Cognitive Behavioral Therapy

“People are disturbed not by things, but by the view which they take of them”

(Epictetus in Wedding, 2014, p.157)

What is Cognitive Behavioral Therapy (CBT)

Cognitive therapy is one of the few forms of psychotherapy that has been scientifically tested and found to be effective in over three hundred clinical trials for many different disorders. In contrast to the humanistic and psychoanalytic approaches, it is a structured, goal orientated, problem focused, and psycho educative therapy that aims where possible to be time limited (usually 6 to 20 sessions). CBT takes a hands-on approach to problem solving. It focuses on the present, and on the processes involved in maintaining your problems or anxieties, rather than the historical processes that might have led to the development of your psychological distress.

The basic aim of CBT is to see beyond clinical diagnosis and examine the inter relationship between how we think (cognition), how we act (behaviour), how we feel (emotion) and our body sensations can negatively or positively affect our mental health and wellbeing.

CBT is a recommended treatment of choice for depression and anxiety by mental health professionals, the Health Service Executive in Ireland and the National Health Service in the UK.

Is CBT Suitable for Me?

CBT is particularly suitable for you if your goal is to reduce or eliminate the symptoms of your distress in a relatively short space of time compared to other talking therapies. Improvements in symptom reduction are often reported within 6 sessions, making it one of the most accessible and affordable therapies available to clients who do not wish to do deep or long term work. However, clients who have had long-standing problems may choose to stay in therapy for many months. CBT aims to teach you the practical coping skills to manage your state of mind and emotional wellbeing daily. CBT is most commonly used to treat and manage the symptoms of depression and anxiety, and it may be helpful where medication alone has not worked.

Here are some client specific issues where CBT has proven to be a very effective treatment:

• Depression
• General anxiety disorder
• Trauma and Post traumatic stress disorder (PTSD)
• Worry
• Social anxiety
• Health anxiety
• Panic disorder
• Eating disorders
• Insomnia
• Phobias
• Obsessive compulsive disorder
• Personality disorder
• Exam anxiety
• Fear of public speaking
• Anger management
• Suicidal ideation
• Self-harm

What Does CBT Entail?

During a CBT session, you and your therapist will work together to identify and understand your problems, and develop new strategies for tackling them. Even before your therapy session begins, your therapist may have you fill out certain forms to assess your mood. Depression, Anxiety and Hopelessness Inventories help give you and the therapist an objective way of assessing your progress. One of the first things your therapist will do in the therapy session is to determine how you’ve been feeling this week, compared to other weeks. This is what we call a mood check. The therapist will ask you what problem you’d like to put on the agenda for that session and what happened during the previous week that was important. Then the therapist will make a bridge between the previous therapy session and this week’s therapy session by asking you what seemed important that you discussed during the past session, what self-help assignments you were able to do during the week, and whether there is anything about the therapy that you would like to see changed.

Next, you and the therapist will discuss the problem or problems you put on the agenda and do a combination of problem-solving and assessing the accuracy of your thoughts and beliefs in that problematic situation. You will also learn new skills. You and the therapist will discuss how you can make best use of what you’ve learned during the session in the coming week and the therapist will summarise the important points of the session and ask you for feedback: what was helpful about the session, what was not, anything that bothered you, anything the therapist didn’t get right, anything you’d like to see changed. As you will see, both therapist and client are quite active in this form of treatment.

How Can I Benefit from CBT?

CBT can be life changing for you. If applied appropriately it will give you an understanding of how and why certain situations trigger your negative thoughts which effect your emotions, behaviours and bodily sensations. This feeds the vicious cycle of anxiety and/or depression causing you to feel overwhelmed and unable to cope. During CBT treatment, you will learn:

• To understand yourself more fully, and the significance of personal meaning you give to things
• To develop rational interpretations of situations, events and experiences
• How your negative thoughts, assumptions and consequential maladaptive behaviours have been self-sabotaging
• How to change your current behaviour patterns that feed your anxieties
• To successfully manage your bodies physical reaction to attacks of panic, anxiety and worry
• To confidently communicate your thoughts and your feelings to others
• To understand, manage and cope with challenging people and unhealthy relationships
• It can improve your self-awareness.
• How to Improve your mood and reduce the symptoms of depression
• Decrease maladaptive behaviours
• It can enhance your interpersonal relationships.
• It can help you process and reduce feelings like shame, guilt, insecurity, or defensiveness.
• It can assist you to confidently express yourself and how you feel.

Most clients notice a decrease in their symptoms within three to four weeks of therapy if they have been faithfully attending sessions and doing the suggested assignments between sessions daily. They also see the scores on their objective tests begin to drop within several weeks.

Are There Limitations to CBT?

CBT may not be appropriate for all people in all situations. Its structured nature and requirement for active client participation in session and at home, may present difficulties in people with learning difficulties, or people carrying the residue of unhappy schooldays. The self-reporting inventories that clients complete during the CBT assessment stage may be open to understatement or overstatement of the client’s subjective levels of distress, particularly in the case of depression.  Additionally, CBT’s time limited approach, and the narrow focus on current problems and symptom reduction, consequently may not address deep underlying causes of emotional distress or a mental health condition.