What is CBT?
Cognitive Behavioural Therapy or “CBT” is a form of talking therapy that focuses on your patterns of thought and how these affect your behaviours and abilities to cope with emotional situations. CBT primarily focuses on the present and looks to see how we can cope better in the current life circumstances we face but it may be useful at times to look into our past in order to understand our current patterns of thought and behaviour.
Like other talking therapies, it relies on a good relationship between client and therapist involving confidentiality, a supportive environment and empathic listening and understanding of issues. CBT also relies on a collaborative working relationship, supported behaviour change, a goal-driven nature and a motivated client willing to do some work outside of the therapy room.
It tends to be short in duration, taking between 6 weeks and 6 months, this varies depending on the level of difficulties faced.
What is a session like?
The first session is an assessment session, an hour long where the therapist will develop an understanding of the client’s issues and together goals may be discussed, short, medium and long-term.
CBT is structured with both parties bringing items to the agenda each week to discuss in the hour long session. It is important that both parties get to discuss items on their agenda each week. Of course the therapist will wish to discuss issues the client may have had this week and together come up with methods to improve this situation should it occur again. However, after analysing a few individual situations that have caused issue, it will start to become apparent that there are overarching patterns of thought and behaviour having a negative impact on the client’s life. Discussion of these patterns and teaching of CBT skills and techniques will then be the focus of the therapist's agenda for following weeks.
With sessions being only one hour long and sessions being weekly or fortnightly it is important that agreed potential behavioural change or skills taught are practiced outside of the therapy room. For this reason “homework” will usually be assigned each week. These tasks will not be tedious and will be collaboratively discussed and assigned. Clients who work the hardest outside of the therapy room will progress considerably quicker.
In CBT, symptoms will be measured weekly on one or two easy to fill in inventory forms. These give an objective numerical measure of how the client is progressing.
Is it effective?
The National Institute for Health and Clinical Excellence (NICE) is an organisation tasked with providing evidence-based guidance and information to the NHS on the most effective ways to treat disease and ill health. NICE recommends CBT for the treatment of Depression where it has found it to be highly effective and also Anxiety Disorders.
CBT - The 5 Part Model
This model is a key concept of CBT and something we will look at early on in session in more depth to see how your problems may fit but for now I will outline the basic premise. A good understanding of this model will help you make sense of alot of your own problems and is crucial to understand the logic behind a lot of what we will do in CBT.
The model consists of 5 interlinking "parts". The Situation is the "who, what, when, where, why" element, it includes the environment that you find yourself in and gives rise to the thought.
E.g: "I was out walking my dog at 8am yesterday morning when i saw Bob. I went to say "hello", but he walked straight past me without looking up".
From this you could have many Thoughts but for this example you think: "He didn't care to stop for a quick chat and was very rude"
- "Bob doesn't like me".
Our thoughts then interlink with our Emotions, thinking someone doesn't like you is negative in impact and could leave you feeling upset, sad, rejected.
Our thoughts/emotions share a close link to our Physical state. In this example we are thinking someone else doesn't like us and are feeling sad/down/rejected, our physical state may reflect this feeling heavy with slumped body language, experiencing general lethargy, and perhaps feel teary.
The final part of the model is Behaviour - what we do next from this situation. In this example this very negative mood state may cause us to go home, avoid a planned meeting with other friends later on and even avoid Bob's phone calls in the future. This example is shown below.
I hope the above example is useful and helps to illustrate the links between the "5 parts". Perhaps this is easy to relate to for you or perhaps this thought makes little sense at all. As I mentioned above, this example is of only one possible thought of many but how you think is determined by your own personal life experiences. The situation is what has already occurred and is something that we cannot change but what other thoughts may we have had in this same situation?
"Bob didn't see me at all, he was in his own world, perhaps he has got bad news and is upset" - "Bob is upset".
How might this different thought affect our model?
Emotionally we may now be feeling concerned or worried for Bob. Physically this may have little effect on us but we won't get teary eyed or heavy. With this different thought we will also behave differently, perhaps now you enjoy your walk but phone bob to see if he is ok when you get in, perhaps you even suggest meeting up. This is all shown, again below.
The power a different thought holds is illustrated above and it does not just affect that day. The knock-on effects of our original example thought may have been losing contact with Bob altogether and a negative impact on our other friendships while our second example thought sees our friendship with Bob affirmed.
Both thought options are equally viable based on the information we have at hand from the situation but why we choose either one depends on our own unique perspective of ourselves and our world. Through analysing a number of these models based on situations from your life we can start to spot patterns in thinking. If your current patterns of thought are causing problems in your life using other CBT techniques we our able to work together to try and change this.
To further understand this model, try considering other thoughts anyone might have in this situation, how would you have thought here? Try applying this model to a couple of situations in your life, sometimes it can be easier to start with the emotion and work back - when were you last feeling sad, anxious, angry? What thought caused this?