Cognitive Behavioural Therapy (CBT)

CBT is a type of talking therapy that focuses on how your thoughts, beliefs and attitudes affect your feelings and behaviour, and teaches you coping skills for dealing with different problems.

It combines cognitive therapy (examining the things you think) and behaviour therapy (examining the things you do).

 

How CBT Works

CBT is based on the idea that how we think (cognition), how we feel (emotion) and how we act (behaviour) all interact together.  Specifically, our thoughts determine our feelings and our behaviour. Therefore, negative and unrealistic thoughts can cause us distress and result in problems. When a person suffers with psychological distress, the way in which they interpret situations becomes skewed, which in turn has a negative impact on the actions they take.

"A human being is but the product of his thoughts what he thinks, he becomes."

"Your beliefs become your thoughts
Your thoughts become your words
Your words become your actions
Your actions become your habits
Your habits become your values
Your values become your destiny"

Mahatma Gandhi

For example, if someone you know walks by without saying hello, what's your reaction?

You might think that they ignored you because they don't like you, which could make you feel rejected. So you might be tempted to avoid them the next time you meet. This could increase the bad feeling between you both and generate more "rejections", until eventually you believe that you are an unlikeable person. If this happened with enough people, you might start to socially withdraw.

But how well did you interpret the situation in the first place?

CBT aims to break negative thought cycles by helping people to spot problematic ways of reacting, and replacing unhelpful thoughts with more useful or realistic ones. For example, did the person who just "ignored" you actually see you? Were they really just in a hurry?

Making sure your reaction is based on the evidence can be a challenge for people with mental health problems, as their thinking styles can be well-established. When someone is depressed or anxious, negative thoughts often persist, but more positive thoughts are easily forgotten.

Its goal is to change patterns of thinking or behaviour that are behind people’s difficulties, and so change the way they feel. CBT works by changing people’s attitudes and their behaviour by focusing on the thoughts, images, beliefs and attitudes that we hold (our cognitive processes) and how this relates to the way we behave, as a way of dealing with emotional problems.

 “Every bad feeling you have is the result of negative thinking. Self-defeating emotions are caused by negative thoughts, illogical pessimism and strong inner critique. Your emotions result entirely from the way you look at things, by your internal dialogue on a series of events that happen to you. If your understanding of what’s happening is accurate, your emotions will be normal. If your perception is twisted and distorted in some way, your emotional response will be abnormal.”

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Challenging Cognitive Distortions

Cognitive distortions are simply ways that our mind convinces us of something that isn’t really true. These inaccurate thoughts are usually used to reinforce negative thinking or emotions — telling ourselves things that sound rational and accurate, but really only serve to keep us feeling bad about ourselves. 10 of the most common cognitive distortions are:

1. Mental Filter - Mental filtering is when we focus exclusively on the most negative and upsetting features of a situation, filtering out all of the more positive aspects.

Example: You undertake a presentation at work which is complimented and praised by ninety-five percent of the team - but you dwell and focus on the five percent of feedback that you could have done a slightly better job. This leaves you convinced you didn't do well enough and not only don't you recognise and enjoy the praise being offered but you decide not to participate in future events.

2. Disqualifying the Positive - Disqualifying the positive is when we continually discount and dismiss the positive experiences we encounter, by deciding they are unimportant or 'don't count'.

Example: A friend compliments you on a dinner you made, but you decide that “they are just saying that to be nice” or “they are trying to get something out of me”. 

3. 'All or Nothing' Thinking - 'All or nothing' thinking is when we see things purely in 'black or white'. These types of thoughts are characterised by terms such as or 'every', 'always', or 'never'.  Everything is seen as good or bad or a success or failure. It is generally the negative perspective that is endorsed, discounting all the shades of grey that lie in between the two focussed on choices.  

Example: If you get eighty per cent on a test, you feel like a failure that you didn't get a perfect score.  

4. Overgeneralisation - Thinking in an over-generalising way means we will often see a single unpleasant incident or event as evidence of everything being awful and negative, and a sign that now everything will go wrong.

Example: If you fail to get a job you interview for, you decide you are never going to get a job. Or you might go on one unsuccessful date and that is it, you decide you are never going to find a partner.

