In response to my article on “neuroplasticity” a couple of days ago, describing how I “cured” myself of the effects of a stroke, (with the help of my family, which I acknowledge) a couple of people have privately asked me why I specifically recommended Cognitive Behavioural Therapy as one of the things I would suggest for people wanting to work on their brain.
The answer is simple. Many years ago now, I was suddenly and fiercely struck down with an illness called “Obsessional Compulsive Disorder” (OCD). I have never hidden this from anyone who knows me, so I have no fears about revealing it in a blog. It was part of my life, I understand what triggered it, (the death of our first child), I was treated, I am recovered. And have been for some time.
So praise be to the pharmaceuticals, psychiatrists, psychologists, counsellors, family and – for a while – “CBT”. And we move on.
But at the time – and on occasions since – I found personally CBT incredibly helpful, even though I didn’t do a lot of it. In a few sessions, a therapist managed to explain to me how the brain often thinks things through wrongly, and this “wrong thinking” (and often, over thinking) lay at the heart of much stress and anxiety for many people. Essentially, we tell ourselves a load of crap (usually about emotional issues) and because we’re telling ourselves this, we tend to believe it.
Fact is, though, our brains require active management. Left to their own devices, left without any better or more deliberate instructions, they will faithfully regurgitate fears, assumptions, emotions, reasonings and learnings from our past – often our childhood – all of which (or at least some of which) may be total nonsense.
We weren’t paying attention – we weren’t “mindful” – when we laid down these reactions, and now they overtake us willy-nilly when similar situations occur. Unless – unless – we consciously choose to alter the way we respond to those situations, and the way we allow ourselves to think about them.
So when people asked “what is it?”, I went hunting for some approachable, easy to read explanatory notes. And I found them, at mind.org, which is a mental health charity in the United Kingdom.
I’m sure they won’t mind me reproducing their explanation, especially if you’re reading this and you need to know what’s in them.
I will reproduce them in full – and they’re long – so if you don’t need to know just stop reading now and wait for tomorrow’s story.
But if you think you do need to know, then read on.
And know that I have made a small donation to the charity on your behalf, to say thank you for shamelessly nicking their wisdom without asking permission.
If this stuff helps you, you might like to bung them a bob or two, too.
THE MIND.ORG NOTES – Making sense of Cognitive Behavioural Therapy
What is cognitive behaviour therapy?
CBT is a form of talking therapy that combines cognitive therapy and behaviour therapy. It focuses on how you think about the things going on in your life – your thoughts, images, beliefs and attitudes (your cognitive processes) – and how this impacts on the way you behave and deal with emotional problems. It then looks at how you can change any negative patterns of thinking or behaviour that may be causing you difficulties. In turn, this can change the way you feel.
CBT tends to be short, taking six weeks to six months. You will usually attend a session once a week, each session lasting either 50 minutes or an hour. Together with the therapist you will explore what your problems are and develop a plan for tackling them. You will learn a set of principles that you can apply whenever you need to. You may find them useful long after you have left therapy.
CBT may focus on what is going on in the present rather than the past. However, the therapy may also look at your past and how your past experiences impact on how you interpret the world now.
CBT and negative thoughts
CBT theory suggests that it isn’t events themselves that upset you, but the meanings you give to them. Your thoughts can block you seeing things that don’t fit in with what you believe to be true. You may continue to hold on to these thoughts and not learn anything new.
For example, if you feel low or depressed, you may think, “I can’t face going into work today. I can’t do it. Nothing will go right.” As a result of these thoughts – and of believing them – you may call in sick.
By doing this you are likely to continue to feel low and depressed. If you stay at home, worrying about not going in, you may end up thinking: “I’ve let everyone down. They will be angry with me. Why can’t I do what everyone else does?” Consequently, you may judge yourself as being a failure and give yourself more negative feedback such as: “I’m so weak and useless.”
You will probably end up feeling worse, and have even more difficulty going to work the next day. Thinking, behaving and feeling like this may start a downward spiral. It may be part of an automatic negative way of thinking.
By continuing to think and behave in this way, you won’t have the chance to find out that your thinking and prediction may be wrong. Instead, the way you think and act can lead you to be more convinced that what you are thinking is true. In CBT, you will learn to recognise how you think, behave and feel. You will then be encouraged to check out other ways of thinking and behaving that may be more useful.
How does negative thinking start?
Negative thinking patterns can start in childhood, and become automatic and relatively fixed. For example, if you didn’t get much open affection from your parents but were praised for doing well in school, you might think: “I must always do well. If I do well, people will like me; if don’t, people will reject me.” If you have thoughts like these, this can work well for you a lot of the time; for example, it can help you to work hard and do well at your job. But if something happens that’s beyond your control and you experience failure, then this way of thinking may also give you thoughts like: “If I fail, people will reject me.” You may then begin to have ‘automatic’ thoughts like, “I’ve completely failed. No one will like me. I can’t face them.”
CBT can help you understand that this is what’s going on and can help you to step outside of your automatic thoughts so you can test them out. For example, if you explain to your CBT therapist that you sometimes call in sick because you feel depressed, the therapist will encourage you to examine this experience to see what happens to you, or to others, in similar situations. You may agree to set up an experiment where you will agree to go to work one day when you feel depressed and would rather stay at home. If you go to work, you may discover that your predictions were wrong. In the light of this new experience, you may feel able to take the chance of testing out other automatic thoughts and predictions you make. You may also find it easier to trust your friends, colleagues or family.
