Cognitive Behavioural Therapy; CBT

What is CBT?

CBT stands for Cognitive Behavioural Therapy, a short-term therapy model that focuses on solutions to your problems and provides practical activities to help you feel better.

During the process of CBT, you will discover how your attitudes, thought processes, and behaviours affect not only how you feel but also the things you do.

CBT is used to help people with mental health conditions such as,

• anxiety problems
  depression
• anger
• panic attacks
  health anxiety
  

CBT explainer video

CBT is a therapy model that combines many cognitive and behavioural approaches, such as Rational Emotive Behaviour Therapy.(1)

The cognitive approach examines how your thoughts can affect your feelings, and the behavioural approach looks at the relationship between what you do and what you are thinking.

What is a CBT session like?

I’ve made a quick video to explain what will happen in a CBT session with a therapist.

There is nothing either good or bad, but thinking makes it so.

Hamlet

These are sage words, meaning that nothing is good or bad; how you feel about a situation depends on your interpretation; the meaning you give to it is essential to work with your cognitions (thoughts).

Example. Sarah and John see a dog in the park. For Sarah, this event created fear as a dog chased her when she was a child, and she has been fearful ever since.

It delights John to see the dog, and he approaches it as he loves dogs. The event is the same, seeing a dog in the park, but two different people have different feelings about the dog based on their interpretation.

For Sarah, it means danger, and it means fun for John.

Who provides CBT?

CBT is provided in my clinic in Dublin and also via my online courses, but it can also be provided by other mental health practitioners which I shall explain below.

Cognitive Behavioral Therapy (CBT) can be provided by a range of mental health professionals who are trained and qualified in delivering this type of intervention. Here are the primary providers of CBT:

Psychologists:

• Clinical psychologists and counseling psychologists often provide CBT. They typically have a doctoral degree (Ph.D. or Psy.D.) in psychology and have received specialised training in assessment, diagnosis, and treatment of mental health conditions, including the delivery of CBT.

Psychiatrists:

• Psychiatrists are medical doctors who specialize in mental health. They can prescribe medication and also provide psychotherapy, such as CBT.

Licensed Professional Counsellors

• LPCs and LMHCs have a master’s degree in counselling or a related field and are trained to provide psychotherapy, including CBT.

Licensed Marriage and Family Therapists

• LMFTs are trained in family systems therapy but can also provide CBT, usually with a focus on relationship and family dynamics.

Nurse Psychotherapists:

• Some advanced practice registered nurses (APRNs) specialize in mental health and are trained to provide psychotherapy, including CBT.

How does CBT work?

CBT works by changing the belief systems holding you back and changing the things you do that keep your problem going. For example, if you believe you are not good enough, you might not apply for the job you want. It will not matter if, in reality, you are the best candidate, as your beliefs about yourself will hold you back.

I shall briefly explain how CBT helps by using the scenario above where the person did not apply for their dream job as they believed they were not good enough.

For example, if you believe you are not good enough, you might not apply for the job you want. It will not matter if, in reality, you are the best candidate, as your beliefs about yourself will hold you back.

• C is your cognitions, your thought processes and memories. How you talk to yourself inside your head.
• B is your behaviour- things you do, like sleeping, eating or avoiding something.
• T is for therapy.

CBT looks at negative automatic thoughts

As I stated above, it’s not events themselves that are bad, but the meanings you give to them. The job interview in my example above was not bad, but the person’s thoughts about themselves were not good. They thought they were not good enough. Repeated negative thoughts, such as

• I’m not good enough.
• I’m stupid
• others are better than me

It can stop you from getting what you want or feeling good about yourself. It also makes it hard to see examples when you are doing well, as it will not fit with how you view yourself.

Negative thoughts can become a self-fulfilling prophecy.

If the person in my example felt so low and had such critical thoughts about herself, she would think, ‘I won’t apply for the job.’

Having the belief in her head the thoughts are true; she does not give herself a chance to get the job. On the day the interviews are being held, she may worsen her thoughts; I’m a mess; it will upset my friends when they find out I didn’t even apply for the job. They’ll think I’m a loser. 

Things go from bad to worse and strengthen the belief that she is not good enough.

Where Do These Negative Thoughts Come From?

Some can originate when you are pretty young if things you never seem to measure up to your parents’ expectations. For example, you got an on a test, but your parents asked why you did not get an A+.

You could grow up thinking that it is never good enough no matter what you do. I must be the best at everything I do to be good enough.

That last sentence was an example of a maladaptive assumption. I have to be best at everything I do to be good enough may have been adaptive as a child to get my parent’s praise, everything had to be perfect, but as a grown-up, it is tough to live up and become maladaptive. It also stops you from seeing when you are doing well.

Read more on negative automatic thoughts.

How will CBT help with negative thoughts?

First, it will make you aware of them as they can be so entrenched in how you are as a person that you may not notice them.

