What is Cognitive Behavioural Therapy?

What is Cognitive Behavioural Therapy?

Cognitive Behavioural Therapy (CBT) is one of the few forms of psychotherapy that has been empirically tested, in hundreds of trials, and found to be moderately or highly effective for the treatment of many disorders including: depression, generalised anxiety disorder, post-traumatic stress disorder, panic disorder, agoraphobia, social phobia, obsessive-compulsive disorder, general stress, anger, eating disorders, marital difficulties, early psychosis, chronic pain conditions and childhood anxiety and depressive disorders.

CBT is appropriate for children, adolescents, adults, families and couples.

CBT is time-limited, problem-solving oriented, and focused on the here and now. Building trust and rapport, and working with the client collaboratively are integral to the success of CBT.  It aims to teach skills that clients can use for the rest of their lives. The skills involve learning to be aware, identify and modify false thoughts and beliefs, and change habits of behaviours to live consciously and more truly aligned with the client’s real values.

The three levels of focus are awareness (mindfulness), thoughts and beliefs (cognitions) and behavioural change (behaviours), ie the title that I prefer is “Mindfulness based Cognitive Behaviour Therapy”. 

What is the theory behind the CBT model?

The way we perceive situations determines how we feel emotionally.

People’s behaviour always makes sense once we know what they’re thinking and believing.

For example, one person reading this may think, “Wow, this sounds great. I can do that!” and feel empowered and happy. Another person reading this might think, “Well that sounds easy, but I don’t think I can do that” and feel discouraged, sad and helpless.

So it is not the situation as such that directly affects how a person behaves emotionally, but rather their thoughts and beliefs in that situation.

When people are upset or suffering negative emotions, their perspective is often inaccurate and unrealistic. They are upset not for the reason they think.

In other words, it is false thoughts and beliefs that cause emotional suffering.

I think this is very good news. It is your thoughts and beliefs rather than the situation that determines your emotional well-being. You are the change. You are responsible. It is the opposite of what we have been taught and it puts the client in the driver’s seat, no longer the victim of other people, situations and circumstances. We can take responsibility for our part and learn skills to reduce suffering. It works.

Emotional distress acts as the alarm clock to wake up, to examine what we are thinking and believing in the moment, to identify the distressing thoughts, to write them down, to evaluate how true/realistic the thoughts are, to let go of thoughts that are untrue and not serving us, and to feel better. Alternatively, if the person, situation or circumstance is harmful, we can choose to take action, alter our behaviour or move out of the way. The power is with you. You are the change.

It is all too easy to blame others, the situation or the circumstances. However, it is unhelpful because if I am a victim, I am not responsible for the problem and I am waiting for something in the world to change to fix it. I feel helpless and hopeless. This does not work and keeps you in suffering.

Techniques of CBT

Socratic questioning (named after the philosopher Socrates) is at the heart of cognitive therapy and is a disciplined technique for questioning thoughts and beliefs in many directions to get to the truth, to distinguish what we know from what we do not know, to uncover assumptions and to follow logical consequences of believing thoughts. It is based on the foundation that thinking has structured and consistent logic.

Socrates said, “The unexamined life is not worth living”

The steps involved:

  1. When you have a negative emotion, try to get a handle on the thoughts and images in the moments before.
  2. Write down the raw thoughts. Make them concrete. For example, my husband does not love me anymore or he lied to me.
  3. Question the veracity of these thoughts? Is it true? Do you absolutely know this? What is the evidence (for and against)? What is the impact of believing this thought – how do you react? What is likely to occur in the event? Is this something within my control? Is the thought bringing me peace or suffering? Is this thought worth keeping?
  4. What is important in this process, is that you go inside and truly ask yourself, meditate and reflect on your own answers because it is not what other’s believe but what you yourself truly believes that matters.
  5. Under investigation, many thoughts simply drop away as not true or not serving us. The analogy is often made to a snake and a rope. If you see a snake in your path you are terrified with fear but once you investigate and realise it is not a snake but a rope, you will never fear it again. Once the thinking is undone, it is undone forever.

Cognitive therapy is ultimately about undoing conditioned thoughts, beliefs and assumptions that direct our behaviour but which are ultimately false and not serving us. Once these assumptions are removed, the faith or power that was invested in these beliefs returns to you and you are left with a clearer quieter mind. In this way, we untangle and de-clutter the mind to bring lightness, clarity, space and peace. It is the de-conditioning or the undoing of the mind made suffering.

If you examine more deeply the mechanics of the mind, we have indeed many conditioned habitual ways of thinking and believing that ultimately are self-defeating, not serving us and giving rise to unnecessary suffering, such as

  • Worrying, projecting and catastrophising about the future that something bad will happen.
  • Thinking/ruminating about the past.
  • Worrying about what is out of your control or realm of responsibility (including worrying what others think and seeking other’s approval).
  • Judging, criticising, making wrong other people, situations and circumstances.
  • Self-persecution and self-critical thoughts – any form of non self-acceptance and seeking happiness out of the self.
  • Requiring certainty – the need to know for sure which is not possible.

Eckhart Tolle (2017) has said that 80-90% of thinking is in fact repetitive, useless and harmful because of its often dysfunctional and negative nature. This kind of thinking is like an addiction because it has a false sense of pleasure that invariably causes pain and suffering, and due to its compulsive nature we have no choice to stop it. [1]

Clearly, there is a strong argument for culling and streamlining our thinking patterns to reduce suffering and ultimately towards quietening the mind and bringing greater clarity.

What is the relationship between mindfulness, cognitive therapy and behavioural modification?

Mindfulness is about becoming the witness, watching yourself continuously, watching your thoughts and watching your actions. To bring conscious awareness moment to moment to what you think and do.

Socratic questioning is a technique of investigation to weed out the thoughts and beliefs that are not true and do not serve us. The end game is to slow and quieten the mind.

The third component is behavioural modification. It is the behaviour, action or practice side of the equation focusing on responding in new ways, not avoiding, taking responsibility for your part, finding a voice, expressing your needs, asking when you do not know, systematic exposure to gain confidence, not sacrificing yourself, being yourself, and so forth.

[1] [1] https://upliftconnect.com/eckhart-tolle-how-to-rise-above-thoughts/