“All that we are is the result of what we have thought”
The Buddha's teachings on the nature of thought and the reasons why people suffer could be seen as at the heart of the theory of CBT.
CBT is based upon the relationship between our thoughts and emotions and our behaviours and physical sensations. Our perception and interpretation of the events and experiences that occur in our lives define our mood and emotional state. These interpretations are made through a constant stream of thoughts and images many of which occur at a level of which we are barely aware.
For example, thoughts related to the future of bad things that might happen, the familiar ‘what if’? scenario typically lead to feelings of fear and anxiety. Thoughts that focus on things that we regret about the past or things that we have ‘lost’ may cause feelings of sadness and characterise depressive states. The idea that something is unjust or unfair or that we have been wronged in some way can result in feelings of anger.
It is not only the connection between thought and emotion but physical sensations and behavioural responses that are also playing their part in the emotional difficulties we get caught in. For example, the perception of threat and danger in anxiety causes a powerful physical response through the release of the stress hormones, adrenaline and cortisol that often results in the ‘fight or flight’ response. Such a response equally comes into play when we feel angry. When we feel anxious we avoid the situations we feel afraid of but this has the effect of never allowing us to discover that there might in actuality be no danger.
CBT is a form of psychotherapy that supports you to look at these four elements. There is a strong focus on how you think about the things that are going on in your life – so there is an emphasis on exploring your thoughts, images, beliefs and attitudes, in other words your cognitive processes. This is examined in parallel with how they are influencing your physical self, your behaviour and lifestyle so you can think about changes that you might like to make. Often books and therapists talk about CBT as a treatment that helps you to think more rationally. I prefer not to describe thoughts as ‘irrational’. All of us have such thoughts and they have often developed as a consequence of our earlier experiences and as a way of coping with distress. It is perhaps more important to consider how thoughts can at times be harmful by keeping us awake at night and avoiding fully engaging in the life that we would choose.
What Happens in Therapy?
The first session is an opportunity for us to discuss the difficulties you have been experiencing and how they have been affecting you. As well as exploring the present it may feel important for us to talk about your background history and earlier life experiences in order to gain an understanding of how they might have shaped you as a person. We can then agree the areas you would like to work on during therapy.
As therapy progresses the sessions are tailored towards the goals we have agreed. We may observe the thoughts, emotions, physical sensations and behaviours that occur in aspects of your daily life that maintain feelings of distress. We may explore new patterns of perceiving and responding to experience both in the inner and outer world. These elements of therapy may harmonise well with both mindfulness and compassion focused approaches. As the session ends we may agree together things you would like to work on before we meet again.
CBT is a collaborative therapy, the therapist is not the ‘expert’ but perhaps someone who guides and facilitates clients to develop a deeper understanding of their problems and teaches skills that contribute to emotional resilience that will stay with them after the therapeutic relationship ends.
Sessions typically last 50 minutes and are held weekly.
How effective is it?
CBT is a widely researched therapy with many clinical trials undertaken that have demonstrated positive outcomes in relation to the relief of existing symptoms and also the prevention of further episodes.
The National Institute for Health and Clinical Excellence recommends CBT for a wide range of mental health problems. Nice Clinical Guidelines can be found http://www.nice.org.uk
What can CBT help with?
- Panic attacks
- Social anxiety
- Generalised anxiety and worry
- Obsessive compulsive disorder (OCD)
- Health anxiety
- Body dysmorphic disorder
- Post-traumatic-stress disorder (PTSD)
- Bipolar disorder
- Binge Eating and Bulimia
- Sleeping problems
- Low self esteem
- Chronic Fatigue Syndrome
- Chronic Pain and Long Term Conditions