Some of the work we did involved looking at the way I interacted with people, e.g. if somebody had seemed to reject me, I’d write a list of all the reasons against why the way I was thinking might be incorrect. This helped me see things from the other person’s perspective, and realise I might be wrong in my assumptions.
Of course, negative things can and do happen. But when you feel depressed or anxious, you may base your predictions and interpretations on a ‘faulty’ view of the situation. This can make any difficulty you face seem much worse. CBT helps you to understand that if things go wrong or you make a mistake, this does not mean that you are a failure or that others will see you as a failure.
What type of problems can CBT help with?
CBT can be an effective therapy for a number of problems:
- anger management
- anxiety and panic attacks
- chronic fatigue syndrome
- chronic pain
- drug or alcohol problems
- eating problems
- general health problems
- habits, such as facial tics
- mood swings
- obsessive-compulsive disorder (OCD)
- post-traumatic stress disorder
- sexual and relationship problems
- sleep problems.
CBT does not claim to be able to cure all of the problems listed. For example, it does not claim to be able to cure chronic pain or disorders such as chronic fatigue syndrome. Rather, CBT might help someone with arthritis or chronic fatigue syndrome, to find new ways of coping while living with those disorders.
There is also a new and rapidly growing interest in using CBT (together with medication) with people who suffer from hallucinations and delusions, and those with long-term problems in relating to others.
It’s less easy to solve problems that are severely disabling and long-standing through short-term therapy. But you can still learn principles that improve your quality of life and increase your chances of making further progress.
Experts know quite a lot about how they can help people who have relatively clear-cut problems, eg if you know your problem is a fear of spiders. They know much less about how the average person may do – somebody, perhaps, who has a number of problems that are less clearly defined. Sometimes, therapy may have to go on longer to do justice to the number of problems and to the length of time they’ve been around.
CBT may be less suitable if you feel generally unhappy or unfulfilled but don’t have troubling symptoms or a particular aspect of your life you want to work on.
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.
CBT is usually a one-to-one therapy. But you may also be offered group sessions. You may find it helpful to share your difficulties with others who have similar problems, even though this may seem difficult at first. The group can also be a source of valuable support and advice, because it comes from people with personal experience of a problem.
How effective is CBT?
Clinical trials have shown that CBT can reduce the symptoms of many emotional disorders. For some people it can work just as well as drug therapies at treating depression and anxiety disorders. The National Institute for Health and Clinical Excellence (NICE) recommends CBT via the NHS for common mental disorders, such as depression and anxiety (see ‘Useful contacts’).
Comparisons with other types of short-term psychological therapy aren’t clear-cut. Other therapies, e.g. inter-personal therapy and social skills training, are also effective. The challenge is to make all talking therapies as effective as possible, and also, perhaps, to establish who responds best to which type of therapy.
I attribute the success of CBT to the skills of my therapist; my starting therapy at a time when I was motivated to change; a structured programme tailored to my individual needs; and my determination.
Is CBT for me?
CBT is more likely to be helpful to you if can relate to its ideas around thought and behaviour patterns, its problem-solving approach and the need for homework. People tend to prefer CBT if they want a more practical treatment – where gaining insight isn’t the main aim.
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.
Making a decision
If you are referred for a treatment through the NHS, (or the public health system in your country), you will usually be assessed before you are allocated a treatment or a therapist. The assessor will check out what your problems are, and can then decide with you if CBT is likely to be helpful for you.
If you choose to see a therapist privately, many will offer a free consultation, so you get a chance to discuss directly with the therapist what you want help with. You can then decide if you feel this therapy might be right for you.
Don’t be afraid to ask questions during the assessment. It will be helpful for both you and the therapist if you raise any concerns before therapy starts.
Can I learn CBT techniques by myself?
Since CBT has a highly educational component, the therapist will often suggest that you read through relevant material between sessions – there is a large selection of self-help books available. Some people find this helpful. How useful it is will depend on how severe your problem is and how long it’s been going on. There are some interactive CD-ROMs and online programmes, e.g. Beating the Blues and MoodGYM which can help with depression; and FireFighter for panic, anxiety and phobias.
MoodGYM is available from the web and is free to use. If you want to use Beating the Blues or FireFighter, you will need a referral from your GP or other service-providers. Some people may prefer them to seeing a therapist, particularly as a first step. They can help with creating useful activities and monitor your progress with graphs, which may be encouraging.
I hope you found these notes useful – Yolly
A hotch-potch of related articles
- Try These Cognitive Exercises To Improve Your Mood (lifehacker.com.au)
- How useful are self-help books for treating depression? | Luisa Dillner (guardian.co.uk)
- Guided self-help cognitive behavioural therapy for depression in primary care: a randomised controlled trial (scicombinator.com)
- Positive Thinking With Cognitive-Behavioral Therapy (ralanenterprisesllc.me)
- Cognitive behaviour therapy for insomnia on NHS (storagebedsdirect.co.uk)