What is cognitive behavioural therapy?

CBT, in my experience, is a very popular and well-known therapy due to the exposure it has gained in the media and through NHS commissioning. I regularly get asked over the phone by a client if I provide CBT, and it's not often that people know exactly why they want CBT, but they have heard a lot about it. CBT is often recommended as a first-line treatment for a variety of mental health problems such as;

• anxiety
• depression
• post-traumatic stress disorder
• eating disorders
• bipolar
• borderline personality disorder (BPD)
• obsessive-compulsive disorder (OCD)
• phobias
• psychosis
• schizophrenia

This comes from the National Institute of Clinical Excellence (NICE), which as an organisation evaluates research and develops the policies and pathways that the NHS follows. It is not uncommon for CBT to now be the primary or secondary taught orientation on most counselling and psychology training courses.

CBT rose to popularity and fame because, as a method of counselling, it was one that could be standardised (counsellors providing this could offer it in one way) and therefore researched. This does not mean that CBT is always the best treatment for the above problems, but research has shown that it can be effective when used with these problems. The benefit being that CBT is an evidence-based therapy, meaning that your therapist should only be using what empirically works.

The history of CBT

CBT comes as a second wave of treatment from combining cognitive therapy and behaviourism. People who subscribe to cognitive theory believe that changing thoughts, images, and cognitions impact on feelings and, as a result, a change in behaviour follows. From this perspective, people’s emotional reactions and behaviours are strongly influenced by the individualised meaning that they assign to events that they experience, whereas behaviourists believe that a change in behaviour or environment results in a change in thoughts and feelings. From this perspective, it is believed that what we do is the crux of what is maintaining our psychological distress.

When we combine the two perspectives, we get CBT. This theoretical orientation suggests that mental health problems are an extreme or exaggerated version of normal processes. The focus of this belief is that we are focusing on what is happening in the present, and the main concern is processes that continue the problem rather than what caused it, whether this is a thought, emotion, bodily sensation, or behaviour.

What does CBT involve?

In CBT, you will first learn to identify painful and upsetting thoughts you have about your problem and then look to evaluate whether these thoughts are realistic. If they are deemed to be unrealistic, therapy will help you learn skills that can challenge the pattern of thinking so that you can accurately evaluate the situation. One way of doing this is to look at the ABC (or more recently the ABCDE) which stands for;

• A: Activating event. This is what has triggered the place you find yourself in. 
• B: Belief. This looks at both the inference about the trigger, a person’s core beliefs, and the evaluation of the situation.
• C: Consequence. This looks at how you react because of these beliefs.
• D: Dispute. Then you are encouraged to find evidence and learn new skills to dispute the beliefs.
• E: Effective new belief. Following this space is made so that you can learn a new, realistic, and effective belief.

It is also likely together that both you and your therapist will create a formulation which is a diagram that highlights the relationship between your thoughts, emotions, bodily sensations, and behaviour.

Following this, is it likely that you and your therapist will spend some time trying to build a robust therapeutic alliance as you start to challenge the thought patterns through active participation in therapeutic activities that are tailored to your problem, and reinforcing these new skills with 'homework'. 

CBT can be delivered in a range of ways, such as one to one or group therapy, or even through self-help materials.

How long?

CBT is often considered a short-term therapy and it is common to be delivered in a block of 12 sessions for one hour a week, over 12 weeks. This can vary with the type of problem that you are coming to therapy for and what you need. Some people need a bit more time; some people need less.

Is CBT for me?

CBT can help with a range of problems as mentioned above, and it helps many people. For it to work you need to be ready, willing, and able to engage with your counsellor. Your practitioner is not there to give you the answers and tell you how to fix the problem but help you learn ways of coping and challenging your current thoughts, feelings, and behaviour. This can be hard at times, but it's worthwhile, and it will be done in a non-judgemental and caring way.