Cognitive behavioural therapy (CBT) can help you make sense of overwhelmingproblems by breaking them down into smaller parts.
In CBT, problems are broken down into five main areas:
- physical feelings
CBT is based on the concept of these five areas being interconnected and affecting each other. For example, your thoughts about a certain situation can often affect how you feel both physically and emotionally, as well as how you act in response.
How CBT is different
CBT differs from many other psychotherapies because it’s:
- pragmatic– it helps identify specific problems and tries to solve them
- highly structured– rather than talking freely about your life, you and your therapist discuss specific problems and set goals for you to achieve
- focused on current problems– it’s mainly concerned with how you think and act now rather than attempting to resolve past issues
- collaborative– your therapist won’t tell you what to do; they’ll work with you to find solutions to your current difficulties
Stopping negative thought cycles
There are helpful and unhelpful ways of reacting to a situation, often determined by how you think about them.
For example, if your marriage has ended in divorce, you might think you’ve failed and that you’re not capable of having another meaningful relationship.
This could lead to you feeling hopeless, lonely, depressed and tired, so you stop going out and meeting new people. You become trapped in a negative cycle, sitting at home alone and feeling bad about yourself.
But rather than accepting this way of thinking you could accept that many marriages end, learn from your mistakes and move on, and feel optimistic about the future.
This optimism could result in you becoming more socially active and you may start evening classes and develop a new circle of friends.
This is a simplified example, but it illustrates how certain thoughts, feelings, physical sensations and actions can trap you in a negative cycle and even create new situations that make you feel worse about yourself.
CBT aims to stop negative cycles such as these by breaking down things that make you feel bad, anxious or scared. By making your problems more manageable, CBT can help you change your negative thought patterns and improve the way you feel.
CBT can help you get to a point where you can achieve this on your own and tackle problems without the help of a therapist.
Exposure therapy is a form of CBT particularly useful for people with phobias or obsessive compulsive disorder (OCD).
In such cases, talking about the situation isn’t as helpful and you may need to learn to face your fears in a methodical and structured way through exposure therapy.
Exposure therapy involves starting with items and situations that cause anxiety, but anxiety that you feel able to tolerate. You need to stay in this situation for one to two hours or until the anxiety reduces for a prolonged period by a half.
Your therapist will ask you to repeat this exposure exercise three times a day. After the first few times, you’ll find your anxiety doesn’t climb as high and doesn’t last as long.
You’ll then be ready to move to a more difficult situation. This process should be continued until you have tackled all the items and situations you want to conquer.
Exposure therapy may involve spending six to 15 hours with the therapist, or can be carried out using self-help books or computer programs. You’ll need to regularly practice the exercises as prescribed to overcome your problems.
The first few sessions will be spent making sure CBT is the right therapy for you, and that you’re comfortable with the process. The therapist will ask questions about your life and background.
If you’re anxious or depressed, the therapist will ask whether it interferes with your family, work and social life. They’ll also ask about events that may be related to your problems, treatments you’ve had, and what you would like to achieve through therapy.
If CBT seems appropriate, the therapist will let you know what to expect from a course of treatment. If it’s not appropriate, or you don’t feel comfortable with it, they can recommend alternative treatments.
After the initial assessment period, you’ll start working with your therapist to break down problems into their separate parts. To help with this, your therapist may ask you to keep a diary or write down your thought and behaviour patterns.
You and your therapist will analyse your thoughts, feelings and behaviours to work out if they’re unrealistic or unhelpful and to determine the effect they have on each other and on you. Your therapist will be able to help you work out how to change unhelpful thoughts and behaviours.
After working out what you can change, your therapist will ask you to practise these changes in your daily life. This may involve:
- questioning upsetting thoughts and replacing them with more helpful ones
- recognising when you’re going to do something that will make you feel worse and instead doing something more helpful
You may be asked to do some “homework” between sessions to help with this process.
At each session, you’ll discuss with your therapist how you’ve got on with putting the changes into practice and what it felt like. Your therapist will be able to make other suggestions to help you.
Confronting fears and anxieties can be very difficult. Your therapist won’t ask you to do things you don’t want to do and will only work at a pace you’re comfortable with. During your sessions, your therapist will check you’re comfortable with the progress you’re making.
One of the biggest benefits of CBT is that after your course has finished, you can continue to apply the principles learned to your daily life. This should make it less likely that your symptoms will return.
For more information about counselling and therapy, the following resources may be helpful.
- Canadian Professional Counsellors Association. https://www.cpca-rpc.ca
- Canadian Mental Health Association. www.cmha.ca
- Canadian Counseling and Psychotherapy Association. https://www.ccpa-accp.ca
- The Federation of Associations for Counselling Therapists in B C. https://www.factbc.org
- Counselling Psychology. American Psychological Association. https://www.apa.org/ed/graduate/specialize/counseling.aspx
- Psychology Help Centre. American Psychological Association. https://www.apa.org/helpcenter/
- Who needs counselling? PsychCentral. https://psychcentral.com/lib/who-needs-counseling-10-therapy-myths-dispelled/
Source: Adapted from information provided by National health Service (UK) open licence.
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