Are you hijacked by your thoughts? You’re not alone. We think about 60,000 thoughts in any one day, most of which are negative.
These negative automatic thoughts are detrimental to how we live our lives, reinforcing behaviour patterns that don’t serve us well which can lead to experiences of stress, anxiety and even depression. They can also leave us feeling overwhelmed when wanting to tackle and change a habit, fear or phobia.
If you are struggling, then Cognitive Behavioural Therapy (CBT) might be able to help. It has a proven track record for combating conditions such as anxiety, depression, eating disorders, fears and phobias as well as addictions. It can also be used to enhance performance, from public speaking to setting and achieving goals.
What is cognitive behavioral therapy (CBT)
CBT techniques and exercises are a relatively quick treatment taking between 3 to 20 sessions depending on individual needs, most requiring a total of 6. CBT is based on Stoic philosophy, the quote by Epictetus sums it up best – “It is not events that distress men but the way they think about them”.
CBT’s function is to turn a vicious circle of negative thinking, feeling and behaviour into a virtuous one by way of challenging and changing existing thoughts, beliefs and behaviours. Unlike some talking therapies, it doesn’t go into past issues. You won’t be laying on a couch regaling your therapist with all your childhood woes and angst. Instead you and your therapist work alongside each other going on a fact-finding mission to find out what’s going on with your thinking and how it is impacting your life. You are very much like scientific investigators, exploring the what, when and how. This could be done through various means such as active questioning or keeping a thought record.
Once established, the therapy aim is to research, experiment and test alternative thoughts, beliefs and behaviours using tools and techniques to practice in your daily life.
History of cognitive behavioral therapy
CBT originally developed as two independent disciplines. The American psychologist Aaron T. Beck (one of the major players in the field of CBT) worked in the cognitive field. Here, he learned one of the main reasons his clients failed to recover from trauma was not the actual event but the negative thoughts and irrational thinking they had surrounding the event. He reasoned that if their thinking could be changed, so would their response (1). Exploratory questioning, “What, When, How” challenged the clients faulty thinking which changed the original assumptions into more beneficial reasoning.
Russian psychologist, Ivan Pavlov lead the charge in the development of behavioural therapy with his famous experiment on dogs that showed how they could be conditioned to drool at the sound of a ringing bell in the anticipation of being fed. It was deduced that as behaviour is a learned response to stimulus, it can be unlearned, modified and adapted to something more useful (2). When the two disciplines were combined it created a powerful conduit for change.
How do thoughts, feelings and behaviour affect the brain?
Our brains are full of neural pathways – each memory and idea has its own unique path. Every time we do something new, a pathway is created so we can easily access that experience again. This is where CBT can be of huge benefit – by exploring alternative behaviours and thought pattern’s new pathways are created.
Every time we repeat a behaviour the associated neural network is strengthened, the more we repeat a behaviour the stronger the pathway becomes. This is a reason some people find it so hard to quit a habit such as smoking or biting nails. The habit becomes so deeply entrenched that it becomes a challenge to stick to new habit behaviours which is why regular practice and repetition are essential to strengthen the new pathway pruning away the old one.
How does CBT work for anxiety?
Let’s look at CBT in action using a hypothetical scenario most of us have experienced at some stage in life – fear of public speaking, how the fear was developed and how mental and physiological responses developed to reinforce the idea.
Imagine being back at school and in class, your teacher asks you to read a chapter from a book aloud. In the past you have hated it, you have felt yourself go red, you stammered, your words didn’t come out right. You felt embarrassed, you tell yourself you don’t want to speak in front of your classmates ever again. The very thought brings back the past horror which makes you feel uncomfortable, your mind starts thinking, “I can’t do it”, “I will stutter, stammer”, “They will laugh at me”, “It’s going to be awful”. You have that feeling of impending dread at the thought of speaking in front of classmates. You start to experience a physiological effect of your thinking with sweaty palms, heart palpitations, that feeling of unpleasant butterflies in your tummy, your face goes red, you start to tremble and so on.
