Cognitive Behavioural Therapy (CBT)

Cognitive Behavioural Therapy is currently the most well researched and scientifically validated form of talk therapy. Founded in the 1960s by Aaron Beck, CBT is the basis for most of the popular and evidence based therapies available today, including Dialectical Behaviour Therapy (DBT), Acceptance Commitment Therapy (ACT), and Schema Therapy. CBT is based on the premise that how we think and behave contributes to the way we feel.

The Cognitive Part of CBT

The cognitive part of CBT involves identifying unhelpful or inaccurate thoughts that are contributing to negative emotions, and then challenging them. For each upsetting thought, CBT asks;

• Is this thought rational
• How have I come to this belief?
• Realistically, what is the likelihood of this happening?
• What are some other ways of viewing the situation?
• How might someone else view the situation?
• What would I tell a friend?
• What does the evidence say (basing conclusion on the evidence rather than feelings)
• What has happened in similar situations in the past?
• Does this thinking help me achieve my goals?
• So what if this were true? Is it truly that bad?

The Behavioural Part of CBT

The behavioural part of CBT involves identifying behaviours that are unhelpful and that contribute to negative emotions. Behavioural strategies can include;

• Relaxation training
• Social skills training
• Goal setting
• Systematic desensitisation (gradually taking steps to overcome fears/phobias)

What causes feelings?

A wide held assumption is that feelings and emotions that are experienced are a direct result of external events. That is, people generally believe that certain events make them feel a certain way, and as long as those events occur, they will continue to be made feel that way. Examples of this kind of thinking include:

• “My partner makes me so angry”
• “Exams make me so anxious”
• “I’m depressed because I lost my job”
• “I feel happy as long as my daughter continues to spend time with me”
  

These statements seem to suggest that we have no control over our emotions whatsoever and that our feelings are completely at the mercy of others or the universe. While events certainly play a significant role in how we feel, CBT argues that if we stop to look at the process of how our feelings come about, we can see that feelings are not a direct results of events alone, but that something else is also influencing how we feel.

The Relationship between Thoughts and Feelings

According to CBT, how we feel following a situation is not the situation itself, but how the situation is perceived. It is how we feel about the situation, our behaviour in the situation, or another’s behaviour in the situation that determines how we feel. That is, the strongest determinant of our feelings is not events but our thoughts and beliefs about certain events. Keep in mind that there are definitely exceptions to this.

The example below showing different individuals perspectives on the same event demonstrates this point:

Basic CBT Principles

• The way you think greatly contributes to the way you FEEL and how you BEHAVE
• An event or situation does not CAUSE you to feel or act in a certain way, it is how you PERCEIVE a situation
• Thoughts and beliefs affect our physical responses (bodily changes)
• It’s not about positive thinking. It is about thinking in a way that is realistic, rational, balanced, flexible, and most importantly, HELPFUL
• Change in thinking are central, BUT changes in BEHAVIOUR, PHYSICAL FUNCTIONING, and our ENVIRONMENT are important too

What can CBT help with?

CBT has been shown to be helpful for:

• Depression and anxiety
• Anger and stress
• Phobias
• OCD
• PTSD
• Eating disorders
• Relationship difficulties
• Addiction
• Chronic pain

Does CBT work for everyone?

No. As well researched as it is, CBT is simply not for everyone. Some individuals find that for them it doesn’t address areas such as emotion dysregulation (intense emotional states), thoughts that persist despite being challenged, or intrusive PTSD symptoms.

The good news is that when presented with summaries of different therapies and their strategies, individuals are generally able to identify early on which therapy approach appeals to them. Your treatment team can also guide you to which intervention would be the best fit given the specific issues you are wanting to target.

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All clinicians at Exhale Psychology Centre are trained in CBT.