What is CBT?

 

CBT is short for cognitive-behavioural therapy, a therapy based on the principle that how we think affects how we feel and behave. It is a goal-directed, systematic, problem solving approach to emotional problems.

 

CBT is an umbrella term for a variety of different psychological approaches, some of which can be used for a wide range of problems, while others are specific to certain mental health conditions, and includes:

  • behaviour therapy
  • rational emotive behaviour therapy (REBT)
  • cognitive therapy (CT)
  • dialectical behaviour therapy (DBT) including mindfulness
  • acceptance and commitment therapy (ACT) and
  • Schema Therapy. 

 

CBT therapists encourage their patients to approach their so-called overwhelming problems by breaking them down into smaller manageable parts. First, CBT helps people to identify each part of their problem and how it personally affects them. These parts include people's personal experiences of:

  • Thoughts and perceptions (or cognitions in therapy-speak)
    Eg,     “I’m going to die”, “Something bad will happen”,  "I can't handle it", “I’m worthless”, "I'm unloveable", "I'm nothing but a pile of crap" …

  • Emotions and moods
    Eg, f    ear, anxiety, feeling blue, depressed, hurt, frustrated, anger, betrayed …

  • Behaviours (what you are doing or not doing)
    Eg, a    voiding supermarkets, isolating yourself from others, drinking more, staying in bed, repetitive hand washing or door checking …

  • Bodily sensations
    Eg, b    reathing difficulties, pounding heart, butterflies in stomach, always tired, no get up and go, restless sleep, muscle tension, the shakes …

  • Situational / environmental aspects 
    Eg, r    ecent assault, marriage breakdown, job loss, pushy parents, motor vehicle accident, personal illness or injury …

Secondly, the client and therapist collaboratively - that is work together - to evaluate whether each of these parts are helpful or harmful to the clients quality of life and whether it helps them achieve their goals in life. This is usually not the case with most people who present to therapy. Consequently, a third step in CBT is to learn and practice new skills to respond more helpfully and healthily towards each part of the client's problem. 

 

In this way, clients learn that positive small changes in one part of the problem can have a knock-on positive effect on other parts of their problem, as all parts end up inter-relating to each other to cause emotional distress.

 

While all these parts or components can be important, CBT therapists place central importance on the cognitive – or thinking and perceiving – part of people’s problems.  

 

Early in the therapy process, it is important to determine whether clients have a real life problem that is causing a realistic and appropriate level of emotional distress given the circumstances, or whether the current emotional distress is out of proportion - that is disproportionately large and inappropriate - for the given situation.

 

When an appropriate level of distress is present a problem solving approach is often called for. If inappropriately high levels of distress are present, then unrealistic or unhelpful thinking is often present. In which case using CBT can help people to explore their irrational or unhelpful thinking and learn to challenge and dispute their unrealistic thinking, thereby decreasing their distress. By participating in this process, clients learn that by changing the way they think, they can change themselves.

 

Cognitive behavioural therapy though is not limited to cognitive or thinking processes. It also includes:

  • Body-based exercises - e.g., relaxation/calming techniques
  • Skills training - e.g., problem solving, social skills, anger management
  • Trying new behaviours - e.g., approaching ‘feared’ situations
  • Encouraging healthy lifestyle habits - e.g., improving diet, exercising
  • Minimising harmful practices - e.g., substance abuse.

An important advantage of CBT is that it has been shown to be an effective treatment for a range of mental health disorders through vigorous scientific testing. As such CBT is often cited in the Australian media as an effective psychotherapy, e.g., ABC National Radio’s (621AM) ‘Health Report’ and ‘All In The Mind’ programs.

 

Basically cognitive-behaviour therapy:

  • Is educational, it teaches clients to be their own therapist
  • Emphasises the present rather than the past
  • Aims to be time and session limited (e.g., 6 – 20 sessions)
  • Is goal oriented and problem focused and includes paying attention to obstacles stopping patients from solving problems and reaching goals
  • Stresses client collaboration and active participation in all aspects of therapy and encourages clients to undertake homework tasks between sessions
  • Has structured sessions that build upon previous sessions
  • Teaches clients to identify, evaluate & respond to their unrealistic and unhelpful thoughts & beliefs
  • Uses a variety of techniques to change thinking, mood and behaviour 
  • Consists of several therapuetic stages: (a) assessment; (b) problem formulation; (c) treatment; (d) relapse prevention and (e) maintenance stages.

And the characteritics of people who benefit most from CBT include:

  • Regularly attending appointments
  • Maintaining an open mind that change is possible
  • Being open and honest about their problems
  • Having some insight into their problems
  • Being motivated to work on themself
  • Attempting and completing homework tasks to the best of their ability and working on refining their newly learnt skills over time.