Your physical experiences start to reinforce your negative belief that you can’t speak in public, and this creates a huge feeling of anxiety. So, the pages of the book shake as your hand trembles, your voice falters, the wrong words tumble out. You think you hear your classmates laugh. The whole experience reconfirms your belief that you can’t speak in public resulting in you doing everything you can to avoid that experience again so much so that when the thought of public speaking flashes across your mind it brings on anxiety. The vicious cycle starts with your thoughts which creates a feeling which then creates the behaviour. Until this cycle is broken it will keep repeating itself compounding your negative experience.
CBT sessions and techniques
During the initial session or the evaluating session, the 'therapeutic alliance' begins. This relationship is key to successful treatment – it is the relationship between client and therapist. The role of the therapeutic alliance is to set tasks and goals and to develop a trusting bond. A good working bond between therapist and client is essential. The client must trust that the therapist has the best interest of the client at heart and the therapist has to trust that the client will take all the agreed actions and steps towards achieving their goal.
The goal(s) is what the client ultimately wants to gain from their CBT therapy session and the tasks are the steps the client needs to take in order to achieve their goal. For example, overcoming a long-standing fear of spiders might be the clients ultimate goal, and in order to achieve this the client will have to undertake a number of actions which must be mutually agreed and carried out. If the client fails to follow through on their steps, they won’t achieve their goal.
The bond between client and therapist develops over time, and the client must be confident that the therapist will help them achieve their goal and the therapist has to trust that the client is fully committed to achieving their goal. In partnership the two set the session agendas and the tasks and goals for each session, reviewing the results from the previous session at the beginning of a session and reflecting at the end session. This keeps the sessions tightly focused, with clear expectations.
During the evaluating session, goals and the structure of the session are laid out and explained. The presenting issue will then be explored. The aim of the treatment is discussed along with setting the initial goals for the treatment plan. We are all unique individuals and as such the treatment plan is specifically tailored. During this initial stage, expectations of treatment will be discussed to make sure they are realistic and achievable. Your initial cognitive conceptualised treatment plan will be devised. The next session is the 'first' session, and the therapy and work begins in earnest.
Each session has a similar format. At the beginning of the session, the agenda and goals are set. The therapist may do a mood check to see how you are. There is a review of the previous week, discussing what worked and what didn’t, followed by the therapy session. There is an end-of-session summary, the setting of homework, and finally there is feedback. The exact structure of a session will vary depending on individual needs and will change as needs change.
Judith Beck, Aaron Beck’s daughter is carrying on the torch of CBT development. She breaks down CBT into 10 points:
1. CBT is based on an ever-evolving formulation of clients’ problems and individual conceptualisation of each client in cognitive terms.
2. CBT requires a sound therapeutic alliance.
3. CBT emphasizes collaborative and active participation.
4. CBT is goal oriented and problem focused.
5. CBT initially emphasizes the present.
6. CBT is educative, aims to teach the patient to be her own therapist and emphasize relapse prevention.
7. CBT aims to be time limited.
8. CBT sessions are structured.
9. CBT teaches clients to identify, evaluate and respond to their dysfunctional thoughts and beliefs.
10. CBT uses a variety of techniques to change thinking, mood and behaviour.
These principles are like a map, keeping you from getting lost, removing any ambiguity from the client and therapist relationship, putting you in charge of your treatment. This is usually very empowering.
Einstein said the definition of insanity is doing the same thing over and over again, but expecting different results. It’s easy to see how this can happen when you consider our lives are shaped and conditioned by our past experiences which keep us trapped in a negative cycle. Change requires practice, commitment and courage, it isn’t always easy but with perseverance it is possible. CBT gives you the skills and experience to be the master of your own life. Is it time to create a new way to be?
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1. Beck Institute: https://beckinstitute.org/about-beck/our-history/history-of-cognitive-therapy/
2. Simply Psychology: https://www.simplypsychology.org/pavlov.html