Cognitive behavioural therapy (CBT) is a talking therapy that can help you manage your problems by changing the way you think and behave.
Thousands of peer reviewed scientific studies show that CBT is effective for a wide range of people and problems. All of the psychologists at Share Resolve have been trained to use CBT. However, some of us prefer to use approaches such as Acceptance & Commitment Therapy (ACT) or Compassion Focussed Therapy (CFT) that build on the foundations of CBT.
What happens during CBT ?
You will be invited to have a session with a psychologist once a week or once every 2 weeks. Each session is normally an hour in length. Depending on the problem it usually takes between 5 and 20 sessions to make a significant improvement.
Unlike some other talking treatments, CBT deals with your current problems, rather than focusing on issues from your past. However, your psychologist may ask some questions about your past if it’s relevant to help you make a change in the present. Everything you tell your psychologist will be confidential (you can read more about Share Resolve’s confidentiality policies here).
During the sessions, you’ll work with your psychologist to break down your problems into their separate parts, such as your thoughts, physical feelings and actions. CBT assumes that your thoughts, feelings, physical sensations and actions are interconnected and that negative thoughts and feelings can trap you in a vicious cycle.
Your psychologist will then be able to help you work out how to change unhelpful thoughts and behaviours. Some psychologists use diagrams and worksheets to do this whilst others will use an approach that will seem more like a natural conversation.
After working out what you can change, your psychologist will ask you to practise these changes in your daily life and you’ll discuss how you got on during the next session.
The eventual aim of therapy is to teach you to apply the skills you have learnt during treatment to your daily life.
This should help you manage your problems and stop them having a negative impact on your life, even after you stop meeting with your psychologist.
How does CBT help?
You do not need to understand how CBT works before you meet with a psychologist. They will explain anything that you need to know. However, if you would like to know the theory behind it we have attempted to explain that below.
CBT is a combination of two other therapy approaches; Behavioural Therapy and Cognitive Therapy. We will start by explaining Behavioural Therapy, then we will discuss Cognitive Therapy and finally we shall see how they combine into Cognitive Behavioural Therapy (CBT).
What is Behavioural Therapy?
Behavioural therapy is rooted in the principles of behaviourism, a school of thought focused on the idea that we learn from our environment. It states that there are two main ways that we learn from our environment; classical conditioning & operant conditioning (the video below gives a good explanation if you’re interested).
The goal of Behavioural Therapy is to reinforce desirable behaviours and eliminate unwanted ones.
Operant Conditioning is more comedically demonstrated in this clip from the Big Bang Theory:
Therapeutic Techniques Based on Classical Conditioning
This approach means pairing an undesirable behaviour with an unpleasant stimulus in the hope that the unwanted behaviour will eventually be reduced. For example, someone with an alcohol use disorder might take disulfiram, a drug that causes them to feel sick when combined with alcohol.
Our page on overcoming fears and phobias explains how to use this approach. In brief, people make a list of fears and then learn to stay in the fear inducing situation. They start with the least fear-inducing item and work their way up to the most fear-inducing item.
Therapeutic Techniques Based on Operant Conditioning
Operant conditioning focuses on how reinforcement and punishment can be used to either increase or decrease the frequency of a behaviour. Behaviours followed by desirable consequences are more likely to occur again in the future, while those followed by negative consequences become less likely to occur.
Behavioral therapy techniques use reinforcement, punishment, shaping, modeling, and related techniques to alter behavior. These methods have the benefit of being highly focused, which means that they can produce fast and effective results.
This approach is often used with children & adolescents who are having behavioural difficulties. A contract is written up between the young person and a parent or teacher that outlines behaviour-change goals, reinforcements, rewards, and penalties. Contingency contracts can be very effective in producing behaviour changes since the rules are spelled out clearly, preventing both parties from backing down on their promises.
This strategy relies on reinforcement to modify behaviour. People are allowed to earn tokens that can be exchanged for special privileges or desired items. It works well in situations where the environment can be controlled, such as prisons and long-term psychiatric or learning disability wards.
People with depression often find themselves doing less and less due to their mood. Unfortunately, the less we do the worse we tend to feel. Behavioural Activation involves helping people to get back to doing activities that could be rewarding and positive for them.
What is Cognitive Therapy?
The key assumption behind Cognitive Therapy is that how we think about an event determines how we feel about it. According to Cognitive Therapy although we tend to attribute our distress to difficult situations, in reality, it is our reactions to situations that are more to blame.
Let’s look at an example. Imagine you saw a friend at the mall and waved at them but instead of waving back they walked straight past you.
If you thought ‘he deliberately ignored me’. You might feel upset and angry.
