Cognitive Behavioural Therapy

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What is CBT?

Learn about what is CBT, what you might expect from engaging in CBT and what will be expected of you

Negative Cycles

Learn about how your thoughts, feelings, behaviours and bodily responses are all connected and can lead to a negative cycle

How to get the most out of CBT

Some tips and advice on how to get the most out of CBT so that you can gain the most benefit

What is Cognitive Behavioural Therapy?

(Please note: This information is very similar to the “what is CBT” handout on the resources page. If you have already read over that, you can skip this! Or if you haven’t, you can jump over to the resources page to download a PDF. copy of the information below!)

What is CBT?

Cognitive behavioural therapy (CBT) is a talking therapy that can help you manage your problems by changing the way you think (cognitive) and act (behavioural). It is a scientific, evidence-based approach recommended by the National Institute for Health and Clinical Excellence (NICE) – who provide national guidance and advice to improve health and social care – to treat a wide range of psychological issues. It is most commonly used to treat anxiety and depression, but can be useful for many other mental and physical health problems.

CBT is not about denying that real problems exist, nor is it simply an exercise in positive thinking. CBT involves teaching new skills which enable individuals to re-evaluate negative experiences, taking in all available evidence and produce a wider range of options available to deal with problem situations. The overall aim of this form of therapy is to investigate the real problems you are experiencing now and look, in detail, at how these problems can be better understood and effectively managed.

How does it work?

As human beings, our minds are very ready to notice cause and effect and we frequently give meaning to events that are happening around us. For example, if you let go of an object it will fall to the floor or if we hear an ambulance we might think it means that someone has been hurt. The rules of cause and effect become so natural to us that it feels like common sense, but this simple ‘cause and effect’ way of thinking doesn’t apply very well to our feelings.

Our ‘common sense’ way of thinking about the world tells us that certain situations make us feel a certain way. But if events always led directly to feelings then everybody would be affected in the same way. Yet, we know that isn’t the case. Indeed, if you asked a group of people to sing in front of an audience some would feel excited whereas others would be horrified. Clearly things are not as straightforward as they seem.

CBT suggests that it is not an event itself that bother us but instead the way we interpret events that gives rise to our feelings and determines how we respond. We often don’t realise that two people can give two very different meanings to the same event, and that the way we interpret an event is not always accurate, realistic or helpful. You can see from the example below how the same situation led to two very different results depending on how you thought about the situation.

Event: A friend walks past you in town but doesn’t say hello

Unhelpful Helpful
Thought They Ignored me. They must not like me. They look like they are in a rush and must not have seen me
Emotion Low, sad, and rejected neutral and content
Physical Stomach cramps, low energy, feeling sick None – feel comfortable
Behaviour Go home and avoid them next time you see them Go about your day and let them know you saw them next time you see them.
Result Your day is ruined, you feel low, lose contact with your friend, leads to more thoughts where you start to wonder if other people also don’t like you. You keep going about your day, you talk to them next time you see them and end up going out to lunch together to catch up

 

Event: A friend walks past you in town but doesn’t say hello

Unhelpful Helpful
Thought They Ignored me. They must not like me. They look like they are in a rush and must not have seen me
Emotion Low, sad, and rejected neutral and content
Physical Stomach cramps, low energy, feeling sick None – feel comfortable
Behaviour Go home and avoid them next time you see them Go about your day and let them know you saw them next time you see them.
Result Your day is ruined, you feel low, lose contact with your friend, leads to more thoughts where you start to wonder if other people also don’t like you. You keep going about your day, you talk to them next time you see them and end up going out to lunch together to catch up

 

Event: A friend walks past you in town but doesn’t say hello

Now, it could be that your friend really did ignore you because they didn’t like you. However, it might also be true that this reflects a tendency to expect the worst and to be critical of yourself, and that the unhelpful thought may not actually be based on much evidence. Similarly we might have had a different chain of thoughts, feelings, behaviours and physical responses if you thought they were being rude, or if you were worrying you had done something wrong to upset them (maybe have a think about what different emotions, physical responses, behaviours and results you might have in those situations). As we can see, these unhelpful thoughts lead to unpleasant emotions and unhelpful behaviours (e.g. avoidance) that then reinforce our negative thoughts and maintain the problem. 

