What is Cognitive Behavioural Therapy (CBT)?
Cognitive-Behavioural Therapy is a psychological treatment that was developed through scientific research. That is, all of the components of CBT have been tested by researchers to determine whether they are effective and that they do what they are intended to do. Research has shown that CBT is one of the most effective treatments for the management of anxiety. The good news is that although it is best done with someone who is qualified you can apply CBT principles at home to manage your own anxiety and conquer your fears.
What are the Principles of CBT?
CBT involves learning new skills to manage your symptoms. It teaches you new ways of thinking and behaving that can help you get control over your anxiety in the long-run. CBT focuses on the here and now. An important principle of CBT is that treatment involves dealing with the symptoms that you are struggling with right now, rather than focusing on the cause of your problem. Although it can be interesting to understand how your anxiety developed, just knowing why you have anxiety problems is often not enough to help you manage your anxiety.
CBT emphasises the importance of homework
Whether you are receiving CBT from a trained therapist or you are using self-help CBT techniques at home, homework is a key component. Doing homework for CBT basically means that from week to week, you will need to practise the new skills that you are learning and apply them to your daily life. And like the homework that you were given in school, you need to practise those skills every day.
Why is homework so important?
Unless you practice the new strategies that you learn to manage anxiety, you will not use them very well, and you will probably forget to use them when you need them most: when you are feeling very anxious. Learning new ways to manage anxiety is a little like developing a new healthy habit. If for example, you wanted to start exercising regularly, you would want to fit in a new exercise routine into your schedule. It would be difficult at first, but if you kept at it, that new routine would become a habit, and eventually a part of your regular activities. The same is true with CBT skills: if you practise them every day, they will become a part of your daily routine. The good news is that the more you use your CBT skills, the easier it gets, and the better you will become at managing your anxiety.
What to Expect if You See a CBT Therapist
If you decide that you need some guidance in CBT and would like to see a trained CBT therapist, here are some other aspects of treatment that you can expect:
1. CBT is structured and educational:
Treatment sessions in CBT involves learning new ways to think about and understand your symptoms. Because of this, sessions are structured so that you are usually reviewing the homework you did, learning new information and skills, and then developing a new homework assignment for the next session.
2. CBT is collaborative:
Because you are learning new skills in CBT, therapy is very active. Both you and your therapist will be working on helping you to understand your symptoms and ways to manage them. You can expect to participate both in and out of session in order to see positive changes.
KEEP IN MIND: When it comes to CBT, you get out of it what you put in. If you don’t put your best effort into managing your own anxiety, you probably won’t get as much benefit from CBT as you could.
3. CBT is time-limited:
People who go to see a CBT therapist to help them with their anxiety will usually have between 8 to 20 sessions. CBT is not supposed to be a life-long process.
Rather, you are learning to become your own therapist. Once you have learned new skills, had a chance to master them and see positive changes in your life, it will be time for you to leave therapy and continue managing your anxiety on your own.
What will I learn in CBT?
CBT involves learning how to change your thoughts (also called cognition's) and your actions (or behaviours), which is why it is called cognitive-behavioural therapy.
Why is this important? Because in any given situation, you will have thoughts and feelings about it, and behave in a certain way. These thoughts, feelings, and actions all interact and influence each other.
The best way to understand this is to think about them as a triangle:
Imagine a situation where you are walking down the street and you see a dog. You might expect to feel afraid, to think that the dog will bite, and to run away or avoid the dog in some way. In our triangle, it would look like this:
However, if we imagine that you have a friend who is not afraid of dogs and actually likes them very much, your friend’s thoughts, feelings, and actions might be very different:
If we return to the first example, you might be able to reduce your fear of dogs if you either:
Change your behaviour:
By using exposure, you could gradually approach dogs rather than avoid them. Over time, your fear of dogs would be reduced, and you would probably learn that not all dogs bite. Exposure is one of the best tools at your disposal to face your fears and manage your anxiety in the long run (see Facing Your Fears - Exposure)
Change your thoughts (cognition's):
You might also change the triangle if you were able to challenge the thought that all dogs bite. For example, you might tell yourself that if all dogs were vicious and bite people, no one would have them as pets. When we feel anxious, our thinking tends to be overly negative, because it is completely focused on danger and threat: we don’t always see the whole picture.
Pros and cons of CBT
Cognitive behavioural therapy can be as effective as medicine in treating some mental health problems, but it may not be successful or suitable for everyone.
Some of the advantages of CBT include:
it may be helpful in cases where medicine alone has not worked
it can be completed in a relatively short period of time compared with other talking therapies
the highly structured nature of CBT means it can be provided in different formats, including in groups, self-help books and apps (you can find mental health apps and tools in the NHS apps library)
it teaches you useful and practical strategies that can be used in everyday life, even after the treatment has finished
Some of the disadvantages of CBT to consider include:
you need to commit yourself to the process to get the most from it – a therapist can help and advise you, but they need your co-operation
attending regular CBT sessions and carrying out any extra work between sessions can take up a lot of your time
it may not be suitable for people with more complex mental health needs or learning difficulties, as it requires structured sessions
it involves confronting your emotions and anxieties – you may experience initial periods where you're anxious or emotionally uncomfortable
it focuses on the person's capacity to change themselves (their thoughts, feelings and behaviours) – this does not address any wider problems in systems or families that often have a significant impact on someone's health and wellbeing
Some critics also argue that because CBT only addresses current problems and focuses on specific issues, it does not address the possible underlying causes of mental health conditions, such as an unhappy childhood.
Just remember what works for some will not work for others, but you have to try different things to establish what works for you.
References and Sources
Paul Brown - Senior Member - ACCPH
CBT Coach - Practitioner - Wellness Consultant - MHFA