More about cognitive-behaviour therapy (CBT) in Glasgow
What is cognitive-behaviour therapy and who can it help?
Cognitive Behavioural Therapy (CBT) is a form of therapy that focuses on changing both cognitions (how you think) and behaviours (what you do) and has been shown to be helpful in depression, anxiety, phobias, eating disorders, addictions, post traumatic stress disorder and other mental health issues. CBT was the first therapy to be shown to be as effective as drug interventions in depression and is the mainstream treatment for depression and anxiety in the NHS.
What is the theory behind cognitive-behaviour therapy?
An important premise of CBT is what you think affects how you feel and what you do. Every moment of every day, our minds are thinking, interpreting situations, analysing others and trying to make sense of events. Every feeling (negative or positive) that we have is the direct result of thinking, no matter how fleeting the thought. It is impossible to feel a certain emotion, without having first had a thought. For example, in depression, thoughts are often concerned with themes of loss of failure; in anxiety, thoughts are often concerned with themes of danger or threat; and in paranoid delusions, thinking is characterised by themes of purposeful maltreatment by others.
How can my early experiences impact on the way I think today?
Early experiences can lead to core beliefs, attitudes and assumptions. These beliefs tend to cause negative automatic thoughts which lead to certain, sometimes damaging, behaviours. For example, if both parents are overly critical of their child and rarely show their child love, that child may grow up with the core belief that they are unlovable. This will result in negative automatic thoughts such as “people are selfish” and this can have obvious impacts on wellbeing. As well as these negative feelings, thoughts such as “If I am unlovable then everyone will leave me” can result in destructive behaviours such as pushing a partner away before “the inevitable happens”. These behaviours can feed back into negative thoughts because if you push a partner away and then they leave, you can say “I was right – people are selfish and I am unlovable”. By understanding this sequence, you can change thoughts and behaviours and therefore change the way you feel.
Surely my thoughts reflect reality, don’t they?
It is easy to believe that the content of our thoughts reflect reality, but thoughts are our way of conceptualising reality and do not reflect the truth about a situation. There are certain thinking errors that people make every day. For example, ‘catastrophising’ describes those times when we turn a small event into a big disaster. In therapy, you will learn to question assumptions about a situation by trying to put things into perspective, considering alternative explanations and weighing up the evidence logically. Another common mistake is ‘mind reading’: people often think they know what others are thinking. For example, if someone yawns while having a conversation with you, you may interpret this as them being bored by what you are saying. However, rather than accept this thought as a fact, you should consider the alternative, that the person is just tired. ‘Overgeneralising’ is another common thinking error that everyone makes, but in therapy you will learn to recognise when you are doing this and have the opportunity to question yourself. For example, one bad experience with a dog can lead to a global fear of dogs, or a belief that “all dogs are dangerous”. You will learn to ask yourself: Am I looking at the big picture? Am I really being accurate?
What does cognitive-behavioural therapy involve?
In CBT, an individual works with their therapist in a team. The therapist is there to help as you learn to modify your thinking, behaviour and, therefore, mood. By teaching people to be their own therapist and talking about relapse prevention, CBT is a good therapy for minimising relapse. Moreover, as the responsibility for change throughout the treatment is in the patient’s hands, improvement is also due to their efforts.
How is CBT different to a ‘talking therapy?
CBT is not simply a ‘talking therapy’ that discusses issues you have had in the past. Although it may be important to talk about past experiences, therapy focuses on the here-and-now. It involves solving problems and setting goals in order to reduce symptoms. For example, interventions tend to focus around the identification, evaluation and alteration of negative, unhelpful thoughts. A ‘dysfunctional thought record’ is often used to become aware of thoughts, record them and question their accuracy. This is done by asking what evidence there is for the thought/belief, if there are any alternative explanations for it and what the effect of it is. For example, one woman held a very low opinion of herself, but held a belief that “no one really likes themselves”. To test the accuracy of this belief, she asked a few close friends and family members how they felt about themselves. To her surprise, every person she asked said that they did like themselves. This allowed her to question the accuracy of her belief, and led to change.
Why is homework necessary for CBT?
Homework tasks, as in the above example, are important as one session per week is not a lot of time. By continuing to practise and develop the skills you learn in your session outwith therapy and after you finish, it is less likely that your symptoms or problems will return. Although there is usually a greater emphasis on the above cognitive aspects of CBT, the behavioural component of CBT is also carried out when not in therapy. It emphasises engaging in positive, rewarding experiences and scheduling activities.
How many sessions of CBT will make a difference and what is likely happen in the sessions?
CBT is time-limited and the time will be discussed in your first session if you decide to continue with therapy. It can generally last from five to 20 sessions, which are usually one hour long. The first CBT session usually involves you and your therapist getting to know one another and talking about the problems you are experiencing. The therapist will discuss possible treatment plans with you and you will agree on a specific day and time. Generally, you will decide to focus upon a few specific issues you would like to change and find ways to implement these changes. The following sessions will consist of working towards these goals. At the start of the session, the therapist will likely want to hear how you have been since the last session and you will agree on an agenda for the current meeting. This usually involves reviewing homework tasks, discussing your progress in learning new skills, discussing dysfunctional thought records, receiving feedback from the therapist, deciding on tasks or goals for the following week, and so on. The latter sessions will review the skills you have learned in order for you to leave therapy and manage on your own.
Is CBT an easy quick fix solution?
CBT is hard work and will require your effort and so it can be difficult, at first, if you are lacking in energy or have trouble concentrating. It is natural to feel overwhelmed, but you can pace your sessions at the level you feel comfortable with. Your therapist will not rush you and once you notice yourself accomplishing goals set in the therapy, you may find it gets easier. Also, it can be difficult to talk about feelings in any type of therapy, but this too will get easier as therapy goes on and you feel more comfortable with your therapist.
Should I consider another therapy instead?
Although CBT is the most widely used therapy and has been shown to be helpful for depression, anxiety, phobias, eating disorders, addictions, post traumatic stress disorder and other mental health issues, there are plenty of other therapies you can discuss with your therapist too.
- Interpersonal therapy is concerned with the effects of interpersonal relationships upon mood
- dialectical behavioural therapy is similar to CBT, but receives an influence from Buddhist teachings and mindfulness-based practices
- transactional analysis is particularly helpful in couples therapy
- psychoanalytic therapy is a ‘talking therapy’ which is not focussed on goal-setting, but emphasises the benefits of a listener
- group therapy is the opposite of individual therapy and can be useful for building supportive relationships with others experiencing the same problems, and is often less expensive than individual therapy.
More information about cognitive-behaviour therapy (CBT) or other therapies
- First Psychology Centre, Glasgow can help you: contact us to find out more or to arrange an initial session.
- Alternatively you may wish to speak to your GP.
- See our useful links for details of organisations that may be able to provide assistance or information.
Shilpa Sreenath, Counselling Psychologist (Online only)