What is Cognitive Behavioural Therapy?
Cognitive Behavioural Therapy (or CBT for short) isn’t all that complicated, or at least it shouldn’t be. It’s a goal orientated, evidence based therapy, which basically means it works towards targets decided collaboratively between the client and the therapist, and it has been proven to be effective. CBT tends to focus initially on the present and the problems which are causing difficulty in our lives, as these are the most pressing issues.
By incorporating our environment, thoughts, emotions, behaviour, and physiology (physical sensations), we can best determine how to work to alleviate the difficulties we are having. It aims to be time limited, with a structured approach that can be directive and active, so it tends to be much more hands on and solution focused than other therapies.
Cognitive Behavioural Therapy can be seen as a common-sense approach that has at its foundation two basic ideas:
1) Our thoughts have a huge influence on our emotions and behaviour
2) our behaviour can strongly affect our thought patterns and emotions.
The connection between how we feel, think and behave is so strong that if we could only change how we think and behave, we would influence our feelings.
It is not what happens to us, but how we think about what happens to us that matters.
This, for me, is the most important concept of CBT. Our reaction to a situation tends to happen instantly. So, if two people receive negative feedback on a job they are doing, one person might think:
“Ok, I need to take a look at how I am doing this, maybe seek help, or tweak a few things, then I’ll be back on track”,
Whilst the second person might think:
“My boss thinks I’m incompetent. I knew I wasn’t good enough for this role, and I’d be found out one day. I could lose my job”.
These thoughts we have are called automatic thoughts, and with anxiety, they are usually negative, and occur outside our conscious awareness, which means they just pop away in the background, without us really realising what we are doing. Although they can be background noise at times, they have a massive effect on how we feel. In the above example the first person will probably have a proactive approach, and find a solution to the problem. The thinking of the second person makes this so much more difficult, and they may isolate, procrastinate, and worry about the situation, making the problem more difficult to solve. This was all down to the irrational belief about the situation. Although negative feedback may never be easy to take, how we think about it can make all the difference to how we feel about it, and what we do to overcome the problem.
Thinking can become excessive or harmful, with people often seeing themselves as worthless, useless, failures, or weak and helpless
CBT for anxiety enables us to recognise what we are thinking about a situation, challenge any negative thoughts that arise, and come up with a more rational thought. Thinking can become excessive or harmful, with people often seeing themselves as worthless, useless, failures, or weak and helpless. CBT is certainly not about positive thinking, but instead, trying to get balance into how we react to a situation, and how we see ourselves, using the evidence around us.
The Role of Behaviour
With anxiety, our behaviour can also cause difficulty, and often contribute to our problems. Poor coping skills, such as avoidance or substance abuse, is often used to ease pain, or escape from a problem, or a feeling. However, in the long run this only leads to more anxiety, as the problem does not go away. If we look at the potential behaviour pattern of the second person in the above example, we can see this at work.
1. A person receives negative feedback in work, and instead of looking for guidance, or reaching out to a colleague for assistance, they isolation, as I think they have been found out as incompetent.
2. Without the help and experience of others their situation becomes more difficult. Their anxiety makes the situation which harder to fix and they begin to procrastinate as I don’t know where to start.
3. Negative irrational belief: “I’m not good enough for this role. I will be found out. Everyone knows I’m incompetent”
4. The standard of the work begins to fall, as they believe they are not good enough at their job and that their boss is now looking for a chance to get rid of them. Anxiety around work now multiplies that they start missing days off sick.
CBT looks to intervene at the behaviour level also, which, in turn, can have a big impact on our thinking and emotions. If we can become aware of our unhelpful behaviour, and learn to change it to more adaptive behaviour, then this can change the whole cycle of anxiety.
One reason why one person may perceive a situation as threatening, and another person may not, is because of core beliefs. Core beliefs, which underlie many of our negative automatic thoughts, are fundamental assumptions and beliefs that we have about ourselves, others, and the world (our environment). They are deep-seated beliefs which often go unrecognised and yet constantly affect our lives, and shape how we see the world. They have a huge influence on how we interpret our experiences, and for someone with anxiety, they can look something like this:
|I’m incompetent / I’m stupid||Other people are harsh and critical||The world is a dangerous / cruel place|
|I’m weird / I don’t fit in||Others have it easy||The world is a lonely place|
|Everyone else is better at their job than I am||Other people are more social||The world is full of selfish people|
|I don’t belong / I’m a loner.||Others are not reliable or trustworthy|
|I’m not attractive / I’m ugly||Others will disapprove and leave me|
|I’m unable to cope / I need other people to help me get by.||Others breeze through life and everything works out for them|
|I’m boring / I’m not a likable person|
Again, going back to the example in this article of the criticism in work, can you see how core beliefs of “I’m incompetent / I’m stupid”, “Other people are harsh and critical”, and “The world is a dangerous place” can be a difficult starting point to deal with this situation? We experience everything through our core beliefs, so it is important to know what we believe about ourselves, others and the world, and CBT can help us do this. CBT can help us change long-held beliefs, or create new, more realistic ones going forward.
In summary, CBT for anxiety has been found to be a very effective tool for addressing the negative thoughts and unhelpful behaviours that create and maintain the anxious emotions. With CBT, we can address anxious thoughts quite quickly, and learn to deal better with anxiety. CBT has specific models to tackle such disorders as General Anxiety, Social Anxiety, and Panic. These skills can be taken out of the therapy room and used in our everyday life, giving us a better awareness of ourselves, and more confidence that we can cope with adversity going forward.