The idea is that over time they will get used to not engaging in the compulsion and their anxiety will naturally decrease. The exposure is done hierarchically, starting on the least distressing trigger and working up.
CBT and Post Traumatic Stress Disorder
CBT in the context of PTSD (Post-Traumatic Stress Disorder) may look a bit different from some other anxiety disorders. TF-CBT (Trauma-Focused Cognitive Behavioural Therapy) could also be an option for people struggling with trauma-related symptoms. TF-CBT mainly focuses on how the client is processing the trauma, psychoeducation about trauma and managing trauma-specific symptoms. Exposure therapy is helpful for trauma as being exposed to triggers in a safe and controlled way can help clients become more comfortable in a potentially distressing context. Cognitive restructuring helps to challenge irrational beliefs about oneself such as self-blame or guilt which commonly come with trauma. Other techniques that can be helpful are relaxation techniques, which can help with anxiety responses, or grounding techniques, which can help during flashbacks or dissociation.
Practical Tips for Implementing CBT Techniques
One of the best ways to ensure that CBT is most effective is the daily practice of techniques taught in sessions. Making techniques part of a daily routine can be a helpful way to integrate them into one’s life. Setting times every day to practice can be a good way to make it part of a routine and continue to think about them through daily life and regular interactions.
Conclusion
The main goals of cognitive behavioural therapy are to challenge negative or unhelpful thoughts and develop coping mechanisms and tools to deal with these thoughts. Meeting these goals and developing the skills discussed can be life-changing for some people. The best way to make these outcomes possible is by working with the therapist as a guide through the course of therapy.
If you are someone who struggles with your mental health or knows someone who does, seeking professional help through CBT can be very impactful for not only their mental well-being but oftentimes their physical health as well. Learning the techniques used in CBT can be pivotal in improving someone’s quality of life even if they do not struggle with serious mental health issues as these tools are universal. If you are interested in seeking therapy contacting us below is the best way to get in