Cognitive Behavioural Therapy (CBT) - what is it and how can it help me?
A lot of people have heard the term Cognitive Behavioural Therapy (CBT) but don’t fully understand what it is or how it helps. Here I offer some explanation and a key exercise to try.
What is CBT?
The way we feel is influenced heavily by our thoughts and behaviours, so when we feel bad, sad, mad or scared, altering the thoughts and behaviour can make a big change in the feeling. Mental health could be called ‘thinking/feeling health’ in reality.
‘Cognitive’ basically means thinking and perceiving, and CBT aims to challenge unhelpful thinking and change it into more realistic and helpful thinking. Behaviour is what we actually do in a situation and changing unhelpful behaviour into helpful behaviour is the other equally important part of CBT. Rather than talking about the past, the focus is on what the current problem is, and what you can change in order to feel better.
How can CBT help me?
When we need help for our mental health, it’s mainly because we want to ‘feel’ better or to be rid of unpleasant feelings; it wouldn’t occur to most people that they want to ‘think’ better. But, when you can change your thoughts you can change your feelings, and most techniques are aimed at this. It is also important to encourage supporting behaviour changes too.
The reason why thoughts are so important is that they are fundamentally tied to our deeper beliefs and values about ourselves, others and the world generally. Longer-term CBT helps identify core beliefs that may be difficult to recognise and accept and so needs to be done with care and support. This can be powerful and can reveal the reasons why you think a particular way sometimes.
In the therapy room, it is a collaborative process requiring the client to want to make changes to thoughts and behaviours with the guiding and supportive help of a therapist. Importantly, it is an approach with many practical techniques that can be taught easily via self-help, and that’s why it’s good to raise awareness of it and share techniques widely.
An Example
It’s helpful to look at an example of how this internal interaction plays out, but before we do, it’s important to say that although we need to focus on one specific situation and a specific thought to demonstrate what’s happening, this natural interaction between thoughts, feeling and behaviours is happening ALL the time in ALL situations, sometimes working well for us and sometimes causing issues.
We all can fall into automatically thinking negative thoughts, and sometimes, especially with the amount of stress in modern life, they can take over and cause more harm than good, if we don’t understand this interaction playing out. Raising your awareness by looking at a number of difficult situations and understanding what could change, is the start of making many changes for good.
Situation: The situation is that you’ve been invited to an important event (it could be a work or personal event).
Thought: You think “what if I don’t say the right thing, make a fool of myself, or I look out of place?”
Feeling: In response to this line of thinking (as there will be many unhelpful thoughts assessing the forthcoming event) you will then feel some tension and anxiety in your body, but you may not be too aware of what that is, other than not feeling great. There may also be more noticeable physical symptoms like an upset tummy, clammy hands, shallow breathing and palpitations.
Behaviour: You decide to cancel the meeting or event from your diary and don’t go. This is the chosen behaviour.
Result of behaviour: By avoiding the event you think, “thank goodness I don’t need to go through that now” and you feel relief as the anxiety reduces. This is a reward to your mind and body in the short term as your brain’s fear centre now believes it has avoided a catastrophe.
However, later you may find yourself thinking “what will they think of me for not attending? I missed an opportunity by avoiding, how stupid of me” causing you to feel bad about yourself and possibly lowering your mood.
The part that avoidance and exposure play
In this situation, if the person had gone to the event (behaviour), they would have discovered they functioned fine, that it went well, and they actually had a good time (with more helpful thoughts and more pleasant feelings). Additionally, this would reduce the anxiety felt for the next occasion like this as thoughts would be more positive because it went well previously. Regular exposure to uncomfortable situations will reduce anxiety over time and is the basis of exposure therapy (see here for more about exposure therapy).
“Regular exposure to uncomfortable situations will reduce anxiety over time and is the basis of exposure therapy.”
Unfortunately, when we avoid these situations, we don’t get to see what would have happened, we know no more than previously, our ability to cope hasn’t been demonstrated and the anxiety becomes compounded and set for the next similar experience, remaining as a problem in the longer term.
In the above example, a CBT approach would encourage behaviour change and support the person to reduce their avoidance and attend more similar events. It would also be necessary to look closely at their thinking patterns.
A key CBT technique - Cognitive Restructuring
A simple CBT technique that would help here would be something called Cognitive Challenging and Re-structuring. This basically means identifying, challenging and changing your thoughts, and perspective, consciously; a change of thought that supports a change of mind.
It is important to understand that the thinking pattern at the start of the example is negatively biased faulty thinking; there is no evidence for these worries and the person is catastrophising. The premise of CBT is that in order to alter the anxious feeling, the thoughts needs to change, and the behaviour needs to support the new thought.
Asking yourself a number of the following specific questions helps you challenge these irrational and unhelpful thinking errors:
What am I thinking and is this thought realistic?
Am I basing my thoughts on facts or feelings? If it’s facts, am I looking at all the facts, or just the supporting facts?
What is the evidence for and against this thought?
Could I be misinterpreting the evidence?
Am I viewing the situation as black and white, when it’s more nuanced and complex than that?
How likely is this scenario and am I thinking the worst-case sceanrio?
What could a more realistic thought be?
What could my supporting actions be?
Applying these questions systematically to the above scenario gently allows a change in perspective away from one that is governed by fear, towards one that is more realistic. It acknowledges strengths and weaknesses, weighs up the benefits and losses of attending the event, and helps the person to arrive at a choice that is informed and aligns with their values of what they want out of life.
What else will CBT help me with?
CBT not only focuses on changing thoughts and behaviours at an achievable pace, it encourages general awareness of thoughts through mindful practices and advocates relaxation practices for stress relief. Identification and engagement in activities that you value and give you a sense of personal achievement, social connection and enjoyment are essential life behaviours that will provide a foundation for confidence and more helpful thinking opportunities.
In summary
CBT is a huge area with masses of books and research about it, but it can be simplified and applied with much benefit to mental health and to life generally, through improving self-awareness, communication, relationships, emotional intelligence, and encouraging engagement in activities that benefit and grow you as a person.