Over the past 50 years, cognitive behavioural therapy – or CBT – has become one of the world’s most popular talking therapies. Peeling away the technical jargon, Happiful shows you how CBT works, what it entails, and how it can help with your everyday life
Falling under the umbrella of talking therapies, cognitive behavioural therapy combines two approaches – the cognitive (how we think) and the behavioural (how we act). The theory is quite simple: our thoughts and actions affect each other, so by changing the way we think or act in certain situations, we can change the way we feel.
CBT looks at behaviours we have learned over time, habits we’ve picked up, and negative ways of thinking. The aim is to challenge these habits and behaviours, and ultimately change them to be more positive.
While some talking therapies encourage you to explore your past, CBT is very much rooted in the present, and looks towards the future. Past experience will, of course, be taken into account and considered, but the focus is on your situation in the here and now. The name of the game here is to help you break negative cycles. CBT does this by taking what may feel like an overwhelming problem and breaking it down into smaller, easier to manage chunks.
The therapy is a hands-on approach, with structures, goals and tangible tasks. It requires effort (you’ll even have some homework!), but it’s a collaborative therapy, meaning your counsellor will work with you to find solutions.
The theory is quite simple: our thoughts and actions affect each other, so by changing the way we think or act in certain situations, we can change the way we feel
CBT was founded by psychiatrist Aaron Beck in the 1960s. At
the time, he was working in psychoanalysis – an approach looking at deep-rooted thoughts and repressed memories from childhood. Beck noticed that his patients were having a dialogue with themselves in their heads, but were only reporting a fraction of this back to him. Beck recognised the link between thoughts and feelings, and coined the term “automatic thoughts”. This much-misunderstood term describes the emotion-filled thoughts we have, though we are not necessarily aware of why we have them.
Beck also found that identifying unhelpful or negative automatic thoughts was key to helping clients understand and overcome difficulties. The process was known simply as cognitive therapy, but as behavioural techniques were slowly introduced, it became known as cognitive behavioural therapy.
This rather scary-sounding term describes the inaccurate thoughts that fuel negative emotions. Essentially, they are “faulty” ways of thinking that make us believe things that simply aren’t true. There are many different types of cognitive distortions. Below are just three types that CBT can help to change:
This happens when we blow negative events out of all proportion, or when we expect the absolute worst to happen. For example, if you feel you’ve made a mistake in a personal relationship with someone at work, instead of thinking reasonably, you think your boss will give you a written warning; or worse, you’ll lose your job! And then what?
Filtering is when we ignore all the good things in our day and instead focus on that one tiny negative thing. So, while almost everyone is praising the amazing dinner you prepared, you dwell on that one dry comment about the pudding. Night ruined!
3. Black & white thinking
Also called “polarised thinking”, black and white thinking happens when we fail to appreciate the complexity or nuance of a situation. Someone sent you a vague text? Instead of brushing it off, you ignore the grey and see only black or white. It’s usually black.
This sounds even scarier! Fear not, behavioural action is used in CBT to help reverse your cycles of depression and low moods. It works by encouraging you to engage in “valued activities” – basically, things you love doing. It usually involves the following steps:
Activity and mood monitoring – becoming more aware of your mood fluctuations.
Relationships between activity and mood – understanding how certain activities affect your mood.
Better mood activities – scheduling more activities that improve your mood.
Achievement activities – balancing the activities you enjoy with those you don’t, but get achievement from.
Action before motivation – doing activities even though you don’t really feel like doing them.
Rewards – rewarding yourself for completing activities to keep your mood lifted, and to reinforce change.
Experimentation helps you understand which thoughts and behaviours are helpful in your progress, and which are unhelpful. Behavioural experiments encourage you to test out some thoughts on yourself. For example, you could say: “If I am hard on myself at work, I will be more motivated.” Or you could say: “If I am kind to myself at work,
I will be more motivated.” Here are some examples:
1. Thought Records
This experiment is when you gather evidence for and against certain thoughts. For example, if you had the thought: “My friend doesn’t like me anymore,” then you would think about the evidence for and against this thought (for: she doesn’t reply to my texts; against: she calls me to see how I’m doing). The aim is to come up with balanced, logical thinking.