Undertaking CBT will not tell say are wrong; instead, it will allow you to set up experiments to determine whether your thoughts are accurate.

If not, it will show you how to change your thoughts to more helpful ones.

CBT and your self-talk

Self-talk is how you talk to yourself inside your head. More often than not, your internal dialogue can be pretty harsh, as shown in the video below. In the explainer video, you can see how the person feels terrible about herself based on the judgement she makes in her internal dialogue.

We call all the judgements and thoughts negative automatic thoughts in CBT, and they change your mood.

The link between what you are thinking and feeling is a fundamental concept in CBT.

How effective is CBT?

1. Depression:

CBT has demonstrated robust efficacy in the treatment of depression. A meta-analysis by Hofmann, Asnaani, Vonk, Sawyer, and Fang (2012) affirmed the substantial effectiveness of CBT in reducing symptoms of depression, highlighting its status as a first-line intervention. CBT emphasizes the identification and restructuring of negative thought patterns, facilitating improved mood regulation.

2. Anxiety Disorders:

CBT is highly efficacious for anxiety disorders, including Generalized Anxiety Disorder (GAD), Social Anxiety Disorder, and Panic Disorder. A review by Olatunji, Cisler, and Deacon (2010) revealed that CBT interventions result in significant symptom reduction and functional improvement, providing relief from debilitating anxiety symptoms through exposure and cognitive restructuring techniques.

3. Obsessive-Compulsive Disorder (OCD):

Studies indicate that CBT, incorporating exposure and response prevention, is the treatment of choice for OCD. The American Psychiatric Association (APA) acknowledges the profound impact of CBT in alleviating OCD symptoms, reinforcing positive behavioral change and adaptive thinking patterns (APA, 2013).

Accessibility and Adaptability:

CBT is renowned for its adaptability and can be administered in varied formats, including individual, group, and online settings, allowing for broad accessibility. CBT’s structured, goal-oriented approach makes it suitable for telehealth applications, extending its reach to individuals unable to access traditional therapy services. A study by Andrews et al. (2018) emphasized the comparable outcomes of online CBT and face-to-face interventions, showcasing the versatility of CBT delivery.

Pediatric Applications:

CBT is not confined to adults; it is also a proven intervention for children and adolescents experiencing psychological distress. The effectiveness of CBT in pediatric populations is evidenced by its successful application in treating anxiety, depression, and behavioral issues in young individuals (Comer et al., 2017). It empowers youth with essential coping mechanisms and cognitive restructuring skills, fostering resilience and emotional well-being.

Substance Use Disorders:

CBT’s effectiveness extends to substance use disorders, where it aids in addressing the underlying cognitive processes and behaviors contributing to substance abuse. A comprehensive review by Magill and Ray (2009) concluded that CBT is effective in reducing substance use and preventing relapse, emphasizing its role in fostering long-term recovery through relapse prevention strategies and cognitive restructuring.

Where can I get CBT?

If you are ready to start therapy and want to undertake CBT, several options are open to you.

• You can meet with someone like myself, a psychologist, for therapy.
• You can use self-help books or start with online CBT.
• If you would like to work alone, you do not have to come to Dublin; you can look at my self-help courses, all of which use CBT.

sources

1. David, Oana & Matu, Silviu & Pintea, Sebastian & Cote?, Carmen Domnica & Nagy, Diana. (2014). Cognitive-Behavioral Processes Based on Using the ABC Analysis by Trainees’ for Their Personal Development. Journal of Rational-Emotive and Cognitive-Behavior Therapy. 32. 10.1007/s10942-014-0189-0. 
2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
3. Andrews, G., Basu, A., Cuijpers, P., Craske, M.G., McEvoy, P., English, C.L., & Newby, J.M. (2018). Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: An updated meta-analysis. Journal of Anxiety Disorders, 55, 70-78.
4. Comer, J.S., Chow, C., Chan, P.T., Cooper-Vince, C., & Wilson, L.A. (2017). Psychosocial treatment efficacy for disruptive behavior problems in very young children: A meta-analytic examination. Journal of the American Academy of Child & Adolescent Psychiatry, 56(1), 26-36.
5. Hofmann, S.G., Asnaani, A., Vonk, I.J., Sawyer, A.T., & Fang, A. (2012). The efficacy of cognitive-behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427-440.
6. Magill, M., & Ray, L.A. (2009). Cognitive-behavioral treatment with adult alcohol and illicit drug users: A meta-analysis of randomized controlled trials. Journal of Studies on Alcohol and Drugs, 70(4), 516-527.
7. Olatunji, B.O., Cisler, J.M., & Deacon, B.J. (2010). Efficacy of cognitive-behavioral therapy for anxiety disorders: A review of meta-analytic findings. Psychiatric Clinics of North America, 33(3), 557-577.