Does CBT really work?

Yes – it can change your brain.

To explain this, I will talk about CBT about anxiety, specifically social anxiety, to help make a point.

If you have already read about CBT (if not, I have a brief overview of it here ), you will know that your thoughts, feelings and behaviours are linked.

Brief video showing how thoughts feelings and behaviours are connected

Back to what I was saying. Let’s say I walked past you in the street, and you were all smiles, ready to stop and chat, and had said a big warm hello – and I walked right past you.

You might well feel a bit offended by this and maybe wonder why I shunned you in such a rude way.  For the example, let me take it a step further.

image of a therapy session with Dr Elaine Ryan logo

Retrain Your Brain

Online course for anxiety.

Based on Dr Ryan’s private practice

Later on in the evening, you might be mulling this over in your head and start to think, “the cheek of Elaine” and start to experience some anger, or you might think “, well, why would she bother with me anyway?”  Either way, these thoughts are not going to make you feel good.  One will make you angry, and the other will make you feel bad about yourself.

The next day, you see me again, but you might not have the big hello at the ready.  You could be angry with me or feeling bad about yourself; your behaviour is somewhat different than the day before when you were ready to stop and chat.  Your experience of meeting me yesterday starts to play a part in this.

Let’s go with the example that you started to think, “why would she bother with me anyway?”

This is still playing on your mind when you meet your friend and some new people at the weekend.  You start to feel a little nervous at the thought of being introduced to them – your mind is preoccupied with – why would they want to know me – what will I say?

If this goes on long enough, these thoughts in your head, along with the way they are making you feel about yourself, will take on a life of their own.

After a while, you might be pretty convinced that you have nothing to say, people are not interested in you, and you feel anxious with other people – you start to feel a little afraid when chatting with other people.

When I say afraid, you are starting to get anxiety symptoms (you can read more about that here.)  You start to get a fear response.

If you have stayed with me up til now, I shall start to answer the original question;

Does CBT work?

Anxiety – be it social anxiety, panic disorder, generalized anxiety or phobias, all involve a part of your brain called the limbic system.

This part of the brain processes fear, and studies have shown that these regions are very active during anxiety and can return to normal after CBT.

How does that work?

Think of it as a muscle (and apologies to the neuroscientists amongst you.)  If you flex a muscle often enough, it becomes strong.

In the example above, flexing a muscle is like first thinking, why did she ignore me, why would she want to talk to me.  The more you flex it (have these thoughts), the stronger they become.  They become very active and more ready to spring into action when you need them.  The problem is, you do not need them, but they are there, waiting to work for you in any given social situation.

It is like your brain has become so used to you having them, along with specific feelings, in certain situations that they spring into action immediately, and you have little control over this.

So.  Does CBT really work?  This evidence is looking good for starters, as research shows that CBT can calm down the fear centres in your brain and change the way you think about things.

You may also have read on this blog that when we are startled (whether because of big noise or the thoughts in your head relating to a social situation) that we get the emotions and fear before we have a chance to think about it.

This makes sense in a real dangerous situation.  If I ran at you like a crazy lady, there is no point in you weighing up all the possible options first, as this is too slow.  You get the rush of adrenaline first as I am running at you.  Even if I was joking, the fear is there first, better safe than sorry, and then your logical brain can decide “she is only fooling around.”

Research shows that CBT affects the part of your brain that deals with this logical, rational side of you.

In the example above, thinking why would she bother with me anyway? over time can change into “nobody likes me.”  This logic feels very real but is not necessarily true.  Sometimes, you can see something as true just because it feels true.

From the research, it would then appear that after CBT, the way thoughts are processed in your brain actually change, and the overactive fear reaction returns to normal in the brain.

This means that the way you think in your head and how you feel in your body can change; due to changes in your brain.

So yes, CBT has the most research and the most evidence to suggest that it does indeed work.

2 thoughts on “Does CBT really work?”

  1. Hi Elaine. What are you thoughts regarding other psychotherapy treatments such as psychoanalysis? Where the client is more encouraged to talk about past events, and emphasis put on past events, as this is seen as an important part of the therapy process. How do you think such a style of therapy fares in comparison to CBT for issues like anxiety disorders, depression, victims of traumatic experience, abuse?

  2. Hi there, and thank you for your comment. I have studied psychoanalysis as well, which surprises some people! I completely agree with you that it is important to place emphasis on past events, as we all do not exist in vacuum. Some people misunderstand CBT, and think that it does not emphasize the past. It does. It works with how things are affecting the person today, but all the thoughts and feelings and behaviours that they have today are as a result of past experiences. The way I work, I do use CBT, but I also include a lot of information on how the brain works, which is extremely helpful for issues that you mention.

    To answer your question about my thoughts on psychoanalysis for the issues you mentioned, I have to refer to guidelines which exist to protect members of the public who engage in therapy. The guidelines show what has been shown to work for particular things. I refer to UK guidelines (NICE guidelines) and according to this body, they name psychological therapy, citing CBT. I am just one person, but adhere to what research has told us to be effective, as opposed to what I think, it is a safer way of working for the people to chose to engage in therapy. This is a rather long winded way of saying, that I use guidelines to protect the public and not just my own opinion and psychoanalysis is not on the guidelines for such issues.

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