However, if you thought ‘he didn’t see me’ then you would probably feel fine.
Cognitive Therapy says that some people automatically interpret events like these negatively. They tend to assume the worst. This can lead to emotional problems and difficulties in life.
The reason that people regularly interpret events negatively is because they have negative core beliefs.
Common negative core beliefs for people who are feeling depressed include:
- ‘I’m not good enough’
- ‘I’m weak’
- ‘Nobody likes me’
- ‘I’m a failure’
- ‘The world is cruel’
Common negative core beliefs for people who are feeling anxious include:
- ‘Something bad is about to happen’
- ‘I’m vulnerable’
- ‘Others will try to harm me’
- ‘The world is dangerous’
Our experiences, particularly childhood experiences, shape our core beliefs. For example, harsh critical parenting makes it more likely that we will believe ‘I’m not good enough’.
Despite their strong impact we are often unaware of our core beliefs. Cognitive Therapy helps us become aware of our beliefs and helps us change them.
Therapeutic Techniques based on Cognitive Therapy
Challenging thoughts through Socratic Questioning
Psychologist don’t tell people what to think (it wouldn’t work even if we tried). Instead we use questions to help guide people to re-evaluate their assumptions and discover things for themselves.
To understand Socratic questions it’s best to view a good example of a CBT session. We’ve embedded such a video below (see the video towards the bottom of this page which is titled ‘Downward Arrow’). The psychologist starts the session with some good open questions.
- What comes to mind when you look at this shirt?
- If you were to get rid of the shirt what thoughts would you have?
The Downward Arrow Technique
To make a difference we need to be working on the right thoughts. We need to get to change the deeper thoughts that have the most impact on our feelings and actions. Our example video (see bottom of this page) gives a good demonstration of the Downward Arrow Technique. Note how the psychologist asks the following questions to get to deeper thoughts.
- What would be so bad if you were to throw away the shirt?
- What would be the worst part of that?
Behavioural Experiments to test Beliefs
Sometimes we don’t know the answer to a question because we’ve never tested our assumption. In a behavioural experiment we try to test our assumptions in the real world.
In our example video (see the bottom of this page) you can see how the psychologist sets the experiment up. He establishes what it is that the client fears will happen if she throws away the shirt. Then he asks how certain she is of her prediction. Then they plan how to test it.
What is Cognitive Behavioural Therapy (CBT)?
How do Behavioural Therapy & Cognitive Therapy combine to become Cognitive Behavioural Therapy? The diagram below shows the CBT model.
The CBT model states that our Thoughts, Feelings (/Physical Sensations) and Behaviours are all interconnected. If we can change one of the components then the others should change too.
This also explains why some problems are so hard to change. Sometimes we find ourselves in a vicious cycle where our attempts to solve the problem accidentally make it worse.
Examples of Vicious Cycles:
Depression & Reduced Activity
Worry & Increased Focus
Short-term vs Long Term Rewards
Avoidance & Fear
Therapeutic Techniques in CBT
The CBT uses interventions drawn from either Behavioural Therapy or Cognitive Therapy to change thoughts, feelings or behaviours. We aim to help people to break out of any vicious cycles they have found themselves in.
An example of a good CBT session:
The video below is a really good example of Cognitive Behavioural Therapy. The psychologist uses good Active Listening skills to make sure he has understood what the client means and The psychologist uses Socratic Questions, the Downward Arrow Technique and a Behavioural Experiment to help the client explore their beliefs and change those that they felt were unhelpful.
Meet with one of our Psychologists to explore whether CBT can help you
If CBT sounds like something you would like to explore or if you would like advice and guidance that is specific to your situation you can meet with one of our psychologists.
The psychologist may suggest some other approaches that may supplement or improve on CBT. They will be able to explain which approach should be most effective for you.
Any questions or comments about CBT?
Did you find this article helpful? If you have any questions about Cognitive Behavioural Therapy please write them in comments section at the bottom of this page and we’ll reply to you as soon as possible.
We would also be happy to receive any comments or opinions you may have on this article.
Further Information on CBT …
Listed below are links to other websites and resources that give more information about Cognitive Behavioural Therapy.
If you know of any other websites or resources please let us know in the comments section below so that we can add them to the list.
Aaron Beck developed Cognitive Therapy which later became CBT. This website gives more information about CBT.
Mind is a UK based Mental Health Charity which focusses on the needs of people who use psychological services. Their explanation of CBT aims to be accessible and easy to understand.
The NHS’ pages on Cognitive Behavioural Therapy explain the approach and give some ‘pros’ and ‘cons’ for attending CBT sessions.