Cognitive-behavioral therapy (CBT) is a form of psychotherapy that claims to treat problems and boost happiness by modifying dysfunctional emotions, behaviors, and thoughts.

Unlike traditional Freudian psychoanalysis, which probes into the client's past to identify potentially causal experiences, CBT focuses on solutions, encouraging patients to challenge distorted cognitions and change destructive patterns of behavior.

CBT 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 tries to 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 and looks for ways to improve your state of mind now.

The 'logic' and 'rationale' underlying CBT, as presented by CBT proponents and CBT therapists, is compelling.

In practice many clients find CBT to be neither effective or useful.

Speak to your GP. They may refer you to someone trained in CBT - for example, a psychologist, nurse, social worker or psychiatrist.
The British Association for Behavioural and Cognitive Psychotherapies keeps a register of accredited therapists.
You can try 'self-help' - using a book, internet programme or computerised CBT. This is more likely to work if you also receive support from a professional.

The idea is that CBT helps people to make sense of overwhelming problems by breaking the problems down into their smaller component parts. By making it easier for people to see how the component parts are connected, and where the adverse effect that a client might be experiencing comes from, they are empowered to overcome their problem(s).

These smaller component parts are:

• A Situation - a particular problem, event or difficult situation.
  From this can follow:
  • Thoughts
  • Emotions
  • Physical feelings
  • Actions

Each of these component parts can affect the others - there is a mind-body connection; how you think about a problem can affect how you feel both physically and emotionally.
 

And depending on how you think about things, and the way you think about things, your thoughts might be either helpful - or unhelpful.

CBT educates people about the options that they have available for thinking about things, and their situation - and CBT reminds people that they do have a choice about whether they choose to have either helpful thoughts or unhelpful thoughts.

CBT is based on teaching people that there is a direct sequential connection between thoughts, emotions and behaviour:

1. A thought (or thoughts), lead to an emotion (or emotions).

2. And then that emotion (or emotions) gives rise to physical feelings and behaviours, and/or an action (or actions), that reinforce and amplify the original thought and its emotions - making their situation worse.

In this way CBT clients are instructed, for example, that a 'vicious circle' is created and the thoughts and emotions and behaviours combine to reinforce and amplify each other and have the effect or worsening the client's situation, problem, or condition.

e.g.

For example, someone who is scared of public speaking for a work presentation might experience the sequence:

1. Thought: ''My presentation is going to be a disaster, and I'll fail at this, and lose my job'.

2. Emotion: The thought will induce emotions of panic and fear of failure, and its consequences, that surround the talk.

3. Physical Feelings: Arising from the negative thoughts and emotions, such as panic, sweating, nausea, migraines/headaches, stammering.

3. Behaviour: The induced emotions then lead to adverse behaviour that may be intended to reduce the fear such as either avoiding the presentation, or pretending to be ill to avoid the presentation, or even actually being ill so that they have to miss work for a few days. Sometimes the might even do the presentation and actually have it go very badly because they are in such an upset and emotional state - reinforcing their fear of public speaking even more - so that their next presentation, if they do one, is just as bad, or even worse.

Effectively, CBT teaches that clients with problems are responsible for their own situation and are, in effect, making themselves ill !

To assist a client with their CBT education the CBT therapist introduces the client to the perils of a number of unhelpful 'thinking styles' that CBT has 'usefully' identified. e.g.:

• Positive and negative thoughts - and their difference
• Obsessional thinking style
• Paranoidal thinking style
• Catastrophic thinking style
• Perfectionist thinking style
• Hyper-vigilence thinking style
• Learned helplessness thinking style
• In addition to the above the CBT therapist 

The CBT therapist will also typically teach some other techniques, such as Yoga, Mindfulnees and Relaxation techniques.

The client may also have to do some 'homework' as well between sessions, usually involving keeping a diary record where the frequency, severity and duration of any recurrence of their problem(s) is recorded.

All of these CBT techniques, strategies and interventions are all widely and easily available from Amazon, which has a number of CBT books available for sale at a fairly affordable price.

You can do CBT individually or with a group of people, or even a self-help book or computer programme.

A course of CBT may be from 6 weeks to 6 months. It will depend on the type of problem and how it is working for you. The availability of CBT (available via the NHS) varies between different areas and there may be a waiting list for treatment.

If you have individual therapy:

• You will usually meet with a therapist for between 5 and 20, weekly, or fortnightly sessions. Each session will last between 30 and 60 minutes.
• In the first 2-4 sessions, the therapist will check that you can use this sort of treatment and you will check that you feel comfortable with it.

The therapist will also ask you questions about your past life and background.

Although CBT concentrates on the here and now, at times you may need to talk about the past to understand how it is affecting you now.

• You decide what you want to deal with in the short, medium and long term.
• You and the therapist will usually start by agreeing on what to discuss that day.

* * * * * * * *

With the therapist, you break each problem down into its separate parts, as in the example above.

