Cognitive Behavioural Therapy (CBT)
The basis for cognitive behavioural therapy is the idea that it’s not an event that makes us feel a certain way, it’s how we think about an event that causes our emotions to change, affecting both our physical body and influencing our behaviour. Our behaviour or response to an event in turn confirms what we believe – so we can get stuck in a negative cycle.
How CBT Works
There are several possible outcomes in any situation, dependent on how you think. Take these two examples:
Anxiety: You are invited to go to a party
1. You think: “Ok, so I only know one person going. I’ve no idea who else will be there
but I’ll see how it goes – it might be interesting to meet new people”.
You feel: A bit excited.
Behaviour: You go to the party.
2. You think: “This is a nightmare – I only know one person. No one will else will want to talk to me”.
You feel: Anxious.
Behaviour: You avoid going to the party – or you go but stand back from others.
Depression: You forget to do something
1. You think: “I’m a total idiot – I should have remembered to do it – I never remember
anything – I’m completely stupid”.
You feel: Down and are angry at self.
Behaviour: You keep thinking about it and giving yourself a row.
2. You think: “In an ideal world I would have remembered – I’ll just do it now – everyone makes mistakes.
You feel: Neutral.
Behavour: You get on with the next thing you were due to do.
What are The Most Common Types of Negative Thoughts?
Normally, when we are giving advice to others, we use our supportive, non-judgmental mind. Unfortunately, when we give advice to ourselves, we can tend to use our harsh, critical and unhelpful mind.
There are 2 common ways of making ourselves more anxious than we perhaps need to be:
1. Catastrophically predicting the future – thinking of the worst-case scenario.
2. Mind-reading – deciding what others think, without having evidence for it.
Similarly, there are 4 ways of making us more depressed
1. Thinking in all-or-nothing terms (black and white thinking) – “I’m good or bad”, “I’m a success or a failure” – we fail to see the middle ground.
2. Focusing on the negative and ignoring the positive – thinking of all our mistakes and forgetting our successes. Focusing on what we don’t like about ourselves, rather than what we do.
3. Fixed rule statements: using the words “should”, “must”, “can’t”.
4. Personalising: deciding that events and outcomes are due completely to us, rather than looking at the bigger picture.
How Do I Challenge My Negative Thoughts?
To challenge your negative thoughts, it helps to be aware of:
1. Your emotions.
2. The thoughts that are causing the emotions.
3. Then, you need to ask yourself what the evidence is for the thoughts and
whether there is another way you could look at the situation.
4. One fast way to challenge your thinking is to ask yourself what you would say to a friend in this situation – would you give them the same harsh advice you’re giving yourself?
5. The fast rule is, if you wouldn’t say it to a friend, don’t say it to yourself!
How Quickly Does CBT Work?
Unfortunately, there’s no magic wand and no miracle fixes. Understanding the mechanisms of CBT is only half the battle. You need to actively practice the techniques, much like practicing driving a car - until you’re able to do it on autopilot.
How Effective is CBT for Different Conditions?
While CBT is not a one-size-fits-all solution, research shows that it helps with many mental health problems. The success rates vary by condition:
Generalized Anxiety Disorder (GAD): Approximately 60-80% of individuals experience improvement following CBT.
Depression: Roughly 50-70% of people show significant reductions in symptoms after undergoing a course of CBT.
Phobias: For specific phobias, CBT is highly effective, with success rates of 70-90%.
Eating Disorders: About 40-60% of people with eating disorders, particularly bulimia and binge eating disorder, see marked improvement after CBT.
Functional Neurological Disorder (FND): Around 50% of individuals with FND report symptom improvement through CBT techniques.
Can It Be Used With Other Therapies?
Many other therapeutic approaches build on the principles of CBT and it’s possible to blend them, focusing on the techniques that make most sense to you. Other techniques that come from alternative therapies include:
Schema-Focused Therapy: This approach focuses on deep-seated, long-term patterns of thinking (schemas or core beliefs) that stem from early life experiences, targeting the underlying schemas that fuel maladaptive behaviours.
Acceptance and Commitment Therapy (ACT): ACT integrates mindfulness and acceptance strategies with CBT principles. Instead of focusing on eliminating distressing thoughts, ACT encourages patients to accept them and commit to actions aligned with their values.
Compassion-Focused Therapy (CFT): CFT combines CBT techniques with exercises designed to foster self-compassion, that can be particularly useful for individuals who struggle with self-criticism or shame.
These therapies can be used in conjunction with CBT to provide a more tailored treatment, allowing for flexibility based on the individual’s specific needs.
Conclusion
Cognitive Behavioural Therapy is a useful tool in the treatment of many different mental health conditions. Its evidence base, combined with its adaptability, makes it a practical choice for managing issues like anxiety, depression, phobias, eating disorders, and even more complex conditions like FND. Whilst CBT may not work for everyone, it’s a useful therapeutic intervention. Whether used alone or in combination with other therapies like schema-focused therapy, ACT, or CFT, CBT offers a structured, practical approach to improving mental health. Like any skill, it takes time and practice—but the benefits are well worth the effort.