Cognitive Behaviour Therapy is a short term evidence based therapy that explores the links between the way we think, feel and behave. It encourages patients to identify and challenge their negative thoughts, and to change negative behaviour patterns that can lead to feelings of anxiety or low mood. CBT is recommended by NICE (National Institute for Health and Care Excellenceas) the treatment of choice for a variety of problems including anxiety, depression, panic, phobias (including agoraphobia and social phobia), stress, bulimia, obsessive compulsive disorder, post-traumatic stress disorder, bipolar disorder and psychosis. CBT may also help if you have difficulties with anger, self esteem or physical health problems, like pain or fatigue.
CBT can help you to change how you think (‘Cognitive’) and what you do (‘Behaviour’). These changes can help you to feel better. Unlike some of the other talking treatments, it focuses on the ‘here and now’ problems and difficulties. Instead of focusing on the causes of your distress or symptoms in the past, it looks for ways to improve your state of mind now.
A CBT psychotherapist will helo you to learn to make sense of overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you. For example:
All these areas of life can connect like this:
There are helpful and unhelpful ways of reacting to most situations, depending on how you think about it. The way you think can be helpful – or unhelpful.
For example:
Situation: You’ve had a bad day, feel fed up, so go out shopping. As you walk down the road, someone you know walks by and, apparently, ignores you. This starts a cascade of:
| UnHelpful | ||
| Thoughts: | He/she ignored me – they don’t like me | He/she looks a bit wrapped up in themselves – I wonder if there’s something wrong? |
| Emotional: Feelings | Low, sad and rejected | Concerned for the other person, positive |
| Physical: | Stomach cramps, low energy, feel sick | None – feel comfortable |
| Action: | Go home and avoid them | Get in touch to make sure they’re OK |
The same situation has led to two very different results, depending on how you thought about the situation.
How you think has affected how you felt and what you did. In the example in the left hand column, you’ve jumped to a conclusion without very much evidence for it – and this matters, because it’s led to:
- having a number of uncomfortable feelings
- behaving in a way that makes you feel worse.
If you go home feeling depressed, you’ll probably brood on what has happened and feel worse. If you get in touch with the other person, there’s a good chance you’ll feel better about yourself.
If you avoid the other person, you won’t be able to correct any misunderstandings about what they think of you – and you will probably feel worse.
This ‘vicious circle’ can make you feel worse. It can even create new situations that make you feel worse. You can start to believe quite unrealistic (and unpleasant) things about yourself. This happens because, when we are distressed, we are more likely to jump to conclusions and to interpret things in extreme and unhelpful ways.
CBT will help you to break this vicious circle of altered thinking, feelings and behaviour. When you see the parts of the sequence clearly, you can change them – and so change the way you feel. CBT is a goal-orientated therapy and requires individuals to be an active part of therapy engaging in task between therapy sessions. The ultimate aim of CBT is to get you to a point where you can ‘do it yourself’, and work out your own ways of tackling these problems.
