CBT is a psychotherapeutic therapy or a talking therapy. The model is based on two main ideas: the way that you feel depends on your thoughts and beliefs (‘cognitions’ in the jargon) and is also strongly influenced by what you do (‘behaviour’). That is why it is called cognitive behavioural therapy. The main premise is that external things like people, situations and events do not cause our feelings and behaviours. Furthermore we can change the way we think to ‘feel better’ and choose our actions even if the situation does not change, therefore unhelpful, negative and unrealistic thoughts can be a major source of distress.
What is CBT For?
CBT can be effective in helping people suffering from: Depression, Anxiety, Panic Attacks, Phobias including agoraphobia and social phobia , Low Self-Esteem, Addictions, Trauma, Anger Problems and Stress, eating disorders , obsessive compulsive disorder , post traumatic stress disorder , bipolar disorder and psychosis , low opinion of yourself or psychical health problems like pain or fatigue . CBT also involves repeatedly confronting feared situations that are avoided – this is called exposure.
How does it work?
CBT can definitely help to make sense of a problem or thought and break it into a smaller part. In fact it makes it easier to see the link between them.
To describe it further, the parts can be divided as below:
The Situation- a difficult situation, a problematic area or an event
From the situation thoughts, emotions, and physical feelings whether comfortable or uncomfortable ones and actions can occur.
Each area can impact on each other e.g. How you think about a problem can affect how you feel or act. It can also have a huge impact on what you do about it .There are numerous both positive and negative reactions to most situations depending how you think about them.
The whole sequences, and parts of it, can also feedback like this:
The pattern as shown above can worsen feelings. It can create new situations that further worsen the feelings. You can end up believing the negative talk about yourself that at times is unrealistic. Usually this is seen when we are distressed and are more inclined to interpret things and jump to conclusions while our thinking is unhelpful.CBT can be used to help you break the cycle of negative or damaging thoughts, feelings and behaviours. A CBT therapist aims to give you the skills to take control and break the cycle while tackling these problems.
What does CBT involve?
CBT can be done individually or with a group of people. It can also be done from a self-help book or computer programme.
If you have individual therapy:
You will usually meet with a therapist for between 6 and 24, weekly, or fortnightly sessions. Each session will last between 30 and 60 minutes.
In the first 2-4 sessions, the therapist will check that you can use this sort of treatment and you will check that you feel comfortable with it; this is also where the therapeutic alliance is built.
The therapist will also ask you questions about your past life and background. Although CBT concentrates on the here and now, at times you may need to talk about the past to understand how it is affecting you now.
You decide what you want to deal with in the short, medium and long term and set goals to look at these.
You and the therapist will usually start by agreeing on what to discuss that day.
While working with the therapist, you break each problem or symptom down into its separate parts. To aid this process, the therapist may ask you to keep a diary. The diary may aid you in identifying your individuals’ patterns of thoughts, emotions, feelings and actions.
With your therapist, you will look at thoughts, feeling and behaviors to look at whether they are realistic and helpful and how they affect you.
The therapist will then help you to work out how to change unhelpful thoughts and behaviors.
It is really easy to talk about doing something; it is actually much harder to do it. So after identifying. There will be ‘homework’ – the changes that you have looked at in therapy need to be practiced in everyday life.
Depending on the situation, the client might need to question or indeed analyze negative or self critical thoughts and replace them with helpful ones that you have learn with your therapist. The client also needs to have an awareness of when they are about to do something negative and replace it with something more positive and healthy.
Furthermore at each session the therapist and client will look and how you have got on since the previous session. If homework or indeed bringing the task into your everyday life is proving difficult the therapist along with you can look at ways of adapting it easier.
You will not have to do anything that you don’t want to do – this is your therapy, you decide on the pace of your treatment and what you want to do and what you don’t want to do. The main premise is that you can practice and further develop your skills after sessions. It makes it less likely although not impossible for the symptoms or problems to return.
How long will the treatment last?
A course may be from 6 weeks to 6 months. It will depend on the type of problem and how it is working for you. The availability of CBT varies between different areas and there may be a waiting list for treatment. CBT is also available in private practice where there may be fewer waiting lists; many therapists offer a sliding scale or reduced cost session.
Problems with CBT
It is not quick fix and the client needs to do it for themselves with the support of the therapist.
If a client is feeling low, their motivation and concentration on change may not be there
Anxiety needs to be faced; this involves confronting it which may lead to some short term increased anxiety.
The client needs to stay in control and pace their sessions to their ability.
What happens when you finish therapy if the symptoms return?
With all therapies there is a risk that the symptoms may return. With CBT, if they do return, you have the skills from your sessions to make it easier to control them. This is why it is vitally important to keep practicing your skills even when you are feeling well. If necessary, you can return to therapy for some refresher training or support.