Cognitive behavioural therapy (CBT) is a time-limited and goal oriented psychological intervention that aims to teach individuals practical skills in order to manage their mental health issues. The goal of CBT is to help individuals identify and change patterns of thinking and behaviour that may be maintaining their everyday challenges, such as worry, overthinking, low mood, and low motivations.
CBT is used widely to treat a broad range of mental health issues, from anxiety and depression, to drug and alcohol dependence, to sleeping and relationship difficulties. It is no wonder that it’s one of the most widely used therapies across the globe.
So how does it actually work? What does the therapy actually look like? Can it help me? We will spend some time covering the basics below.
How does CBT work?
Some forms of therapy focus on a person’s childhood and their past to gain an understanding of their current feelings, issues, and behaviours. However, CBT focuses on the present by looking at the person’s current thoughts and beliefs. At times it does acknowledge how someone’s past may be affecting their current thinking and behaviour, but this really is not the focus on CBT.
CBT functions with the fundamental view that current thoughts and beliefs are critical to people’s everyday interactions, their mood, physical sensations and behaviours. It emphasises the need for people to identify, challenge, and change how they view a situation and to become aware of how their negative automatic thoughts are affecting their behaviour.
According to CBT, people see the world in a specific way due to their patterns of thinking and beliefs about themselves, others, and the world. CBT aims to make people more aware of how these automatic thought patterns create their reality and determine how they behave, which ultimately may be maintaining their low mood, anxiety, poor sleep or poor relationships.
CBT is a non-judgemental therapy that tries to help people understand how these cognitive processes (thoughts, images, and beliefs) become a person’s way of dealing with emotional problems. Therefore, by raising awareness and trying to help a person initiate change of how they think about certain situations or how they behave when they are experiencing negative emotions, people may begin to live in line with their values and live a life that they want for themselves.
What is the CBT Framework?
One of the biggest advantages of CBT is that it tends to be a short and time-limited. CBT typically takes about six to ten sessions; however, people can continue on with CBT for many months if they require more support or if they have a greater difficulty putting skills into practice independently. A typical CBT therapy framework will require clients to attend a 50-minute weekly session for about ten weeks.
During the first few sessions, the therapist may ask many questions to gather the client’s history, which include information on:
- a person’s current presenting issues
- their symptoms
- things they would like to target in therapy,
- current alcohol and drug use
- their childhood experiences (very briefly)
- family history,
- any previous treatments sought or tried,
- and current supports in place.
During this time, the therapist works collaboratively with the client to develop a formulation of why a person may be experiencing difficulties, incorporating their goals into the formulation, and discussing how each of the issues identified may be targeted through CBT. Over the next few sessions, the client’s specific problems and goals become the focus of the therapy with the client and the therapist working together to build understanding and develop problem solving strategies to help individuals tackle their specific problems.
CBT relies heavily on structured sessions as this helps to use the limited therapeutic time most efficiently. It also ensures that personally relevant and important information is not missed, for example reviewing the homework, identifying challenges that the client faced outside the session, and building on their skill base from these discussions.
The skills that are taught to clients can generalise to many situations and settings, which helps them build independence and confidence to tackle mental health issues in the present and in the future. Clients begin transferring the skills learned in therapy through homework that the therapist provides at the end of each session and reviews at the beginning of the next session. The homework typically centres on the client using a specific skill that was taught in therapy in different situations in their everyday life.
Homework? Isn’t that for school?
Homework assignments will vary across the therapeutic setting. For example, at the beginning of therapy, homework may include a diary of any situations that trigger feelings of anxiety or depression, so the therapist and client can collaboratively examine thoughts surrounding specific situations. Later on in the therapy, homework may consist of exercises to cope with problem situations of a particular kind using skills learnt in therapy.
Completing set homework between sessions is vital to CBT and its effectiveness. Homework allows clients to generalise their skills to their everyday life and allows them to bring to therapy all the challenges they faced in implementing homework to troubleshoot the skills they need. Homework assignments also empowers individuals to trial new thought patterns and behaviours, which builds on their confidence and solidifies skills for present and future use.
Who benefits from CBT?
CBT is most suitable for people who describe having specific problems that they would like to improve given that it works on having specified goals. For people who feel vaguely unhappy or unfulfilled, there are other longer-term therapies that may be more suitable. CBT is also likely to be more helpful for anyone who relates to its core principles, its problem-solving approach and the need for practical homework assignments. People tend to prefer CBT if they want more hands on skills that can be taught and practised.
CBT can be an effective therapy for the following problems:
- Child and adolescent mental health concerns
- Chronic fatigue syndrome
- Chronic pain
- Drug or alcohol problems
- Eating disorders
- Habits, such as nail biting
- Health anxiety
- Mood fluctuations
- Relationship difficulties
- Social Anxiety
- Post-traumatic stress disorder
- Sexual and relationship problems
- Sleep problems
CBT is a form of psychological intervention where a person learns to alter their thoughts, perceptions, beliefs, attitudes, and behaviour. This can have a positive effect on anxiety, mood and their overall physical, social, and mental wellbeing.
CBT can help people with a wide range of mental health difficulties, ranging from depression to sleep difficulties.
CBT is built on a collaborative, non-judgmental relationship between a therapist and the client whereby goals are identified and worked on. The client must be an active participant to benefit, often completing homework tasks independently.
For people considering CBT, please seek advice from a general practitioner on how to access CBT with a qualified and registered therapist. Some self help and online options are available which can be viewed in the article titled “Online and self help CBT- The What, Where, How, and Why?”