2. Pleasant Activity
This is all about having something to look forward to. Activities could include meeting a friend for coffee, enjoying a long bath, or even taking a long walk through the park.
3. Imagery Based Exposure
This involves visualising a past negative event (say, an argument with your partner) and identifying your feelings or urges. The aim is to expose you to tough emotions so that you can survive them, thus taking away some of their power.
“I tried counselling previously but felt it didn’t help at all. I’ve been living with high functioning depression and anxiety for the last six years or so, but it was only last year that I came to terms with it, and tried to get some help.
My depression stems from my anxiety, so CBT is helping me to control and understand my anxiety, which helps reduce my depression. I have social anxiety, and currently feel like I’m stuck at the current stage of my life.
CBT helps me to recognise my negative thoughts, to break the habit of these thoughts, and to find a more positive way of thinking. So far, it’s helped me greatly, and I am grateful I’ve had the chance to go through with my sessions. I have almost finished my sessions now and am using the techniques learned daily. I would highly recommend CBT.”
There are lots of different techniques and tools that can be used in CBT, depending on what’s bothering you. Here are a few essentials you’re likely to come across during your treatment:
Progressive muscle relaxation focuses on one muscle group at a time, as you’re instructed to physically relax them. You can practise this at home by listening to an audio recording or following a video online.
2. Interoceptive Exposure
Exposure to bodily sensations (interoceptive exposure), used to treat panic and anxiety, is a technique that requires you to actually feel panic. The aim is to expose yourself to panicky sensations to recognise that they aren’t dangerous.
Once you’ve identified distorted thoughts, you can learn how they took root in the first place. You can then build a structure of more positive and helpful ways of thinking.
4. Honest Communication
Working with your therapist through talking (and journalling outside of sessions), you can recognise which cognitive distortions are actually affecting your thinking.
Writing about your moods and thoughts is an easy way to gather “data” for CBT sessions. You may be asked to keep a mood journal or to note down negative thoughts. This can help you to spot patterns and triggers.
The Pros - CBT can teach you practical coping skills to help you deal with different problems. It can be carried out in different formats: one-to-one, group therapy, or online! It offers a structured and practical way of work.
The Cons - CBT may not be suitable for people with complex mental health conditions, or people with learning difficulties. It requires effort and work outside of the session on your part, which some people can find difficult. It focuses on the individual’s ability to change, rather than looking at wider problems in systems or families.
Studies show CBT is helpful for many different mental health conditions, but it’s particularly effective for problems that involve depression, phobias, or anxiety. CBT can also help the following:
- Eating Disorders
- Panic Disorder
- Post-Traumatic Stress Disorder Problems related to alcohol misuse
- Obsessive Compulsive Disorder
- Sleeping Disorders
If your doctor recommends CBT, you can go through the NHS or go private. If you go private, it’s simply a case of finding a counsellor (read our special guide on finding the right counsellor). You can visit the Counselling Directory online to find a CBT counsellor in your local area.
With the NHS, you’ll need to refer yourself to a local organisation that offers CBT – your doctor will provide you with contact details.
After a telephone assessment, you’ll join a waiting list. Please be aware, this waiting list can take one to six weeks.
If you can’t really wait, and if you can afford it, then maybe going private is an option. If you go down the private route, chances are your wait will be far shorter. However, this comes at a cost. The price of private CBT will depend on the individual counsellor, but expect to pay around £40 per session.
Usually, you’ll be face-to-face with a counsellor, but you may have telephone sessions or online CBT. In some cases, you may be advised to try group CBT, by joining people with similar struggles. In face-to-face sessions, you typically meet your CBT therapist for between five and 20 sessions, either weekly or fortnightly. Sessions usually last between 30–60 minutes and you’ll be asked to complete “homework” outside of sessions. You may be asked to complete some cognitive behavioural activities during your therapy sessions. These can include:
- Mindfulness meditation: focusing on the present moment
- Successive approximation: breaking large tasks up to smaller, manageable steps
- Visualising your day: bringing to mind the positive
- Reframing negative thoughts: countering negative thoughts with positive thoughts
Evidence is proving CBT to be a helpful form of therapy for many people, but like any therapy it may not be suitable for everyone. Together with your doctor, you can discuss your options to see what’s working for you and what isn’t. Whatever you decide, remember, everyone deserves support.