What is Cognitive Behavioural Therapy (CBT)?

“The greatest discovery of my generation is that human beings can change the quality of their lives by changing the attitudes of their minds.” – William James

The basic idea of cognitive behavioural therapy is that your thinking determines your quality of life. If you change your thinking, you will improve your life. External factors influence your life to some degree, but it is mostly how you interpret external factors that has the greatest impact.

If you think that you have to be perfect, small disappointments will feel like major failures. If you dwell on your worries or fears, you will eventually feel overwhelmed. If you hold on to disappointments or resentments, you will sap the joy out of life. How you choose to interpret events, and your ability to reframe them is the power of mind over mood.

Ask your therapist or doctor if cognitive therapy is right for you. These techniques can complement the work you do with your therapist or doctor, but they are best done in combination with professional guidance.

History of Cognitive Behavioural Therapy

Many people who contact us have already heard or read at least a little about CBT. Its recent popularity might mislead you to think that it’s something entirely new, but in fact certain elements of it have been known to scientists for a very long time. The philosophy of stoicism, which is as immensely interesting and applicable today as it was thousands of years ago, expressed that our way of thinking was instrumental in changing our emotions, sense of pain and other factors. In writings from ancient Greece and later Rome, we can find reasonable arguments and detailed descriptions of the fact that by trying to change one’s thoughts, and learning to think logically and positively, we can affect the emotions towards our improvement.

In applications specific to treatment, several precursors of the present-day theory have been known for over 200 years. The works of distinguished Russian scientist Pavlov were the basis for further developments by such prominent US, UK and SA scientists as Wundt, Watson, Wolpe, Thorndike, Eysenck, Skinner, Rotter, Bandura and others.

These names are known to all students of psychological studies, who obviously appreciate their contribution in what is known as the first wave of Cognitive Behavioural Therapy.

Through the merging of the behavioural side from the early days, and the cognitive one, around seventy years ago the modern version of CBT became fully developed. By the 1950s -1960s, the main elements were well known and constituted a range of therapies. These early techniques, with little change, eventually evolved into the blend of several distinctive therapies we have today, all of which rightly fall under the name of CBT.

In the 1950s, American psychologist Albert Ellis introduced Rational Therapy in which people were taught the A-B-C-D approach for dealing with uncomfortable situations. When a person is confronted with an adversity A, their beliefs B, will influence the way they respond to that adversity and lead to emotional and behavioural consequences C.

If the beliefs B, are rigid, absolute, and unrealistic, the consequences C, will likely be self-defeating and destructive. If the beliefs B, are flexible and constructive, the consequences C, will likely be positive. People can change their thinking and their lives by D, disputing and challenging their beliefs.

Rational therapy was partly developed as a reaction to psychoanalysis, which was considered inefficient because individuals went through years of therapy but were not explicitly directed to change their thinking. Psychoanalysis was based on the approach that understanding your subconscious thoughts would eventually lead to self-change. Rational therapy takes a more directive approach. You are encouraged to challenge your beliefs in order to achieve faster and more efficient change.

In the 1960s, American psychiatrist Aaron T. Beck introduced Cognitive Behavioural Therapy partly based on the ideas of Albert Ellis and used it as a treatment for depression. Beck developed the idea of the thought record, in which individuals could challenge their thinking through writing their thoughts down and looking for healthier ways of thinking. He also developed self-reporting measures for anxiety and depression including the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI).

What is Cognitive Behavioural Therapy?

Cognitive Behavioural Therapy, commonly referred to as CBT, is a therapeutic approach widely used in the management of mental health difficulties. CBT helps individuals to identify and challenge negative, unhelpful thought patterns, and replace these with ones that are more helpful. By recognising and changing these negative patterns, it can help to change the way we think, feel and behave.

CBT explores current issues and difficulties rather than focusing on the past. CBT will help you learn new skills to alter behaviours and apply these into everyday life. CBT has been well researched and is recommended by NICE for the management of anxiety, depression, OCD, phobias, PTSD and depression.

How long a course of CBT lasts is dependent upon a person’s individual needs but you can typically expect a course to comprise between 5 and 20 sessions, with each session lasting up to 1 hour. For an effective result, CBT should only be delivered by an appropriately qualified practitioner.

