CBT

CBT, Cognitive Behavioural Therapy, was developed by Aaron Beck in the 1960s.  He noticed that people with depression tended to have spontaneous negative thoughts about themselves, the world or the future.  He began to help people identify and evaluate these negative thoughts and found that when people started to change these thoughts about themselves they were able to behave more as they would like to, which consequently improved how they felt. 

There have been many research studies on CBT and over time it has developed so there are specific techniques working on thoughts, trying out new behaviours, using imagination and anxiety management techniques, which have been found to work particularly well with different problems such as anxiety, panic attacks, phobias, post traumatic stress disorder, depression and low self confidence.

CBT is widely used around the world and in the NHS.  It is a practical therapy which is done as much at home as within sessions, as participants learn and try out new ideas and techniques.

CBT, Cognitive Behavioural Therapy, is based on the idea that how we feel is influenced by our beliefs (cognitions) and also how we react (behaviours). 

In a given situation two people may feel differently as we have different beliefs.  For instance, if you find out that there is a party which you haven’t been invited to, one person may think “no-one likes me” and feel hurt and depressed and react by distancing themselves from their friends.  Another person may think “they just forgot to invite me” or “it’s a party for everyone in the tennis club, which I don’t belong to”.  They would feel indifferent and continue to make contact with their friends as normal. 

Over time we may notice that there are certain situations or people who tend to bring up familiar feelings, and there may be times when events happen and we feel disproportionately bad given the objective circumstances.  In these situations we are probably being reminded of difficult events in the past and reacting in a way which made perfect sense for the historical situation.  For instance, if you failed an important exam at school, and your teachers and parents were critical, you may think “I’m not good enough” and you may respond to that by giving up or working even harder, thinking “there’s no point, I’ll fail whatever I do” or “if I work exceptionally hard I might get by and avoid criticism”.  In turn you may feel depression or anxiety when under pressure.  Later in life, there will be situations where you fail, like job interviews or sporting goals, and this may bring up familiar feelings of “I’m a failure” or beliefs that “I should work harder”, with linked depression or anxiety. 

As a child, you didn’t have the life experience or perspective to realise that criticism of one thing wasn’t an overall criticism of you as a person, so it is understandable that you would feel bad.  As an adult, you probably do objectively see the wider perspective, yet it can still be really hard to feel and remember this when under pressure, because the patterns from the past are activated. 

In contrast, someone who failed an exam as a child may have had supportive teachers and parents who helped them put it down to experience and to learn better study skills, therefore increasing their confidence.  If you were that person, failing a job interview or having an argument might be situations where you are upset and disappointed but you soon move on to thinking about how you can improve things for the future. 

CBT therapy works by helping to identify these patterns; how we react to situations in our heads and what we do in response, noticing how this makes us feel.  We look at examples of recent incidents as well as significant events in the past.  Once we can start to recognise these patterns we can actively come up with new ways of thinking about situations and test out different behavioural reactions to see how this changes how we feel. 

In therapy we start by looking at the difficulties which you are currently having and how you would like things to change, setting goals for the short, medium and long term if it’s a big project. 

We then look at your current difficulties and pinpoint the thoughts, feelings, physical sensations and how you try to manage these (behaviours). By looking at a few different examples, we will probably start to notice a familiar pattern.

Thinking back to your childhood and key experiences over life, there will probably be some particular situations which stand out which had a big impact on the way you feel about yourself and how you tend to manage difficult situations. 

For example, there may have been a time when you were in the park when you were little and a big dog ran over and barked at you.  You thought it might bite you so you were frightened and ran away.  Since then you avoided dogs to keep yourself safe.  This was a sensible reaction given that you were little and probably found it difficult to distinguish between dogs which were likely to be dangerous or not.  However as an adult, feeling not safe around dogs may have become a problem as they are frequently encountered on the street.  You may cross the street to avoid them, or avoid parks altogether, which may become a problem if you are ending up late for work or you are unable to take your children to the park if this is something you would like to do.  By avoiding these situations you avoid the feeling that you aren’t safe, but you also miss out on the opportunity to learn more about dogs and get used to them. 

If your goal is to be able to take your children to the park, we can start by looking at these patterns and noticing the times when it feels worse, such as when there are lots of dogs around, different types of dogs, or when you are generally feeling more anxious.  We can think about what you might need to achieve your goal, such as learning more about dogs, understanding the physical symptoms of anxiety and setting small, achievable goals, such as looking at a small dog from a distance with a friend, working gradually up to spending time closer to dogs.  At first it might seem impossible, so we can take things at your pace and think about what and who can help you. 

As you work through therapy you might want to make notes so you can remember the details of what happened in particular situations so we can look at them in sessions and work on any difficulties that come up. 

Do I have to think about the past?

While many people like to think about the past to help understand patterns of thinking, reacting and feelings in the present day, it is by no means essential.  The emphasis in CBT is on becoming aware of and making changes to our reactions to present day events.

How long does CBT therapy take?

There is no definitive timescale for CBT, but it is generally thought of as a relatively short term therapy.  Many people start off with around 8-12 sessions and continue for around 20 sessions if they are finding it helpful.  A key element of CBT is the work that you do yourself between sessions, so the more often you work on the tasks which you have planned to do each week, the quicker you are likely to see a positive difference.  Once you have learnt the techniques, you will be equipped to continue using these long after therapy finishes. 

What type of problems can CBT help with?

CBT has been extensively researched, with good results.  It is recommended in the NICE guidelines for many different problems including anxiety difficulties such as panic attacks, phobias, OCD, excessive worry and social anxiety as well as depression, low self confidence and PTSD. 

BABCP, the British Association for Behavioural and
Cognitive Psychotherapies has a brief description of CBT as well as some
personal accounts by people who have done it

The Northumberland series of self help workbooks are brief, clear and free to download

Get Self Help has some useful handouts and worksheets which are free to download

OCTC, Oxford Cognitive Therapy Centre, has some brief
but clear booklets available to buy  

The Overcoming series of books are written by leading CBT therapists and researchers