Cognitive Behavioural Therapy (CBT)

 What is CBT?

CBT is a form of psychotherapy designed to help us explore and shift unhelpful negative thought patterns, the types of patterns that often cause us to dig in deeper to maintaining persistent problems that we actually want to fix. Using CBT, we learn to spot trends in how we experience the world, empowering us to acquire a more balanced perspective.

Even though we might not want to, we often have unhelpful thinking patterns we get into that distort the way we perceive situations and keep us stuck in unhealthy behaviours and distressing emotional loops.

CBT is a method whereby the psychologist or counsellor you work with aims to give you tools and insight into understanding and spotting these thinking patterns, so that you develop the skills to be the expert at understanding and overcoming them. Essentially, you learn skills to become your own therapist when you need to shift perspectives and behaviours to get a better result. 

The premise of CBT is this: the way we think affects how we feel, which in turns affects how we behave. 

So, if we would like to change our behaviours or feelings, we can work on how we think and process information to produce different results. 

The core outcome sought from using CBT is that people suffering from psychological problems can learn better ways of coping with them, and in this way they relieve symptoms of distress and can become more effective in their lives.

CBT is regarded widely as the gold standard psychological treatment to address several different issues that affect our mental and relational health and is a treatment style with the largest body of evidence to support its effectiveness in producing real change. 

How does it work?

Our thoughts and feelings are inextricably linked to our core beliefs and inform our behaviours. These behaviours we act on a situation with will often reinforce our feelings and then our thoughts again. When we get this loop right, it looks a lot like an ‘upward spiral’- a series of positively reinforcing events that reinforce that the way we are assessing a situation and then acting upon it will produce the desired results, and give a good basis to act with good judgment the next time a similar situation arises. 

Sometimes however, our thoughts or feelings mean we assess situations from a different or distorted sense of reality- a negative core belief about a situation or a distorted way of thinking about a situation can lead to distressing feelings that encourage actions that might avoid approaching the issue appropriately, resulting in poor outcomes for us. In this way, the phenomenon of a ‘downward spiral’ is just as possible, where the bad outcomes reinforce more negative feelings and thoughts about a situation, furthering our chances of taking actions that result in negative results again. 

It is here at this juncture that CBT aims to helps us tackle the way we might ‘process’ a situation, aiming to give us more alternatives for how we think about a situation. If we have more choices here we have a lot more opportunity to break cycles of negativity and distortion, and therefore we have a lot more opportunities to live a more fulfilling life when we can address stressful situations with feelings and behaviours that lead to better outcomes.

EXAMPLE: Facing a stressful situation, like a conflict with a partner, John approaches it with a positive core belief and thought: “Although I don’t yet understand all the factors involved, I can handle this”. This thought produces feelings of confidence and curiosity to understand the issue and results in behaviours that align with problem solving, listening to his partner and talking it out to explain his thought process. The outcome of these behaviours is drastically more likely to lead to resolution of conflict, feelings of closeness and understanding, and closer bonding after the conflict.

Facing the same situation of a conflict with a partner, Mary possesses a core negative belief about her competence in this situation: she thinks “I’m going to fail and conflict means the end.” These thoughts develop severe feelings of anxiety and shame, which encourage behaviours like avoiding her partner or tacking the issue, being defensive and shutting down communication. This is far more likely to lead to an outcome where their relationship feels distant and they both feel misunderstood and unsupported, further straining the relationship and leading to more feelings of hopelessness.  

A CBT counsellor might work with Mary on how she’s perceiving the situation first, and help support her to challenge her unhelpful thoughts that are preventing her from reaching her relationship goals. Just like we develop negative thinking habits, we can practice positive thinking habits that can give us access to better solutions and behaviours (and therefore better feelings about how we addressed the situation). 

Her counsellor may step out the problems and slow down the assumptions she’s making before. CBT helps with challenging negative thinking habits, negative self-talk, and negative assumptions about the self. This routinely results in better mood, more positive feelings and behaviours that help Mary reach her goals and address situations to get better outcomes. 

A CBT counsellor will use lots of different scientific principles to help you arrive at different points of view and ways of thinking about a situation.

 When should you use Cognitive Behavioral Therapy?//  What conditions would a CBT approach help treat? 

General anxiety

• CBT is a helpful treatment option for many people who experience general feelings of anxiety across lots of situations, where their thinking pattern tends to always be fearful or on alert when processing daily life situations.

Social anxiety

• People who experience social anxiety commonly approach a social situation with negative thought patterns and fears that they will be unfairly negatively judged when with other people. These thoughts might influence you to have strong negative feelings and physical reactions like sweaty palms and a racing heart, feelings that encourage anxious interactions or wanting to avoid the situation altogether. Both of these are likely to produce negative outcomes, which further fuels the thoughts and feelings of not being safe in social situations. CBT is highly effective at treating social anxiety by working with what’s “under the hood”, or the thought patterns, self-beliefs and behaviours that create social anxiety in the first place. When we get different tools for thinking and behaving, we can experience more positive social interactions, which further gives us confidence to do well in future social situations.

Phobias

• CBT is a common choice for treating phobias and fears where someone’s ‘worst case mindset’ distorts their fear level of a certain stimulus and their resulting behaviours so much that it can affect a person’s daily life.

Depression

•  CBT can be really useful when people experience ongoing negative thinking patterns that feel automatic but end in unfair judgments about oneself.

Anger management

• Anger is a normal and healthy emotion that everyone experiences. Sometimes however, people react to emotions like anger with strong, distorted or negative behavioural responses that damage situations and the relationships around them. CBT is helpful when working on anger management, as it can help us address situations with more control and healthier behaviours that more closely match what’s appropriate in order to address the situation. 

Marriage and relationship issues

• Often, people get stuck in negative thinking patterns in their relationships that promote unhelpful behaviours towards one another. CBT is used to give more options for thinking about one another and the situations in question, to help promote better feigns and behaviours that help people achieve their relationship goals.

Substance misuse

• When people turn to alcohol, smoking or drugs in response to situations perceived as stressful or negative, CBT can be helpful in formulating more helpful thinking patterns and behaviours to address stressors so that there is less reliance on substances to support your mood.

Insomnia

• Insomnia is often exacerbated by itself, in that the fear of not being able to sleep promotes physical reactions of anxiety that ensure we can’t fall asleep. CBT can be effective in treating insomnia and sleeping issues as it can help us with our thinking before sleep and the skills required to relax our body and mind so our sleep patterns can improve.

CBT can also help with the following conditions

• Eating disorders

• Self esteem

• Emotional and social skill difficulties in kids and teens
• Obsessive Compulsive Disorder

• Health and medical anxieties like hypochondria
• Post-Traumatic Stress Disorder