There is no single “best therapy” for everyone – in different cases, and for different individuals, a custom-tailored therapy approach provides benefits far better than any single type of therapy approach could. “One size fits all”– is not applicable for human beings.

It is a step-by-step method for identifying your negative thinking and replacing it with healthier thinking. It changes your inner dialogue. Numerous studies have shown that cognitive behavioural therapy is effective for treating anxiety, depression, addiction, and life’s many challenges.

Negative Thinking

Negative thinking is thinking that leads to negative consequences. It based on false beliefs or on a few selective facts, and it ignores important facts that would lead to better consequences. Negative thinking is usually rigid, absolute, and not supported by most of the facts.

When your thinking is rigid and absolute, you tend to take an all-or-nothing approach and you are resistant to change. For example, you may think that you are a failure at everything, and you may be resistant to hearing encouraging advice from your friends.

Sometimes it’s hard to recognise negative thinking. You may only recognise that your life isn’t working. Cognitive therapy is designed to help you recognise your negative thinking and discover healthier thinking patterns.

These are the common types of negative thinking. There is some overlap among them, and sometimes a thought can involve more than one type of negative thinking.

Four Common Negative Thinking Patterns

1. All-or-Nothing Thinking:“I have to do things perfectly, and anything less is a failure.”
2. Focusing on the Negatives:“Nothing goes my way. It feels like one disappointment after another.”
3. Negative Self-Labeling:“I’m a failure. If people knew the real me, they wouldn’t like me. I am flawed.”
4. Catastrophising:“If something is going to happen, it’ll probably be the worst-case scenario.”

Six More Negative Thinking Patterns

1. Excessive Need for Approval:“I can only be happy if people like me. If someone is upset, it’s probably my fault.”
2. Mind Reading:“I can tell people don’t like me because of the way they behave.”
3. Should Statements:“People should be fair, and when they are not fair they should be punished.”
4. Disqualifying the Present:“I’ll relax later. But first I have to rush to finish this.”
5. Dwelling on the Past:“If I dwell on why I’m unhappy and what went wrong, maybe I’ll feel better.”
6. Pessimism:“Life is a struggle. I don’t think we are meant to be happy. I don’t trust people who are happy. If something good happens in my life, I usually have to pay for it with something bad.”

 

Causes of Negative Thinking

Negative thinking is learned thinking. You weren’t born thinking this way. You probably learned it by watching the people around you.

If you see important people in your life using negative thinking, it will start to seem normal. You won’t question if it is healthy or not. You won’t even question where it came from. It will feel like you’ve always thought that way.

Negative thinking turns into automatic thinking through repetition. By the time you are independent enough to do your own thinking, you may have been exposed to numerous examples of negative thinking. By then, negative thinking feels like just part of who you are. Without even questioning it, you automatically assume that you are wrong, or a failure, or disliked.

Automatic thinking is helpful in everyday life, because you have so many minor decisions to make that you can’t take time to ponder every choice. It allows you to navigate life efficiently. But automatic thinking is unhelpful if your assumptions are false. If you have absorbed a negative way of thinking, then you will often come to wrong the conclusions without even knowing why.

What you have learned you can unlearn and relearn something new in its place. This is the value of cognitive behavioural therapy. You can learn new life skills and new ways of thinking that will lead to a better life.

Consequences of Negative Thinking

The consequences of negative thinking are cumulative. One negative thought piled on top of another starts to take a toll on how you view yourself and your future. Here are some examples.

If you think that any mistake is a failure, this all-or-nothing thinking can lead to anxiety. You worry that any mistake may expose you to criticism or judgment. Therefore, you don’t give yourself permission to relax and let down your guard.

If you think that you are broken, unfixable, or unlikeable, this negative self-labelling can lead to depression. You are trapped by your own unrealistic view of yourself. Feeling trapped is one of the common causes of depression.

Negative thinking that can lead to anxiety or depression can also lead to addiction, because anxiety and depression feel so uncomfortable that you may turn to drugs or alcohol to escape.

