Jul 14

What is Cognitive Behaviour Therapy and How Does it Work?

Cognitive Behaviour TherapyWhat is Cognitive Behaviour Therapy (CBT)?

An Introduction to Cognitive Behaviour Therapy (CBT)

Cognitive Behaviour Therapy (CBT) is one of the most widely used psychological therapies. It focuses on the way people think, feel and act to help them overcome their emotional and behavioural problems.

CBT aims to alleviate people’s symptoms and distress as quickly as possible and prevent problems from recurring by:

  • Training them to identify unhelpful thought patterns, perceptions and behaviours
  • Helping them develop flexible, non-extreme and self-helping thoughts, beliefs and behaviours, and
  • Providing them with knowledge, skills and strategies that can be used to prevent recurrences of their problems and apply them to other challenges in life.

What is Cognitive Behaviour Therapy used for?

CBT has demonstrated effectiveness with a wide range of psychological problems, including:

  • Generalised Anxiety
  • Depression
  • Panic
  • Obsessive Compulsive Disorder (OCD)
  • Phobias
  • Post-traumatic Stress Disorder (PTSD)
  • Eating Disorders
  • Somatic Disorders
  • Social Anxiety
  • Child Anxiety Disorders and Child Depression
  • Child Behaviour Problems

CBT can also be an effective with other non-clinical problems such as stress management relationship / marital problems, sleeping difficulties, assertiveness, diet, exercise, goal-setting, and procrastination.

The evidence for Cognitive Behaviour Therapy

CBT is based on a comprehensive body of research, and on well-established cognitive and behavioural models of how and why emotional and behavioural problems develop and are maintained. Because of this, CBT is the first-line intervention for many mental health problems.

For some problems, such as anxiety, depression and other non-psychotic disorders, CBT has been shown to be as effective as medication, without problematic side effects.  In addition, while medications can only work so long as you keep taking them, CBT provides you with knowledge, skills and strategies that can address your symptoms on a more enduring basis.

Some Characteristics of Cognitive Behaviour Therapy

CBT is an efficient therapy. Unlike other therapies where treatment can last for years, treatment with CBT is typically much shorter. In fact, many see improvement within 3 to 4 sessions and treatment, depending on the presenting problem, typically lasts for 6 to 12 sessions, though may be longer for more severe problems.

CBT takes a pragmatic approach to problems.  While time may be spent understanding past events that might have contributed to your present condition this is not the main focus. CBT is mainly concerned with how you think, feel and act now rather than attempting to resolve past issues and searching for deeper and often unconscious motivations for feelings and behaviour.

CBT is a structured therapy. Rather than talking freely about your life, you and your therapist discuss specific problems and set goals for you to achieve. At the same time it is highly flexible and treatment is tailored to a person’s presenting problems and circumstances.

CBT has a strong educational component and aims to provide you with long-term solutions – to become your own therapist. This way, you can use CBT techniques by yourself to deal with relapses or with completely different issues that arise in your life.

How does Cognitive Behaviour Therapy (CBT)Work?

A basic premise of Cognitive Behaviour Therapy is that our thoughts (cognitions) and interpretations of life events greatly influence our actions (behaviour) and, ultimately, how we feel (our emotions).

A common but incorrect assumption is that our environment, the behaviour of others and external events make us feel a certain way. We may say, for example, that “my neighbour makes me angry”, or “this beautiful weather makes me happy”.

The reality is that the thoughts, beliefs and meanings we give to an event produce our emotional and behavioural responses.

Our thoughts are constantly helping us to interpret the world around us, describing what is happening, and trying to make sense of it. A lot of our thoughts are automatic and happen so quickly that we fail to notice them. As a result we tend to believe our thoughts and usually don’t stop to question their validity.

Automatic thoughts can be beneficial as they allow us to undertake routine tasks like getting up, getting dressed, and eating breakfast without too much effort. But they can also be problematic.

Often, the way we think about and interpret negative events is not entirely accurate, realistic or constructive. These types of thoughts are called “cognitive distortions”.