This is because CBT is based on the concept that your thoughts, feelings, physical sensations and actions are interconnected, and that negative thoughts and feelings can trap you in a vicious cycle that make you feel worse. You can see from the example below how these are all connected, where in the situation of an upcoming job interview the thought ‘this is hopeless’ may have lead to the behaviour of avoiding preparing, when then makes you feel anxious and your heart race, which leads to the thought that you won’t get the job and that you’ll make a fool of yourself, which leads you to cancel the interview, and makes you feel sad and you get a heavy feeling in your chest.

CBT involves learning new skills to manage your symptoms and break this cycle. It teaches you new ways of thinking, managing your worries, and behaving, that will help you to manage the current difficulties you are facing. Because how you think, feel, behave and how your body responds are all connected, changing how you think and act will also make you feel better and reduce the physical symptoms of low mood and anxiety.

What are the principles of CBT and What can I expect in sessions?

1. CBT focuses on the here and now

An important principle of CBT is that treatment involves dealing with the symptoms or difficulties that you are struggling with right now, rather than focusing on the cause of your anxiety. For example, imagine that you are scared of dogs. Every time you see them you run the other way because you are convinced that all dogs are dangerous and will bite you. The cause of this fear may be because you are bitten by a dog when you were a child. Knowing that this was the cause of you fear doesn’t change the fact you are scared of dogs, but, the fact that you currently avoid dogs, and probably have since you were a child, maintains this problem because you aren’t able to learn most dogs are friendly and you will likely be perfectly safe. However, it can sometimes be useful to understand how your problems developed as this can help you to understand why you feel or behave in the ways you do and it can help us to understand what is maintaining your difficulties.

2. CBT is structured and educational

CBT sessions involve learning new ways to think about and understand you symptoms, developing new skills, and practicing these skills. Because of this, sessions are structure so that you are usually reviewing the skills you have been practicing between sessions (homework), learning new information and skills, and then developing a new homework assignment for the next session.

3. CBT is collaborative

Because you are learning new skills in CBT, therapy is very active. Both you and your therapist will be working on helping you to understand your symptoms and ways to manage them. You can expect to participate with in and out of sessions in order to see positive change. When it comes to CBT, you get out of it what you put in. If you don’t put your best effort into managing your own anxiety, you probably won’t get as much benefit from CBT as you could.

4. CBT is time-limited

CBT is not meant to be life-long process. Rather, you are learning to become your own therapist. All of your problems might not be resolved by the end of the process, but you will have learned the skills to better manage these difficulties, and to face new challenges. CBT sessions are typically between 6-12 sessions that each last between 45-50 minutes. That is why it is important to make the most of each session and practice homework between sessions.

5. CBT emphasizes the importance of homework

Homework is a key component to CBT. Homework for CBT means that between sessions you will need to practice the new skills that you are learning and apply them to your daily life. You need to commit yourself to the process to get the most from it. CBT is a skill, and unless you practice the new strategies that you learn to manage your mood and anxiety, you might not use them very well, you might think that they do not work if they haven’t been given a fair chance, and you might not be able to use them when you need them the most: when you are feeling anxious or low. You will need to practice them every day if you want them to become part of your daily routine and to see positive changes. The good news is that the more you use your CBT skills the easier it gets and the better you will become at managing your anxiety

 

How can I get the most out of sessions?

1. Keep a folder

Keeping a folder of all the resources you are given in therapy can be useful for a number of reasons. First, it stops resources from getting lost or forgotten about and helps to keep everything in once place so that is on hand and easy to access when you need it. Second, having a folder of resources can also help to remind you of all the tools and techniques that you have available to you. As we go through the sessions, you may find that you forget about some earlier techniques if you have not been practicing them regularly. With a folder, you can sit down and go through the resources you have been given to remind yourself of different tools or to pick what ones best suit your current difficult. Lastly, keeping a folder can be of great benefit after you treatment has finished so that you can continue to have the resources on hand and available to use in your day to day life, or as a reminder, as and when needed.

