An introduction to cognitive behavioural therapy
What is cognitive behavioural therapy?
Cognitive behavioural therapy (CBT) is a powerful, evidence-based therapy that’s recommended for many common mental health issues such as depression and anxiety, as well as broader issues like chronic pain, addictions and eating disorders.
The basic premise underpinning CBT is that our thoughts, feelings, behaviours and bodily reactions are all inextricably interlinked, so the way we think about something will ultimately determine our emotional reactions and our behavioural responses.
When we’re distressed, our thinking tends to be negatively biased - we overestimate threats, take failures personally and assume the worst - and this can trigger a cycle of negative emotions and behaviours, which can self-perpetuate and exacerbate our distress.
By identifying biased thinking patterns associated with negative feelings, CBT can help people to re-evaluate their thoughts and change their behaviour accordingly, breaking these vicious cycles.
CBT has several key ingredients, all of which help empower people to fully understand the factors that maintain their problem and gain mastery to overcome them:
CBT teaches us to slow down our thinking processes
We don’t usually notice the individual thoughts that pop into our minds and trigger negative chain reactions, but CBT teaches us to slow down our thought processes and pay them more attention. By tuning into subtle changes in our feelings, we can start to identify the thought processes underpinning them and learn to gently challenge them. The more skilled we become at recognising these changes, the better-equipped we are to catch thoughts and stop them spiralling.
CBT is active, not passive
CBT is an empowering therapy: you don’t passively have CBT, but you actively do it. Rather than simple discussion, CBT involves trying out different ways of relating to problems, often testing predictions and facing fears through experimenting. For someone who fears that they’ll blush uncontrollably during a presentation, experimenting with public speaking will help them gain a better sense of just how well they come across. Or for someone who fears being ridiculed for losing control over their bladder in public, going to a busy place with a wet patch on their trousers would allow them to test others’ reactions. By experiencing the anxiety generated by these situations and witnessing the outcome first-hand, the learning points are far more salient for the person than they would be through a simple discussion.
CBT challenges our rules assumptions
As humans, we all have assumptions about the way the world works, and rules to which we hold ourselves. If these rules are too strict or rigid, they can put us at risk of developing problems. For instance, if we hold ourselves to perfectionistic ideals, we set ourselves up for believing we’ve failed when we make mistakes, and if we assume that the world is inherently unsafe, then we’re likely to feel anxious at even the smallest of threats. CBT helps to identify rigid or unfair rules and assumptions and then works to challenge them. By developing a set of more realistic, flexible standards, we become more adaptable and less prone to being thrown off track. Developing a rule of, “It’s nice to do well most of the time but it’s okay if I’m not always the best”, is more adaptive than holding ourselves accountable to the mantra, “I cannot possibly allow myself to fail”.
CBT examines our thinking biases
One thing we know about depression is that it biases our thinking to become overly negative. People with depression tend to overgeneralise bad experiences, blame themselves for failures and see the worst in situations. Of course, these thinking biases feed back into depression, perpetuating low mood. CBT helps a person identify such distortions and learn how to challenge them, trying to come up with more realistic alternatives. In doing so, they break the link between negative thoughts and negative feelings. So, on making a mistake at work, rather than catastrophising into thinking “I’m totally inadequate and I’ll lose my job” it stays at the level of “I made a mistake and while that’s not ideal, it doesn’t make me a terrible person”.
CBT targets vicious cycles
When it comes to anxiety, CBT tells us that we’ll engage in a variety of activities to stop our worst fear from happening: the person who is afraid of flying avoids planes; the person who fears a panic attack always carries a bottle of water; and the person who is terrified of failure never volunteers to take on any extra tasks at work. However, these things prevent a person learning that their worst fears don’t happen, and they often end up missing out on things they'd otherwise enjoy. CBT works to help understand the role of any avoidance or safety strategies and gently work to change them. Rather than avoiding all flights, the flying phobic person is encouraged to book some short-haul flights, or at least visit the airport; the person fearing panic attacks is encouraged to make some short journeys without water, and the person who fears failure experiments with taking on some small tasks that go beyond their comfort zone. This way, they gain a more realistic sense of what’s dangerous and what’s not and they learn not to waste energy trying to stay “safe”.
CBT is one of the key pillars underpinning the Unmind platform. To find out more about the way we apply the principles of CBT within the Unmind platform, click here.