To help this process, your therapist may ask you to keep a diary. This will help you to identify your individual patterns of thoughts, emotions, bodily feelings and actions.

Together you will look at your thoughts, feelings and behaviours to work out if they are unrealistic or unhelpful and how they affect each other, and you.

The therapist will then help you to work out how to change unhelpful thoughts and behaviours.

After you have identified what you can change, your therapist will usually recommend 'homework' - where you practise these changes in your everyday life.

Depending on the situation, you might start to question a self-critical or upsetting thought and replace it with a more helpful (and more realistic) one that you have developed in CBT.

At each meeting you discuss how you've got on since the last session. The CBT therapist tries to help with suggestions if any of the tasks seem too hard or when they don't seem to be helping.

CBT is, it seems, the 'go to' psychotherapy for the UK's National Health Service, from which it has received a lot of funding. CBT has, apparently, been shown to provide some help, for some people, with many different types of problems. These include: anxiety, depression, panic, phobias (including agoraphobia and social phobia), stress, bulimia, obsessive compulsive disorder, post-traumatic stress disorder, bipolar disorder and psychosis.

CBT may also, apparently, help with difficulties with anger, or a low opinion of yourself or physical health problems, like pain or fatigue.

CBT is not a quick fix. A therapist is like a personal trainer that advises and encourages - but cannot 'do' it for you.

CBT is quite complicated to learn, understand and implement. If you are feeling low, it can be difficult to concentrate and remain motivated.

Most sufferers have had their problem for a considerable length of time, over which they have been trying many, many, CBT like interventions unsuccessfully. Either from self-help guidance books, CBT books from Amazon or the local library, or by implementing well intentioned advice dispensed by counsellors, friends, family and colleagues. All to no avail.

Unfortunately, for many people the basic simplistic underlying assumption of CBT is false i.e.

• Unhelpful Thoughts give rise to Emotions,
• The Emotions give rise to Physical Sensations.
• The Physical Sensations, in turn, give rise to
• Behaviour and/or Actions that reinforce the problem.

Of course the above sequence of events can and does happen. Particularly in, say, children, or young people, or people that lack any kind of self-insight or awareness about their problem. So, up to a point, it is difficult to argue against the basic underlying assumption of CBT.

But for many people CBT is not suitable because the above sequence of events just isn't true. Instead the source of the problem lies in the neurology and circuitry of the brain and what are known as 'emotional learnings', and the sequence of events should be more correctly stated to be:

• Unhelpful past experiences initially give rise to embedded 'emotional learnings'.
• Later in life, mirror neurons in the brain identify, or recognise, similarities between the current situation and trigger the past 'emotional learnings'.
• It is the triggered past emotional learnings that give rise to:
  • Unhelpful Thoughts.
  • Unhelpful Emotions
  • Unhelpful Physical Sensations
  • Unnecessary Behaviour and Actions.

So for many people the difficulties they face are largely caused by some past event(s) that have caused them to behave in the way that they do; and giving them the problem(s) that they have.

And it is because the emotional learnings are stored in a part of the brain where the 'mirroring' and reactivation of neural networks occurs so quickly, that it is very difficult for the conscious, thinking, part of the brain to overide such an emotional response - by the time the person actually becomes aware of their altered, panicked, state, it is almost too late for them to implement any counteractive techniques and therapeutic strategies, particularly because for some people and situations they are already being instantly overwhelmed by the emotion and thnking/behaviour that has been triggered by their past 'emotional learnings'.

For most adults, who have been struggling with their problem for an extended period of time, a counteractive therapy, such as CBT is not that effective, because, in truth, they are battling with the effect of unknown emotional learnings from their past - and their symptoms either subside temporarily before eventually returning, or their symptoms are never ever helped at all.

There is always a risk that the anxiety or depression will return. If they do, your CBT skills should make it easier for you to control them. So, it is important to keep practising your CBT skills, even after you are feeling better. There is some research that suggests CBT may be better than antidepressants at preventing depression coming back. If necessary, you can have a "refresher" course.

Depression and anxiety are unpleasant. They can seriously affect your ability to work and enjoy life. CBT can help you to control the symptoms. It is unlikely to have a negative effect on your life, apart from the time you need to give up to do it.

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It depends very much on the problem. People can live for years with no sign whatsoever of any knid of psychological problem, and then life's circumstances (e.g. the death of a parent) sets in train a problem, or problem(s) that get progressively worse until therapeutic assistance .

If you want to "try before you buy", get hold of a self-help book or CD-Rom and see if it makes sense to you.

If you have had CBT and  find that you problem(s) have returned, or never ever went away in the first place, it is likely that your problem(s) are caused by past emotional learnings.

Contact Peter to arrange a free initial consultation and assessment with regard to your suitability for confidential and private therapy.

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Acknowledgements

1. https://www.rcpsych.ac.uk/mentalhealthinformation/therapies/cognitivebehaviouraltherapy.aspx