Cognitive Behavioural Therapy (CBT) combines two different theories on psychological change. One influence is the behaviourism school led by Richard Skinner who asserted that human behaviour was in response to a stimulus. An example that simplifies this theory is the action of cooking dinner in response to the stimulus of feeling hungry. Similarly, the action of hiding or holding one’s breath may be in response to the stimulus of a spider. Cognitive theorists believed that it was possible to change behaviour by thoughts alone. Cognitive Behavioural Therapists integrate both theories: helping the individual to overcome unhelpful behaviours by changing restrictive and illogical thought patterns that have been present, perhaps since childhood. They also look at how our actions can influence our thoughts.
CBT is focussed on finding practical solutions to present-day problems. A therapist will help you to look at thoughts, feelings and behaviours and assess how unrealistic or unhelpful they are and how they affect you. Once the two of you have identified the core thoughts you will work to change them. This may include doing ‘homework’ to reinforce more positive thoughts or behaviours you have discussed in your session. This homework may be as simple as keeping a diary of thoughts or questioning unhelpful thoughts.
Someone with a spider phobia would, with their CBT therapist identify unhelpful and unrealistic thoughts and assess how they impact emotions, physical feelings and behaviours. They would then collaborate with their CBT practitioner to replace these thoughts with more enabling ones. Below is a CBT approach to manage reactions from seeing a spider in the street:
|Negative thought||That spider is going to poison me and I will die||Positive thought||Most spiders and not poisonous, especially not in the UK|
|Negative emotions||Fear and anxiety||Positive emotions||Relieved and relaxed|
|Negative body sensations||Fast, shallow breathing and clammy hands||Positive body sensation||Calm breathing|
|Negative actions||Freezing, unable to move||Positive action||
Calmly walking past the spider
The National Institute for Health and Clinical Excellence (NICE) has reviewed and evaluated a very large amount of research on CBT. Informed by this, it has recommended to the NHS that CBT be used as an anxiety and depression treatment.
CBT is suitable for those who have limited time or resources and are not looking for in-depth psychotherapeutic exploration but practical tools to cope with an issue. It is suitable for individuals who have the energy and willing to partake in an active therapy. CBT requires practice and that might mean doing ‘homework’ after sessions. However it is always delivered at a pace that is comfortable for you.
It might not suit you if you feel so depressed that you have little motivation to engage in therapy. In this case it might be more helpful to consult a psychiatrist to explore medication that could be taken alongside CBT therapy in order to improve your chances of benefitting.
CBT does not take away issues however it gives you practical skills to cope and manage your reactions. There is much evidence to suggest it is very effective for treating depression and anxiety. It enables you to feel more empowered and in control as together with your CBT therapist you analyse your issue, review it from a different perspective and take practical, concrete steps leaving you feeling more skilled and equipped.
CBT can take between five and twenty sessions therefore it is not a quick fix. In the first two sessions your therapist will ensure that you feel comfortable with the techniques used. This is important so that you can fully benefit from them. Sessions tend to last for one hour and occur on a weekly or fortnightly basis.