Some common cognitive distortions are:

  • All-or-nothing thinking, where you see things in absolute black-and-white terms.
  • Overgeneralisation so that you see a single negative event as a never-ending pattern of defeat.
  • Jumping to conclusions and making a negative interpretation even though there are no definite facts that convincingly support your conclusion.
  • Catastrophising so that you exaggerate the importance of negative events and minimize or downplay the importance of positive events.
  • Personalisation, where you automatically assume responsibility and blame for negative events that are not under their control.

These errors in thought can result in emotional responses that are unhelpful and cause significant distress.

The ways you think and feel also largely determine the way you act. Depressed people, for example, tend to become withdrawn and isolate themselves and anxious people often avoid situations they find threatening or dangerous.
Such behaviours are problematic when they are isolating, avoidant and self-destructive. Furthermore, these destructive behavioural patterns can serve to reinforce your unhelpful thinking.

Identify negative, inaccurate and unhelpful thinking.

An important early step in Cognitive Behaviour Therapy, therefore, is to identify negative, inaccurate and unhelpful thinking that causes your emotional distress and any related behavioural problems.

Recognising patterns of thinking and behaviour that contribute to your problems requires that you pay close attention to your physical, emotional and behavioural responses in different situations.

A variety of techniques are used by skilled psychologists such as Socratic questioning, guided discovery, behavioural experiments, exposure therapy, psycho-education and teaching the skills of self-monitoring, self-reflection and self-change.

You might, for example, conduct an ABC analysis, where you record:

  • an Activating event that causes distress and the your immediate interpretations of the event;
  • your Beliefs about the event, which can be rational or irrational;
  • the Consequences – how you feel and what you do or other thoughts

Techniques such as this can help to build awareness of ‘how’ you think –to see patterns and links over time –and importantly, to see that negative thoughts are often irrational, illogical and unhelpful.

Challenging your thinking

Once you have learned to identify your negative thought patterns, perceptions and behaviours the next step major step in CBT is to challenge them rather than accepting them without question.

This requires a rigorous critical analysis looking at the facts rather than your emotions, testing and challenging their truth, and establishing whether they help or hinder you.  Typically this involves asking questions such as:

  • Where is the evidence (or proof) that the thoughts/beliefs are true?
  • Is there any evidence that disproves the thoughts/beliefs?
  • Are there facts that are being ignored or overlooked?
  • What alternative reasons could there be for what has happened?
  • What is the effect of thinking in this way?
  • What thinking errors (cognitive distortions) are being made?

Changing your thinking

This final step is changing the way you think to improve how you feel.

Clearly, nobody can control every aspect of the world around them, however you can control how you interpret and react to events in life.

Based on the critical analysis described above, your psychologist would work with you to help you adopt flexible, non-extreme and self-helping thoughts, beliefs and behaviours. This will help you to feel better emotionally, change your behaviour for the better.

This is not about denying reality or self-delusion. CBT supports you to accept reality as it actually is: both good and bad, and where necessary engage in problem solving strategies.

Ahead Psychology is an established and trusted private practice of Brisbane North psychologists.
Our psychologists provide expert, patient centred care in a compassionate and confidential environment. Depending on your needs our psychologists integrate a variety of evidence-based approaches to help you improve your mental health and well-being. Common treatment approaches include Cognitive Behaviour Therapy (CBT) a practical, time-limited treatment approach to help people motivate, activate and sustain lasting change through modification of thoughts, feelings, and behaviours. To find out more about our treatment approaches, or to book an appointment please call (07) 3352 3577 or to book online click here.

Further Reading on Cognitive Behaviour Therapy

  • Butler, A.C., Chapman, J.E., Forman, E.M., & Beck, A.T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26(1), 17-31.
  • Chambless, D.L., & Ollendick, T. H. (2001). Empirically Supported Psychological Interventions: Controversies and Evidence. Annu. Rev. Psychol, 52, 685-716.
  • Tolin, D.F., Is cognitive-behavioral therapy more effective than other therapies? meta-analytic review, Clinical Psychology Review (2010).