2. Take notes in the session or after the session

Often times, a lot is discussed within therapy sessions and sometimes what is discussed can be quite difficult or emotion. Because of this, you might forget all or some of what has been said or what is expected of you between sessions. It might therefore to take some notes within the session itself, or to take some notes after the session has ended whilst it is still fresh in your mind. Having a diary might also be useful to write down when you will do the things that have been discussed within the session.

3. Write down the take home message from each session

Taking some time at the end of the session to reflect on what stood out to you, what you found most helpful, or a key message that you took away from that session can be a great way to aid your learning and memory, and make sure that you understood the task or information provided. Having a key message from each session can also be useful at the end of treatment so that you can look back and remind yourself of what you have learned. We might do this together to begin with, and later you might do this on your own.

4. Do the homework

Homework is one of the most important parts of therapy. In CBT we focus on using evidence based techniques, but it is only in the practice of these that you will learn what works best for you. Even if you think it might not work for you, or if it does not work initially, we know that these techniques can be effective and often need to be repeated in order for you to experience the benefit. Be prepared to practice and repeat a task for at least a week or two to see what benefits you experience. If you are not able to do a homework tasks as set out, you might be able to problem solve the barriers you face to enable you to complete these effectively (e.g. changing the day of a task), or we may be able to do this together.

5. If you don’t understand something then don’t be afraid to ask, or if something is wrong don’t be afraid to tell us

Throughout the process you should be able to understand what you are doing, and the rationale behind why you are doing it. If at any point you don’t understand something or if you have any questions then don’t be afraid to ask. This is really important to keep you motivated and engaged, to be able to complete the tasks properly, and to be able to then apply them to new and novel situations after therapy has finished. We want the best for you, so are happy to explain or break things down. We also want you to be able to tell us if we are going on the wrong path or have misunderstood you. You are the expert in your experiences and will know yourself better than we will ever know you, so please let us know or correct us – we are happy when you do this as it helps us to understand you better!

What are the advantages and disadvantages of CBT?

Cognitive behavioural therapy (CBT) can be as effective as medicine in treating some mental health problems, but it may not be successful or suitable for everyone.

Some of the advantages of CBT include:

  • It may be helpful in cases where medicine alone has not worked
  • It can be completed in a relatively short period of time compared with other talking therapies
  • The highly structured nature of CBT means it can be provided in different formats, including in groups, self-help books and apps 
  • It teaches you useful and practical strategies that can be used in everyday life, even after the treatment has finished

Some of the disadvantages of CBT to consider include:

  • You need to commit yourself to the process to get the most from it – a therapist can help and advise you, but they need your co-operation
  • Attending regular CBT sessions and carrying out any extra work between sessions can take up a lot of your time
  • It involves confronting your emotions and anxieties – you may experience initial periods where you’re anxious or emotionally uncomfortable – sometimes people find that things might get worst for a short while before they get better
  • It focuses on the person’s capacity to change themselves (their thoughts, feelings and behaviours) – this does not address any wider problems in systems or families that often have a significant impact on someone’s health and wellbeing

Videos

The videos below give a brief overview of what we have covered, looking at what CBT is, and what we call the “hot cross bun” model, as you saw in the picture above  looking at how our thoughts, feelings, behaviours and physical responses interact (because when you put it all together it looks a bit like a hot cross bun!) Some people prefer learning by video, but if you can, try to still read some of the information above, and use the videos to help you understand anything you have missed. There are also lots of videos on YouTube if you want to keep looking on there!

Disclaimer

The activities, tools, and information found on this website are in no way a substitute for care provided by a trained professional. Please seek help from your GP or a licensed professional if you believe you may be suffering from any mental health difficulties. If you are unsure on if any of these tools are right for you or how to best implement these, please be sure to consult or discuss with a professional about your concerns.

If you are in crisis please contact your GP or the Samaritans on 116 213
Please go the resources page for a full list of the resources available

CALL 999 or go to A&E
If someone’s life is at risk (e.g. they have seriously injured themselves or taken an overdose) or if you do not feel you can keep yourself or someone else safe. A mental health emergency should be taken as seriously as a physical one. You will not be wasting anyone’s time.

 

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Contact your GP

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Ways to Cope

 Exercises and tools
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