WHAT IS COGNITIVE BEHAVIOURAL THERAPY (CBT)?

Cognitive behavioural therapy (CBT) is a time-limited, structured form of psychological therapy. It focuses on helping people develop skills and strategies for maintaining positive mental health. This talk therapy approach is problem-focused and goal-oriented, helping people understand and cope with what is happening in their lives.

The cognitive behavioural therapy model is centred around the bi-directional relationship between thoughts (cognitions) and behaviour patterns. Changing your behaviour can lead to changes in thoughts and beliefs, and vice versa. Cognitions can stem from both conscious and unconscious thought processes. In CBT sessions, those that are most commonly explored include:

The cognitive behavioural therapy model is centred around the bi-directional relationship between thoughts (cognitions) and behaviour patterns. Changing your behaviour can lead to changes in thoughts and beliefs, and vice versa. Cognitions can stem from both conscious and unconscious thought processes. In CBT sessions, those that are most commonly explored include:

• Conscious thoughts: Rational thoughts and choices that are made with full awareness.
• Automatic thoughts: Thoughts that you may not be fully aware of. These thoughts flow rapidly and may not be fully accurate or relevant.
• Schemas: Beliefs and personal rules for processing information. These are shaped by life experiences and early childhood influences.

CBT's basic principle is that psychological problems are based, in part, on faulty or unhelpful ways of thinking and learned patterns of unhelpful behaviour. The model maintains that people suffering from psychological problems can develop better ways of coping with them through CBT, leading to symptom relief and increased positive functioning in daily life. Specifically, CBT addresses ways that individuals can come to recognise unhelpful thoughts and thought patterns and works to help individuals develop techniques to reappraise them.

How does Cognitive Behavioral Therapy work?

Often, problems arise from the meaning that people assign to events. If an individual has many unhelpful thoughts, it can be difficult for them to function properly in daily life. CBT can help individuals learn to make positive changes in how they feel and act as well as teach them coping skills, preparing them to deal with future challenges that may arise.

CBT treatment works to reveal the effect of actions and thoughts on behaviour and overall mental health. Through a process called cognitive restructuring, CBT focuses on modifying distorted thoughts that are affecting behaviour and replacing them with more adaptive and accurate ways of thinking. Distorted perceptions can make a person more susceptible to having a negative mindset, jumping to conclusions, and inaccurately seeing situations as catastrophic.

In CBT, the goal is to identify, recognize, and manage specific unhelpful thoughts or behaviours. A person with unwanted feelings related to depression or anxiety can work to change their thoughts and behaviours to improve the way they feel. CBT strategies include:

• Recognizing one's distortions in thinking and learning to accurately reevaluate them.
• Developing problem-solving skills to cope with difficult situations.
• Learning to calm one's mind and body.
• Facing one's fears instead of avoiding them.

Management of unhelpful thinking patterns involves working to challenge automatic thoughts or schemas and compare them with reality. Viewing situations in more adaptive ways often leads to decreased emotional difficulties and their associated distress. Through CBT training, individuals become more apt at problem-solving, decision-making, and responding to stressors in their lives. CBT helps individuals better understand their thoughts and emotions as driving forces of their behaviour. As such, they learn techniques to change negative thoughts to improve their mood and actions.

For example, if an individual's project proposal is not approved in a meeting at work, her immediate thought could be that her ideas are bad and she is a bad employee. With the help of cognitive behavioural therapy, she can learn to identify how this thought may be unhelpful and inaccurate, and come up with an alternate, more appropriate thought about the situation. This can help her conclude that while she is still a valuable member of the team, someone else came up with a better project idea and that it's okay for her ideas to not always be chosen. Cognitive therapy teaches people to identify unhelpful thoughts and reappraise them, helping individuals feel better and learn to overcome future emotional difficulties in their lives.

Cognitive Behavioral Therapy therapeutic approaches

Cognitive Behavioral Therapy encompasses a range of techniques and approaches that address thoughts, emotions, and behaviours. Specific therapeutic approaches that involve CBT include:

Cognitive restructuring

This is the most popular CBT technique. This involves replacing cognitive distortions with positive and functional thought patterns. Through cognitive restructuring, individuals learn first to identify upsetting situations and the feelings they bring about. Next, individuals learn to evaluate those thoughts and consider another way to think about the situation, replacing unhelpful thoughts with positive ones. Individuals can use this reappraisal technique to deal with a variety of psychological issues and improve their mental health and well-being.

Guided discovery

Guided therapy can be done with the help of a therapist whereby they encourage individuals to think about their own thought processes and how they impact their daily lives. The goal of guided discovery is to bring about awareness of an individual's perceptions. A therapist works to collaborate with the individual to gain insight rather than reveal the problem to the individual. They may do this by asking specific questions that guide the individual towards understanding certain thoughts or beliefs that they hold. Guided discovery can help individuals see that their behaviours are rooted in negative thoughts and schemas instead of reality.

Exposure therapy

The goal of exposure therapy is to help individuals unlearn negative thought patterns, reduce stress-induced reactions and teach coping mechanisms to help individuals manage their own fears. Exposure therapy does not necessarily mean putting someone with a fear of heights on the edge of a cliff. Instead, a therapist might encourage the person to imagine standing on the top of a building to elicit thoughts and feelings related to the fear to better understand their thought processes surrounding the fear. This imaginal therapy can be just as effective as in vivo exposure (physically facing one's fear) without needing to place someone in a traumatising situation.