Negative thinking not only leads to unhappiness, it is also an obstacle to self-change. When you think in an all-or-nothing way, then the idea of change feels like an overwhelming challenge. You can’t see the small steps, and you don’t have the energy to take big steps, therefore you feel stuck.

How Effective is Cognitive Behavioural Therapy?

Cognitive behavioural therapy has been proven to be more effective than other forms of psychotherapy for anxiety and depression.

Cognitive therapy helps to change the wiring of your brain. When you challenge your negative thinking, you create new neural pathways. The more you practice your new way of thinking, the more you strengthen those neural pathways.

MRI studies have confirmed that cognitive therapy changes the wiring of your brain. Your brain begins to reflect your new way of thinking. This is why the benefits of cognitive behavioural therapy are not just temporary. Cognitive therapy changes your brain pathways and has a more permanent effect on your thinking and behaviour.

A review of recent variants of cognitive behavioural therapy, including mindfulness-based cognitive therapy, acceptance therapy, and commitment therapy, has shown that they are no more effective than CBT, and that they work through the same underlying mechanisms.

The principles of cognitive behavioural therapy are so sound that it can be used effectively in a number of settings. Cognitive behavioural therapy has been shown to be effective when delivered in primary care, via computer, and through internet-based self-help programs.

Behavioural Therapy

CBT is really two forms of therapy: cognitive and behavioural therapy. Behavioural therapy is sometimes used initially with individuals who are too anxious or too depressed to even acknowledge that their thinking is part of the problem.

Behavioural therapy encourages you to try simple tasks, and as you succeed, you gradually improve your belief in yourself. Once you see that you can change your behaviour, you may be more willing to change your thinking. In most cases, individuals who are ready to change are encouraged to start directly with cognitive therapy rather than begin with behavioural therapy.

Useful CBT Worksheets & Information

Useful website with lots of handy work sheets- https://www.getselfhelp.co.uk/index.html

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References

1. Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., et al., The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses.Cognit Ther Res, 2012. 36(5): p. 427-40. PMC3584580.
2. Driessen, E., & Hollon, S. D., Cognitive behavioral therapy for mood disorders: efficacy, moderators and mediators.Psychiatr Clin North Am, 2010. 33(3): p. 537-55. PMC2933381.
3. Kahneman, Daniel, Thinking, Fast and Slow: Farrar, Straus and Giroux, 2013.
4. Tolin, D. F., Is cognitive-behavioral therapy more effective than other therapies? A meta-analytic review.Clin Psychol Rev, 2010. 30(6): p. 710-20.
5. Brooks, S. J., & Stein, D. J., A systematic review of the neural bases of psychotherapy for anxiety and related disorders.Dialogues Clin Neurosci, 2015. 17(3): p. 261-79. PMC4610611.
6. Porto, P. R., Oliveira, L., Mari, J., Volchan, E., et al., Does cognitive behavioral therapy change the brain? A systematic review of neuroimaging in anxiety disorders.J Neuropsychiatry Clin Neurosci, 2009. 21(2): p. 114-25.
7. Paquette, V., Levesque, J., Mensour, B., Leroux, J. M., et al., “Change the mind and you change the brain”: effects of cognitive-behavioral therapy on the neural correlates of spider phobia.Neuroimage, 2003. 18(2): p. 401-9.
8. Beutel, M. E., Stark, R., Pan, H., Silbersweig, D., et al., Changes of brain activation pre- post short-term psychodynamic inpatient psychotherapy: an fMRI study of panic disorder patients.Psychiatry Res, 2010. 184(2): p. 96-104.
9. Linden, D. E., How psychotherapy changes the brain–the contribution of functional neuroimaging.Mol Psychiatry, 2006. 11(6): p. 528-38.

• Hofmann, S. G., Sawyer, A. T., & Fang, A., The empirical status of the “new wave” of cognitive behavioral therapy.Psychiatr Clin North Am, 2010. 33(3): p. 701-10. PMC2898899.
• Hoifodt, R. S., Strom, C., Kolstrup, N., Eisemann, M., et al., Effectiveness of cognitive behavioural therapy in primary health care: a review.Fam Pract, 2011. 28(5): p. 489-504.

 

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