Cognitive Behavioural Therapy

Cognitive behavioural therapy (CBT) is a short-term talking therapy and is a way of talking about:

  • How you think about yourself, the world and other people
  • How what you do affects your thoughts and feelings

CBT can help you to change how you think (‘Cognitive’) and what you do (‘Behaviour’). These changes can help you to feel better. Unlike some of the other talking treatments, it focuses on the ‘here and now’ problems and difficulties. Instead of focusing on the causes of your distress or symptoms in the past, it looks for ways to improve your state of mind now.

What happens in a CBT session?
CBT sessions have a structure. At the beginning of the therapy, you will meet with the therapist to describe specific problems and to set goals you want to work towards. When you have agreed what problems you want to focus on and what your goals are, you start planning the content of sessions and discuss how to deal with your problems.

Typically, at the beginning of a session, you and the therapist will jointly decide on the main topics you want to work on that week. You will also be given time to discuss the conclusions from the previous session. With CBT you are also given homework, and you will look at the progress made with the homework you were set last time. At the end of the session, you will plan another homework assignment to do outside the sessions.

The importance of structure
This structure helps to use the therapeutic time efficiently. It also makes sure that important information isn’t missed out (the results of the homework, for instance) and that both you and the therapist have a chance to think about new assignments that naturally follow on from the session.

To begin with, the therapist takes an active part in structuring the sessions. As you make progress and grasp the ideas you find helpful, you will take more and more responsibility for the content of the sessions. By the end, you should feel able to continue working on your own.

Learning coping skills
CBT teaches skills for dealing with different problems. For example:

– If you feel anxious, you may learn that avoiding situations actually increases fears. Confronting fears in a gradual and manageable way can give you faith in your own ability to cope.

– If you feel depressed, you may be encouraged to record your thoughts and explore how you can look at them more realistically. This helps to break the downward spiral of your mood.

– If you have long-standing problems in relating to other people, you may learn to check out your assumptions about other people’s motivation for doing things, rather than always assuming the worst.

The client-therapist relationship
CBT favours an equal relationship. It is focused and practical. One-to-one CBT can bring you into a kind of relationship you may not have had before. The ‘collaborative’ style means that you are actively involved in the therapy. The therapist seeks your views and reactions, which then shape the way the therapy progresses. The therapist will not judge you. This may help you feel able to open up and talk about very personal matters. You will learn to make decisions in an adult way, as issues are opened up and explained. Some people will value this experience as the most important aspect of therapy.

The importance of doing homework

The sessions provide invaluable support. But most of the life-changing work takes place between sessions. You are most likely to benefit from CBT if you are willing to do assignments at home. For example, if you experience depression you may feel that you are not able to take on social or work activities until you feel better. CBT may introduce you to an alternative viewpoint – that trying some activity of this kind, however small-scale to begin with, will help you feel better. If you are open to testing this out, you could agree to do a homework assignment, say to go to the cinema with a friend. You may make faster progress, as a result, than someone who feels unable to take this risk.