What is Cognitive-Behaviour Therapy?
First developed in the 1950s Cognitive Behaviour Therapy (CBT) emphasised the role of thought in the genesis of mental health problems. Initially developed as a treatment for depression, its use was extended over the years to the treatment of anxiety, post-traumatic stress disorder, eating disorders and borderline personality disorder. It is currently the most common type of therapy in the USA and Britain.
Its basic premise is that depression and anxiety (to take the two most common health problems) are triggered by a variety of thinking styles known as cognitive distortions. These include:
Catastrophizing. Imagining the worst will happen.
Black and white thinking. Using extreme language to describe people and events.
Over-generalization. Believing that problems are always there, and ignoring the exceptions.
Negative filters. Focusing on the bad, and ignoring the good.
Emotional reasoning. Believing that if you feel bad, then the situation must be bad.
Self-judgments. Labelling oneself as ‘bad’, ‘weak’, or ‘a failure’.
Mind reading. Imagining that others are thinking badly of you.
Fundamental attribution error. Blaming oneself for problems and ignoring circumstances.
Cognitive distortions lead directly to preoccupation with problems rather than solutions, stuckness, anxious feelings, mood swings, unhelpful behaviour, and avoidance of actions that might improve a situation.
Changing unhelpful thoughts
CBT uses the ABC model as a framework for investigating anxious/depressed reactions, where ‘A’ stands for ‘Activating Event’, ‘B’ stands for ‘Belief’, and ‘C’ stands for ‘Consequences’. For example:
- Activating event: You argue with your partner.
- Belief: It’s all over, and she’s leaving me. (Black and white thinking). I won’t be able to cope on my own. (Catastrophising).
- Consequences: (1) Depressed mood (2) Withdrawal (3) Avoidance of conciliatory talks.
In this way client and therapist are able to track the links between external events, thoughts, bad feelings, and counter-productive behaviours. CBT then develops a treatment program to address the clinical issue:
- Shifting to a different view of the activating event using Reframing.
- Replacing negative thoughts, beliefs and judgments.
- Developing acceptance and tolerance for unwanted feelings.
- Creating more effective behaviours, actions and strategies that address the activating event in a more effective way.
How CBT works
CBT uses a variety of techniques to challenge and replace thoughts.
- Writing down thoughts. Seeing the thought in writing, rather than listening to it in your head enables you to assess it objectively.
- Assessing thoughts. Asking: Is this thought true? Is this thought helpful? What would be a better thought?
- Disputing thoughts. The therapist will engage the client in a dialogue that calls into question the evidence for a belief, the damaging effects it has on the self, and its robustness. Along the way, calling out catastrophising, black-and-white thinking, negative filters and the like.
- Letting go of thoughts. CBT typically employs mindfulness techniques for this purpose.
- Replacing thoughts. Together, clients and therapists work on building stronger thoughts that address the activating event, leading to different feelings and behaviours.
Once clients are equipped with these skills and techniques they are encouraged to keep a journal in which they track problematic episodes, record their cognitive distortions, and detail their applications of new thoughts and responses to the activating event. The journal is used as a basis for work during subsequent sessions.