What is Cognitive Behavioural Therapy?

One of the most well-known forms of therapy, CBT (Cognitive Behavioural Therapy) sounds complex, but the basic premises surprisingly simple. 

CBT has become one of the more common forms of psychotherapy in recent years in large part due to its success in treating a myriad of different mental conditions. It is scientifically well supported, with evidence from both research and clinical use showing improvements in living standards for a great many patients. 

Still, with a name like Cognitive Behavioural Therapy, the mechanisms it uses can seem opaque, even mysterious. But that needn’t be the case. Let's break it down, word by word…

C: “Cognitive”

CBT works on the basis that we are cognisant, or mindful of our own thoughts. What this means is that we recognise patterns in our own thoughts, or thoughts that we tend to repeat. One example might be with some forms of anxiety. Often people find it very easy to ‘catastrophize.’ What that entails is jumping quickly from a seemingly innocuous event to the worst possible outcome thereof. 

For example:
Alex gets a performance review at their work, and the results show that they are areas where he could improve. His thoughts might quickly take a catastrophical turn and lead to him worrying about his performance slipping. He might worry that he might get fired, that this will cause arguments with his partner, that he will not find another job, that he will not be able to make rent, and that he will ultimately lose both their home and their relationship would end. 

However, in reality, Alex's thoughts were not at all related to what his boss had been thinking. His boss simply believed that Alex has had a bad week and has actually been considering putting him forward for a promotion for some time.

B: “Behavioural”

Once we recognise these thought patterns, it becomes easier to deal with them. The next logical question would be what ‘causes these thoughts, and what effect do they have on us?’ The latter is maybe more easy to explain. 

Someone in Alex’s position could naturally feel very anxious when faced with such a serious outcome. For many in these positions such thinking can lead to a full-blown anxiety attack, or at the very least, an increase in their general feelings of anxiety - something that could ironically affect their productivity and become a self-fulfilling prophecy. 

But are there certain patterns of behaviour that are more likely to lead to these thoughts? Is there some habit that Alex has formed which could be making them more prone to these thought patterns? Perhaps if Alex starts to constantly wait and check emails or feedback from his boss then he might be reinforcing the anxiety. 

T: “Therapy”

The therapeutic aspect of CBT could be seen to arise out of this sort of thinking. Once we identify the patterns of behaviour that seem to contribute to negative thought patterns, we have a greater chance of controlling them or at least mitigating them. The intention is that by doing so people can create their own positive, upward reinforcing loops rather than the negative downward spiral that someone like Alex might experience. 

We can seldom control our environment but we can have some influence over how we let it affect us. In our, admittedly very simplistic example, let's say that Alex actually greets the feedback they receive positively. For so long they’ve been trying to think of ways to improve their impact at work, and the constructive criticism from their boss has finally given them the chance to work on their performance; something that could really benefit them in the long term. 

In this case, Alex could’ve been helped to identify the distortions in her thinking, perhaps there were some behavioural habits that were exacerbating them as well. 

A trained psychologist will have an idea of how to identify these patterns and the best ways to treat them, depending on the person or the situation. This might involve keeping a diary of thoughts and feelings, or various ‘homework’ exercises intended to help people like Alex better manage their own thoughts and take better control of their own lives. 

But it is important that such therapy is undertaken by someone with the proper qualifications - for example an accredited psychologist or psychiatrist. The above example of Alex is a very simple case. In reality, even more ‘mild’ cases of depression or anxiety can have very complex causes and behaviours and it is important to have the right expertise when treating those in need.