CBT – what's it all about?

In last week's Southern Star, I explored some frequently asked questions (FAQ) in relation to CBT. The column is reproduced below.

 

Cognitive behavioural therapy (CBT) has been around for over half a century and there’s more awareness than ever before about its benefits. Still, when I mention I’m a CBT therapist, I’m often asked the same questions. What is CBT exactly? Is it about thinking positive? What makes it different to other psychological therapies? So here goes – CBT in 700 words.

 

What is the goal of CBT?

CBT aims to help you manage problems and improve quality of life and mental well-being by changing the way you think (cognitive) and act (behavioural).

 

What is the theory behind CBT?

CBT emphasises that thoughts, feelings and behaviours are interlinked and strongly influence each other. Negative or fearful thinking can lead to negative feelings that drive negative behaviours. CBT says our emotions are influenced not so much by events and situations, but how we see these events and situations.

 

Can you give me an example?

Well, say two equally-qualified people see a job advertised. One person thinks, “Great, I’d love that job”. This thought creates feelings of hope and excitement and the person applies for the job. The second person thinks, “I won’t get it anyway, they’ll think I’m useless”. This thought leads to negative feelings (sadness, hopelessness, etc) and negative behaviours (they don’t apply for the job). This is a simplistic example, but the point I’m trying to make is that the situation here is not inherently good or bad; it is the person’s interpretation of the situation, their self-talk, that is driving their feelings and behaviours.

 

So CBT is about thinking positive?

No – CBT is about realistically evaluating your thoughts and learning to think and act in a balanced, helpful way. Seeing the glass as half full is great, but CBT doesn’t suggest you cod yourself into thinking black is white or vice-versa. I often say there are three ways of managing a difficult situation – sometimes, you should try and change it; other times, you should change the way you look at it; other times, you may have to accept it (continued below...).

 

 

IS CBT EFFECTIVE?

CBT is an evidence-based therapy validated by extensive research trials. This evidence base means it is the most frequently recommended psychological therapy for anxiety, depression and many other emotional problems.

 

How is CBT different to other psychological therapies?

With some talk therapies, extensive time is given to the past (for example, exploring childhood, etc). In contrast, CBT is largely focused on the here-and-now rather than the distant past. CBT does not ignore the past and acknowledges our experiences shaped our outlook in all kind of ways. However, focusing on the past may help someone understand where a problem originated, but it does not necessarily solve that problem. “We can't change the past”, as cognitive therapist Albert Ellis once said, “so we change how people are thinking, feeling and behaving today.”

CBT is also more more practical and action-oriented than other talk therapies. ‘Therapy is not to “talk about” things, but to change the person's life, and to relieve suffering, such as depression, anxiety, or relationship problems’, says CBT therapist Dr David Burns. ‘You can talk until you're blue in the face, and therapists can nod and mutter, "tell me more," but you'll still be suffering from PTSD, or OCD, or depression, or lousy relationships with other people, or whatever the problem is’. Burns is a little blunt, but he is right to emphasise the value of behavioural change.

 

Any other differences?

CBT is a relatively brief therapy, usually consisting of 10 to 20 sessions. Psycho-education is important and clients are encouraged to understand specific factors that drive anxiety, depression and other emotional problems. Acquiring these skills helps you effectively manage problems that arise long after you have left therapy.

 

Many people can’t afford therapy. Others might not want therapy but would like to know more about CBT to manage day-to-day stresses. Any good self-help books?

David Burns’ Feeling Good popularised CBT back in the 1980s and it remains an excellent starting point. Cognitive Behavioural Therapy for Dummies is a useful general guide. For a CBT approach to specific issues, try the Overcoming books (overcoming.co.uk), all of which are written by professional CBT researchers.