Cognitive Behavioural Therapy (CBT) can change your attitudes towards things. Hopes, wants, and desires are all attitudes – as are fears, worries and phobias. Many psychological issues have their roots in inaccurate attitudes towards the self, others and the world. These attitudes can become deep seated habits that can cause great distress. Cognitive Behavioural Therapy works by challenging negative beliefs and encouraging more realistic attitudes.
Cognitivists are interested in the inner processing of information. They hold that our cognitions (the mental processes involved in gaining knowledge) deal with how we interpret the world about us. In contrast behaviourists are interested in nothing but observable behaviour. They assert that it is our experience and the environment that condition us.
As the name implies, Cognitive-Behavioural Therapy comprises of both cognitive and behavioural techniques. CBT claims that difficulties in living, relationships, general health and so on, have their origins in and are indeed maintained by both cognitive and behavioural factors.
CBT recognizes that in a healthy brain, it is the self-defeating beliefs that are often a major reason for difficulties. In the words of the stoic philosopher Epictetus;
“Men are disturbed not by things but by the view they take of them.”
Epictetus (CE 135)
This insight underpins CBT.
When clients seek psychological therapy, they usually describe their problems in terms of their feelings, or in terms of a situation with which they cannot cope. People rarely come complaining about the accuracy or consistency of their thinking or beliefs. In time this might change if CBT is assimilated into our culture.
Cognitive Behavioural Therapy is a problem solving approach to psychological treatment. During treatment clients will become more aware of their thoughts and feelings and the situations that trigger them.
“The Cognitive Behavioural approach is concerned with the whole range of human expression – thought, feeling, as well as the behaviour and the array of triggering events in the environment.” (Dryden, 1996)
Through therapy it becomes clear that events do not cause response, but that it is our thoughts that are triggered by the event and the observed response:
“It is this that determines our behaviour, our emotional response and overall mental state.” (Beck, 1995)
This simple realization is often in itself of therapeutic benefit.
The aim of therapy is to uncover any irrational and problematic thinking styles that often accompany psychological distress. Once the unhelpful or unrealistic thinking has been determined we then begin to modify it.
Checking and challenging our thoughts and assumption helps to generate a more realistic and rational set of beliefs. By thinking in a more realistic way we generate less disturbed and disturbing emotions. Instead of reacting to our often somewhat distorted viewpoint we react to the reality of the situation.
A belief can be verified by evaluating the available evidence relating to that belief. Evidence concerning the validity of the belief can be gathered from knowledge and previous experience (verbal and visual disputing) or by means of behavioural experiments (behavioural disputing):
“The client’s beliefs, attitudes and expectations are tested in reality in a formal structured way.” (Dworetzky, 1982)
Cognitive strategies have been shown to be especially effective in the treatment of emotional problems. Simple to learn cognitive techniques will provide you with practical and powerful skills that can be applied over a lifetime as effective tools in life management.
Behavioural techniques are also central to Cognitive Behavioural Therapy (CBT). These techniques follow from the premise that maladaptive behaviours – counter productive behaviour or behaviour that interferes with everyday life – are learned and create or maintain maladaptive choices or reactions. Behavioural therapy, or behaviour modification, trains individuals to replace undesirable behaviours with healthier behaviour patterns.
Behavioural intervention has been proven to be highly successful in the treatment of a broad range of emotional conditions. Among the techniques employed are training in relaxation, graded desensitization to feared objects or situations, diary methods, modelling and reinforcement.
You are taught relaxation techniques and encouraged to use them on a daily basis. The relaxation method might be used to maintain a general feeling of calm or used specifically in stressful situations. A popular method involves the tension and relaxation of different parts of the body in a specific order.
This consists of imagining a situation that you fear while I employ techniques to help you relax. The imagery of the anxiety-producing situations is encouraged to become progressively more intense. The combination of feared imagery whilst experiencing a deep sense of relaxation will help you to cope with the fear in every day life and eventually eliminate the anxiety all together.
I may ask you to keep a detailed diary recounting your thoughts, feelings and actions when specific situations arise. The journal will help you to become aware of any maladaptive thoughts and to show their consequences on behaviour. In later stages of therapy it may serve to demonstrate and reinforce positive behaviours.
We may engage in role-playing exercises in which I will act out appropriate behaviours or responses to situations. You may then model new behaviour, becoming familiar and comfortable with it.
I may use reinforcement to encourage a particular behaviour. For example a child with difficulties concentrating may get a gold star every time he remains focused on a task. The star reinforces and increases the desired behaviour by identifying it with something positive.
Cognitive Behavioural Therapy (CBT) works with the idea that our interpretations of our experiences are beliefs or hypothesis rather then facts, and as such can vary in their accuracy.
There are three main assumptions underlying CBT. Firstly, emotions and behaviour are determined by thinking about oneself or one’s experiences. Secondly, emotional disorders result from negative and unrealistic thinking. Thirdly, that by altering this negative and unrealistic thinking emotional disturbance can be reduced.
Cognitive Behavioural Therapy (CBT) integrates the cognitive restructuring approach of cognitive therapy with the behavioural modification techniques of behavioural therapy. Taken together, the cognitive and the behavioural strategies create a balanced approach to the understanding and treatment of emotional conditions. This approach provides a means of examining not only the manner in which individuals view themselves and their environment (cognition), but also the way in which they act in their environment (behaviour).
Cognitive Behavioural Therapy (CBT) will essentially help you to think and behave in a more effective and positive way. Ultimately the goal of CBT is to cause positive and lasting change. People usually experience relatively rapid progress and enduring relief.
What Will We Do?
During the initial CBT consultation I will carry out a number of tasks. These include explaining the basic principles of CBT, gaining an insight into some of your beliefs and opinions, making an initial assessment, encourage a comfortable and positive working relationship, recommend a course of treatment and set out clearly defined, agreed upon and compatible goals.
Specific therapeutic objectives are met as we work together as a team. You may feel empowered by having an active role in the therapy process. This is likely to discourage any over dependence that may occur in other therapeutic relationships.
I will set homework and self-help exercises for you to carry out in-between sessions. Examples include completing behavioural goals set in the therapy session and completing and using flash cards addressing issues and possible improvements. This encourages a rapid and continual improvement which become a part of everyday life.