So just what is this Cognitive-Behavioural Therapy (CBT)

You may have heard a lot about a therapy called “CBT” but just what is it and how can it help you?

A common goal of all psychotherapies is to help people achieve a realistic view of their world, including themselves, which they may then act in accordingly.

Within this framework, CBT can be considered the most literal approach as it attempts to identify irrational and maladaptive cognitions, empowering the person to choose more beneficial ones.

CBT is concerned with the cognitive or thinking processes (such as perception, interpretation and recall) that determine the person’s behaviours in response to environmental stimuli. How the person interprets the stimuli will determine the reaction. This differs from the psychodynamic school which is much more concerned with early experience and its influence, the behaviourist school which in its crudest form is not very concerned with the cognitive process preferring  to look at  pre-determined responses to stimuli and the humanistic school which is concerned with the therapeutic relationship itself. Of course, there is overlap and aspects of these schools inform and influence CBT. However its prime concern of working together with the client on the problem in order to solve it, is its unique stance.

Clients seeking counselling, typically describe their feelings. As one therapist said, “People rarely come to counselling complaining of their thinking, although their self-defeating thinking is often a major cause of their difficulties”. With this focus on thinking in mind, Aaron Beck who was the founder of CBT, defined three Major Levels of Cognition, the deeper the cognition level, the more difficult they may be to change. 

1. Full Consciousness - rational decisions made with full awareness. We may like to believe that we make all of our decisions in this way though, this may be due to our inability (or unwillingness) to recognise the other decision making levels within us.

2. Automatic Thoughts - images, thoughts and ideas that flow through us constantly. They may not always be rational or relevant but will impinge on our behaviours. In healthy clients, they can be positive and encouraging as well as negative. In depressed clients these thoughts are skewed towards negative, critical and often illogical modes and are known as Negative Automatic Thoughts (NAT’s).

3. Schemas - the core beliefs. These are at the deepest level and are the templates that we live by. They can be so embedded within our identity that we may not be aware of them, seeing them, not as our subjective internalised rules but rather as an objective reality. They are shaped in early life and affect self-esteem and coping strategies. We have a “personal domain” which contains all the real and abstract things that we value. With the bombardment of information constantly hitting us, we need templates and value judgements to determine what needs our attention and what we can ignore, in order to function effectively. The more an event impinges on our personal domain, the greater will be our emotional reaction. Healthy schemata have a degree of flexibility as we develop and learn throughout life. Unhealthy schemata are more rigid and critical.

An example may help to illustrate the above. In psychological disorders like depression, negative schemata tend to be more active. A depressed person may have a schema that he is stupid and unworthy. From this, he will skew events to confirm this thinking. A busy friend who only gives a brief “hello” instead of chatting may be viewed as confirmation of the person’s innate unworthiness rather than the friend’s need to attend a business meeting.

Negative Automatic Thoughts then further increase the power of the schema. “Even my friend’s don’t want to talk to me”, “he obviously finds me boring”. Thus the belief that he is stupid and unworthy is increasingly validated.

Conscious decisions are then made which when understood within the context of these NAT’s and Schemata are rational. “If I don’t leave the house, friends won’t be able to ignore me and then I won’t get that horrible feeling of abandonment”. The personalising of the stimuli (friend not chatting) has reinforced a generalised view that the person is unworthy and from this, the idea of not leaving the house to avoid other inevitable snubs and their consequent feelings has some merit.

It can be seen that by helping the person become aware of, explore, understand and challenge his schemata and NATs, meaningful change can occur which can lead to more healthy behaviours.

This can be achieved through a number of techniques such as educating the person to understand the above concepts, use of forms that allow a more balanced reality to emerge (e.g. making notes of NAT’s that occur between sessions) and questioning to become aware that catastrophe is rarely a likely outcome of our day to day actions however much we unthinkingly think they are!