Journaling/thought recording

The process of recording one's thoughts and behaviour patterns is a useful CBT technique that can be practised independently outside of therapy sessions. Recording one's thoughts and discussing them with a therapist allows the therapist to get a better understanding of the individual's thoughts in their daily lives. By discussing these thoughts with a therapist, they can teach the individual coping skills and help identify specific situations where these skills could be beneficial, allowing the individual to practice coping mechanisms on their own.

Activity scheduling

This technique is based on the idea that regularly engaging in enjoyable activities that promote personal values can help elevate mood. These activities can include hobbies, education, and exercise. Activity scheduling is as simple as it sounds, whereby individuals schedule activities into their calendars, giving them something to look forward to. When we don't have scheduled plans or events, we feel sluggish and lonely. When we have self-chosen activities to look forward to, however, we feel good and productive.

Role-playing

Role-playing in CBT provides individuals with a safe and supportive environment to confront their fears and negative thoughts. During role-play, the therapist will act out the role of another person or situation that the individual is experiencing difficulty with, while they act as themselves. Acting these situations out helps the individual prepare for them in real-life settings, as well as allows the therapist to provide feedback and support while encouraging the individual to respond in ways that challenge their negative thought patterns.

Relaxation techniques

Deep breathing, muscle relaxation, mindfulness, and imagery can all help improve negative thoughts and cognitions. Negative thinking can lead to psychological and physiological discomfort. During episodes of anxiety, for example, the mind signals to the body that something is not right, leading to a slew of physiological changes such as increased heart rate, slowed digestion, and laboured breathing. Relaxation techniques can help calm the mind and indicate the absence of any immediate danger to the body, leading to improvements in your mental and physical state.

What can cognitive behavioural therapy help with?

Cognitive behavioural therapy is a widely used therapy that can help individuals in various different situations. Individuals learn to address emotional challenges, such as managing symptoms of mental or physical illnesses and relapse prevention, coping with grief or loss, or overcoming emotional trauma. CBT can additionally be used in individual or group therapy as a tool to help establish positive coping techniques and is proven to be an effective treatment for many mental health conditions such as:

• Depressive disorders
• Anxiety disorders
• Phobias
• Post-traumatic stress disorder (PTSD)
• Sleep disorders
• Eating disorders (i.e., anorexia nervosa, bulimia nervosa, binge eating disorder)
• Obsessive-compulsive disorder (OCD)
• Substance use disorders
• Bipolar disorder
• Schizophrenia
• Sexual disorders
• Chronic pain and chronic illness management

What to expect during a CBT session

CBT generally focuses on specific problems, using a goal-oriented approach. CBT is structured and educational, meaning that your therapist may give you independent work to do outside of therapy sessions, such as activities, readings or practices that build on what you learn during sessions.

Depending on your situation, your therapist will help determine how many sessions are right for you. CBT is typically a short-term therapy, ranging from about five to 20 sessions. The length of therapy can be influenced by certain factors, such as the type of disorder, severity of symptoms, how quickly you make progress, etc. As CBT is short-term, one of its goals is to teach coping skills that people can use in their lives, helping support mental and emotional health in the long-term.

How effective is Cognitive Behavioral Therapy?

CBT is recommended as a first-line treatment for many mental health conditions as it is strongly effective for depression, anxiety, post-traumatic stress disorder, substance use disorders and eating disorders, to name a few.

In comparison with psychoactive medication, CBT is just as effective for treating mild forms of mental disorders. While individuals can engage in CBT without medication use, a combination of the two can be beneficial for treating more severe cases of mental disorders such as major depressive disorder.

CBT is advantageous as its benefits can last for a long time after treatment has ended. CBT aims to teach individuals skills like stress management, interruption of automatic negative thoughts, and problem-solving techniques that can be used to deal with future problems that an individual might encounter. Through CBT, individuals develop a tool-kit of techniques they can use after CBT treatment has ended to change unhealthy thought patterns and behaviours to improve mood.

Change can be difficult

The core principles of CBT are to help individuals understand how their thoughts, feelings, and actions are connected. Through CBT, a mental health professional can help individuals feel better through teaching them to:

• Become aware of automatic negative thoughts.
• Challenge unhelpful underlying beliefs.
• Distinguish between distorted thoughts and reality.
• Develop more helpful thinking patterns and ways of seeing situations.

The Kusnacht Practice provides treatments suited to each individual and specialises in CBT and other forms of Psychotherapeutic care, as well as Medical treatment and care, Biomolecular Restoration (BIO-R^®) and Family systems therapy.

The Kusnacht Practice is also equipped at treating conditions such as anxiety, obsessive-compulsive disorder, co-dependency, post-traumatic stress disorder, eating disorders, panic disorder, addictions and more.

Our psychiatric and medical teams are dedicated to your well-being, providing personalized therapies tailored to your individual needs and goals. Whether it be to help establish positive thinking patterns or for treating more serious mental health concerns, our team is there to support you.

Get in touch if you think you or someone you know could benefit from cognitive behavioural therapy to help manage a mental illness or other physical or mental health condition.