Understanding Cognitive Behavioural Therapy (CBT)
What is CBT?
Cognitive Behavioural Therapy (CBT) is a well evidenced and effective psychological model for a range of mental health disorders. These include anxiety, panic attacks, depression, psychosis, obsessive-compulsive disorder and many more.
The emphasis is on developing a collaborative formulation and devising an appropriate treatment plan based on this. The therapist and client work together to agree on this, with the expectation that the client themselves will be an active participant in facilitating change.
Negative thoughts, feelings and behaviours: a maladaptive cycle
CBT works on a number of processes including thoughts, feelings and behaviours. Firstly, it works on the thought processes which occur spontaneously in an individual during any feared situation. For example, if an individual is anxious around crowds, their thought process when in crowded places may be ‘I need to get out of here’ or ‘I will die from suffocation’. Similarly, the thought process of a child who is anxious about speaking in class may be ‘my friends will laugh at me’ or ‘everyone will think I’m stupid’.
Negative thoughts and feelings
Negative thoughts/maladaptive beliefs may come into our consciousness without us realising during feared events and situations. Maladaptive thoughts/beliefs lead to negative feelings such as anxiety, nervousness, fear, panic and dread. These feelings can then lead to maladaptive behaviours which in the long term create further anxiety.
Individuals who are anxious around crowds may avoid public transport, social events or other situations where there is likely to be crowds. Similarly, a child who is anxious about speaking in class may make excuses not to go to school or may become withdrawn and disinterested in their school work.
- Avoidance may be a helpful strategy in the short term, but over a long period of time, any event or situation which is avoided can increase any anxiety associated with it. For example, individuals who have been involved in road traffic accidents may avoid driving for many months or years, fearing that they will be injured again. The longer the avoidance, the harder they may find it to drive again because the anxiety associated with driving will increase.
- Safety seeking behaviours may be another behavioural consequence of these feelings, which initially seem helpful but actually can lead to reduced opportunities to disconfirm the maladaptive beliefs. An example of a safety seeking behaviour is when an individual with OCD fears a contamination and believes that in order to avoid this, they need to wash their hands 50-80 times a day. This excessive hand washing may alleviate anxiety in the short term. However, in the long term, it may only serve to strengthen their maladaptive beliefs (i.e. 'I have to wash all the germs off my hands to prevent catching a life threatening disease').
Will CBT help myself/my child?
A CBT approach may be very effective provided there is a good rapport between the client and therapist. Based on this, a good formulation helps to clarify how the difficult behaviours began and how they are triggered. The collaborative approach in CBT is useful for those who like to solve problems rationally and who like to be involved actively in their treatment. As treatment usually consists of helping the client to try different behaviours and to test the consequence of different behaviours, this approach can be insightful, empowering and therapeutic.
For children, this is a helpful approach which, when used with visual cues, pictures, diagrams and activities, can be both enjoyable as well as therapeutic. Children often respond well to structured activities requiring them to access their thoughts, consider the impact on their feelings and to see how they behave in situations where they feel sad, angry or upset (e.g. school refusal, being aggressive, self-harm etc).
CBT is effective when you or your child feel comfortable with the therapist, you feel supported and appropriately challenged by the process of therapy. A skilled and experienced therapist who is trained in CBT and more models, will help you to learn more about yourself and how you manage your emotional difficulties. Ultimately, this will enable you to identify unhelpful patterns which can be reduced so that more helpful strategies can be adopted and incorporated into your life.
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