5. Jumping to Conclusions - An individual who ‘jumps to conclusions’ will often make a negative interpretation or prediction even though there is no evidence to support their conclusion. This type of thinking is often made when thinking about how others feel towards us. It can show up as either 'mind reading' (assuming the thoughts and intentions of others) or 'fortune-telling' (anticipating the worse ad taking it as fact).

Example: You are at a party and you don't like what you are wearing and you decide 'everyone is laughing at me' (mind reading). Or you are going to take your drivers test and 'know' that you are going to fail (fortune-telling).

6. Magnifying or Minimising (also referred to as “Catastrophizing”) - Thinking in a magnifying or minimising manner is when we exaggerate the importance of negative events and minimize or downplay the importance of positive events. In depressed individuals, it is often the positive characteristics of other people that are exaggerated and the negatives that are understated (and then when thinking of oneself, this is reversed). When we think catastrophically we are unable to see any other outcome other than the worse one, however unlikely this result may turn out to be. 

Example: You send out the wrong letter to a client at work, and this turns into “I will now lose my job, and then I won’t be able to pay my bills, and then I will lose my house.”  

7.  Personalisation and blame - A person engaging in personalisation will automatically assume responsibility and blame for negative events that are not under their control. This is also called 'the mother of guilt' because of the feelings of guilt, shame, and inadequacy it leads to.

Example: You feel it's all your fault that your dog injured his foot even though you weren't at home when it happened but were out shopping. Your thoughts might be 'if only I didn't go out' or even 'maybe when I came home I accidentally stepped on the dog and hurt him' even though this is entirely unrealistic.

8. Shoulds and Oughts - Individuals thinking in 'shoulds', ‘oughts; or 'musts' have an ironclad view of how they and others ‘should’ and ‘ought’ to be. These rigid views or rules can generate feels of anger, frustration, resentment, disappointment and guilt if not followed.

Example: You don't like playing tennis but take lessons as you feel you 'should', and that you 'shouldn't' make so many mistakes on the court, and that your coach 'ought to' be stricter on you. You also feel that you 'must' please him by trying harder.

9. Emotional Reasoning - Emotional reasoning is when we assume feelings reflect fact, regardless of the evidence. The idea here is “I feel it, therefore it must be true”.  Such thinking can lead to self-fulfilling prophecies whereby our thoughts can end up eliciting the very behaviour we predicted, just because we changed our behaviour in accordance with that thought. 

For example, if you think “I feel ugly and stupid, so then I must actually be ugly and stupid” you might then stop buying yourself new clothes and start doing poorly at the course you are taking at university, even though you look fine and were doing very well at school.

10. Labelling
Labelling is an extreme form of 'all or nothing' thinking and overgeneralisation.  Rather than describing a specific behaviour, an individual instead assigns a negative and highly emotive label to themselves or others that leaves no room for change.

Example: You make a mistake on a form you filled out and it's sent back to you in the post. So you decide “I'm such a loser” or “I'm so stupid” rather than thinking “I made a mistake as I had a busy day when I was filling this out”.

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What is CBT Successful in Treating? 

There is a great deal of research evidence to show that CBT works effectively in treating depression and anxiety. This research has been carefully reviewed by the National Institute for Health and Clinical Excellence (NICE). NICE recommends CBT in the treatment of the following conditions:

  • anxiety disorders (including panic attacks and post-traumatic stress disorders
  • depression
  • obsessive compulsive disorders
  • schizophrenia and psychosis
  • bipolar disorder

There is also good evidence that CBT is helpful in treating many other conditions, including:

  • chronic fatigue
  • behavioural difficulties in children
  • anxiety disorders in children
  • chronic pain
  • physical symptoms without a medical diagnosis
  • sleep difficulties
  • anger management

 

Disclaimer 

I do not provide medical advice or diagnosis. All therapies provided are not intended to diagnose or treat any particular individual or condition. If you have a professionally diagnosed mental or physical condition, please consult with your registered medical practitioner first. By seeking therapy with MJB Counselling you are agreeing to this Disclaimer.