An introduction to cognitive behavioural therapy
Due to its growing popularity Cognitive behavioural therapy (CBT) has become a buzz word over the last decade. This is a good thing, as CBT is the most researched form of psychotherapy and has been shown to delivery positive outcomes. Many potential clients are searching for “CBT therapy Melbourne”, but what does CBT actually involve? In this article we’ll briefly look at the background of CBT and give an overview of the model. We hope this will help readers understand the process, what to expect from a CBT therapist, and whether this form of therapy is right for them.
Cognitive behavioural therapy was created by a gentleman named Aaron Beck in the 1960’s. Beck was working with a case load of clients as part of his research as a psychoanalyst before having some interesting revelations. Instead of assuming his client’s emotional reactions and experiences were based on unresolved issues from childhood or from conflicts due to the “unconscious” mind, which was taught by the psychanalytic approach, Beck did something very radical for the time.
He began asking his clients what they were thinking.
Beck recalls having an experience with a female client who was disclosing her sexual exploits during a session. After disclosing her endeavours, Beck noted she looked visibly uncomfortable (experiencing an emotional shift). Using the classic psychoanalytic model, Beck went on to explain that her uncomfortable feeling was due to childhood sexual repression. She responded, “I was actually just thinking that I was boring you”.
A revelation had begun.
Instead of assuming unconscious motivations and repressions, Beck started collecting data on the thoughts his clients were having in sessions. In doing so, he began to see some very interesting patterns in the negative thinking styles of people with depression, which led to a very important revelation: if you could change the way a person thinks, you could change the way they feel and behave. The cognitive model was born.
The cognitive model is what underpins the process of CBT and is crucial to understand for anyone, therapist or client, working with the model. The cognitive model states that:
It’s not the situation that creates our experience (emotions and behaviours) it’s the way we perceive the situation (how we think about it) that dictates our reaction.
Even though we often blame the situation, or other people, for making us feel a certain way, the cognitive model should actually be very intuitive. Think about it this way – if we did an experiment by putting 100 people in the same situation, this could be anything from going to a party, waiting in a psychologist’s clinic, going for a job interview etc., there would be a large spectrum of variation in what all these individual’s experience. Some would be happy at the party, some would be sad, some would be very anxious. Therefore, to understand an individual’s experience (why they are feeling a certain way and/or performing a certain behaviour) we have to understand how they are forming their perspective (what they are thinking at the time). If we had a thought bubble appear over the heads of these people in the experiment that noted their thoughts, it is guaranteed their emotional reaction would make sense.
In the CBT model, one of the major traits that characterise common disorders like anxiety and depression, are distorted/negative beliefs, which heavily influence how an individual perceives certain situations. Hence, if we can assist someone is challenging and modifying their thoughts and beliefs, we can change the way they feel and behave (feel less depression, be more active etc.).
That being said, cognitive restructuring is only one aspect of CBT. There are many different interventions that have been added to the CBT tool kit, falling under cognitive or behavioural categories. Here are some examples:
This is a very simple yet powerful technique, particularly when it comes to depression. When experiencing a depressive spiral, it can seem insurmountable to know where to start. In general, it can be very difficult to change negative thought patterns and/or emotions, but nothing technical is stopping us from performing a behaviour, regardless of the occurring thoughts and emotions. Accordingly, behavioural activation relies on increasing/scheduling positive behavioural as a first step for reversing the negative spiral.
In the course of depression and other disorders, individuals may experience negative thinking styles, which can influence beliefs about themselves, others and situations in the world. For instance, an individual with depression might believe that no one in their work place wants to talk to them and they are being ignored. A behavioural experiment is when the therapist helps set a task for client which will test their belief/assumptions. In this case, the client might attempt to talk to a number of co-workers to observe the reality of the situation, and not rely on their initial evaluations.
One of the hallmarks of anxiety is avoidance. The more an individual avoids something (i.e., social interactions) the scarier it usually becomes. Exposure therapy assists clients in breaking patterns of avoidance by gradually exposing to certain stimuli they may be afraid of. This is done is a systematic, gradual way that teaches clients to face their fears and develop the tools necessary to inoculate to the resulting anxiety.
As stated above, the cognitive model works to identify and modify negative thoughts and beliefs, which help alleviate negative emotions and behaviours. This is referred to as cognitive restructuring – and thought records are the main intervention used to achieve this outcome. In brief, thought records aim to teach clients to gain insight into the link between their thoughts, emotions and behaviours, by examining automatic thoughts that arise when in response to particular situations. The thought record sheet teaches clients to examine the validity of their thoughts while identifying patterns in thinking that may be perpetuating their problems.
One of the simplest places to start in therapy is often psychoeducation. This can provide clients with information regarding their presenting problem, helping them make sense of their experience, symptomology etc,
There are many more interventions within the CBT toolkit, but hopefully this provides some preliminary information of what CBT comprises, and assists those looking for a cognitive behavioural therapist in Melbourne.