CBT – Cognitive Behavioural Therapy
What is CBT, and what is its purpose?
CBT is one most effective therapies backed by scientific research that exists today. It is an effective therapy for people who suffer from anxiety, phobias, stress, & depression.
The CBT triangle shows that all emotions, behaviours and thoughts result from a person’s core belief. From a therapeutic perspective, this is important because how we think, feel and behave are all changeable, whereas an outside stimulus, such as an adverse event, may not be.
The goal of CBT
Help clients uncover cognitive distortions and dysfunctional assumptions. Help change the way experiences are interpreted. As clients become more aware of automatic thoughts, they can, if they so choose, replace them with coping thoughts.
The counsellor’s role in CBT is to:
The counsellor serves as a guide to help the client understand how beliefs and attitudes influence behaviours and feelings.
A catalyst for the client to make changes and learn new skills. They are moving the client from a closed belief system to an open one.
The counsellor’s primary therapeutic device is the use of questions. Homework for the client tests the validity of the behavioural experience.
Now let us look over some of the CBT techniques.
CBT interventions:
Questioning Automatic Thoughts.
1. What evidence is there to support this belief?
2. Are there any alternative explanations?
3. What is the worst-case scenario? Could I live through it?
What is the best-case scenario?
What is the most realistic outcome?
4. What is the effect of my thinking this way?
What could happen if I changed my thinking?
5. What would I tell a friend to do if they were in the same
situation?
Questioning automatic thoughts can help clients. The client can then compare their automatic thoughts about a situation
to a range of other possibilities. The client can then decide if their automatic thoughts are appropriate for the problem.
Listing evidence for and against an automatic thought
The therapist will ask a client what evidence there is from a previous experience to support the automatic thought and what evidence is against this.
The client will gain awareness of the situation and explore if the problem could be interpreted differently. During the process, the therapist must remain neutral and not jump to conclusions about the client’s hypothesis.
When finding evidence against the automatic thought is complex, the therapist may use evidence from their own or others’ experiences with that situation.
Client Self-monitoring of automatic thoughts
A client will record or chart automatic thoughts and shifts in mood. This works best with clients who suffer from anxiety, depression or pain.
By observing the shifts in mood or comfort level, the client will gain greater awareness that the discomfort is not constant.
It is then hoped that the client will be able to move through the period of discomfort with greater ease. This is due to the client’s new perception of pain as having a beginning, middle, and end rather than continuous.
Decatastrophising technique
The therapist and client explore what would happen if the catastrophised situation occurred. These types of problems often include exaggeration and generalisation. The therapist can ask the client about the extent and duration of the case. This encourages clients to be more specific and realistic with their projected outcomes.
Imagery technique
Clients experiencing anxiety often have images that occur shortly before or simultaneously with the anxiety experienced. By discussing the images with the therapist, the client should be able better to understand the images and their reactions to them.
Greater awareness about the images may help the client face any cognitive distortions.
Interpretation
Interpretation helps the client see the situation from other perspectives. The therapist can arrange the interpretation by role play. Getting the client to play someone else in the situation will help the client see different points of view. The therapist may introduce the interpretation through conversation and suggest other ways the data could be viewed and understood.
Homework assignments
Homework assignments can be set (I ask the client if they would like homework) because clients learn through practice and repetition. The client will start to put their new rational beliefs into practice. This will lead to further actions and behaviours. Repetition will help consolidate the new ideas, making the thoughts and actions more comfortable and automatic.
Here are 13 Thinking Traps that lead to negative feelings:
Thinking Traps help people identify cognitions (thoughts) that lead to negative feelings. When we identify our thoughts as thinking traps we can use disputation which is a Rational Emotive Behaviour Therapy technique. Disputation is described above as questioning automatic thoughts.
Self-Dowing – seeing yourself as a failure, unpopular, or unable to cope.
Must/Shouldn’t – seeing yourself and others through laws and rules.
Labelling – seeing yourself and others through one label.
Black and White – All or nothing type thinking.
Blame – Blaming everything on yourself or others.
Mind Reading – Knowing what someone else thinks and feels before asking them.
Fortune Telling – Knowing what adverse event will happen in the future.
Overgeneralisation – If something terrible has happened, it will always happen that way.
Emotional Reasoning – Feeling that something is true without looking for supporting facts.
Jumping to Conclusions – A quick conclusion with little to no information to justify it.
Magnification & Minimization – a person’s achievements are made smaller, while their mistakes are made more prominent.
Mental filter – focusing only on the negative aspects of a situation.
Catastrophizing – believing the situation is much worse than it is.
Learning through teaching
Clients sharing what they learn in therapy with family and friends can help them remember their learnings and strengthen their own rational beliefs.
By learning through teaching, the client becomes aware of areas of their learning, weaknesses, and strengths. This is gained through the levels of difficulty or ease as they teach and answer questions from friends and family members.
Areas of uncertainty can be addressed at the next session with the therapist.
CBT benefits and limitations
CBT helps clients address faulty thought patterns. CBT does not address the past about how and why the client established these thought patterns. Not dealing with the past may give fast and successful results, but does a client feel as whole, secure and integrated as a client who has dealt with their history in therapy?
The CBT therapist has a teaching role without as much value being put on the therapeutic relationship. This may affect the client’s ability to open up and be themselves. Some issues may not be addressed because of the weaker therapeutic relationship.
Even though the CBT counsellor is directive and takes on this teaching role, the client is not forced, and work is done at the client’s pace. The CBT counsellor helps empower the client and remains relational throughout the therapy.
CBT therapy addresses thoughts for clients to experience a change in their emotional issues. CBT requires much effort from the client, and sessions usually have homework attached. CBT Tends to be a short and structured style of therapy.
Glossary – Terms used in CBT and their meanings:
Cognition – The process of thoughts, ideas, images, and how we perceive things in response to an event.
Cognitive distortions – Thoughts which are misleading and may be considered exaggerated or irrational.
Schemata – Our brain’s way of organising thoughts and ideas gives us preconceived knowledge. An example of Schemata is thoughts about what a relationship should be.
Automatic thoughts – Thoughts that come into our consciousness in reaction to an event.
Core Beliefs – This term is interchangeable with Schemata & Schemas; they all mean the same thing.