CBT can be hugely effective in the treatment of depression, anxiety disorders, phobias, self esteem, OCD and other mood disorders. It’s a problem focussed approach where the therapist and client work together to understand how the client’s thoughts, feelings and behaviours have in some way become unhelpful. Dr Jane McNeill - BA, Dip Psych, D Couns.Psych
CBT has grown in popularity in the last few years and has been supported by numerous studies showing it to be highly effective; for instance, many show CBT to be as successful, if not more so, than anti-depressants alone1.
The aim of CBT is to break patterns of behaviour and thought processes that are negative, destructive or distressing. It combines cognitive therapy (examining the things you think) and behavioural therapy (examining the things you do.)
CBT is a more ‘hands on’ type of therapy than other traditional types of talking therapy, such as psychotherapy. The therapist will interact, guide and even ‘coach you’ and you may use worksheets or questionnaires during the course of your treatment. It’s also very common to be given homework and tasks to complete between sessions.
A typical structure of a CBT session may include the following:
At the beginning of therapy, you and your therapist may explore the problems and behaviours you want to work on;
When you have agreed your goals for the issues you want to work on, you may start planning the content of sessions, breaking your goals down into manageable steps and exploring how you could change your behaviour patterns;
During the session, you might work through exercises with your therapist to identify and explore your thoughts, feelings and behaviours. This may be through diagrams or worksheets, which you may refer to in and out of the sessions.
With CBT, you’ll be given work to do in your own time to embed the changes you are seeking to make, so the end of the session may focus on agreeing some exercises to work on afterwards.
At the beginning of the next session, your therapist may begin by revisiting the conclusions of the previous session and discussing the progress you have made with the work you have undertaken between sessions.
CBT has really helped me understand my behaviour and helped me build on my relationships with others. I felt a massive break through in my mind towards the end of my session and have managed to put all my problems in the past. It’s absolutely amazing and I would highly recommend CBT to anyone.
Is CBT right for me?
It can be really hard to know which therapy is the right one for your current circumstances. It’s normal for people to find one type of therapy works at a particular time in their lives, but then change to another type later on.
The key indicators that CBT might be a good choice for you are:
You are looking for something relatively short term – you can choose to stay in CBT (if paying privately) for as long as you like, but normally around 12 sessions is a good place to start.
You don’t want to work through past events in huge depth – whilst CBT will look at the circumstances that have caused your current difficulties, it won’t go over them in the same depth that therapies such as psychotherapy or humanistic will.
If you have suffered prolonged trauma or abuse or feel that you need to go into your childhood and early experiences in some depth, it may be that CBT is not the best choice for you.
You are happy to complete ‘homework’ between sessions – people who are very depressed or living in chaotic circumstances can find it hard to find the energy or time to do this.
You are interested in adopting better strategies to manage the difficulties in your life – this may sound obvious but in order for CBT to be effective you have to be willing to change the way you think and approach certain areas of your life.
You have a clear problem to solve or goal to achieve; CBT often works best if you know what issue you want to deal with first – the therapist will help you identify this in the first appointment.
The good news is that many therapists who practice CBT also have training in other forms of talking therapy, so will be able to adapt the sessions to suit your needs – this is often called ‘integrative therapy’.
Sometimes you might need to talk through something from the past and other times you might just want to learn some better coping mechanisms. Many of our therapists have more than one training and can do this.
Why might CBT be the wrong therapy for me?
Before deciding to have CBT, it might be helpful to think about the following:
Is short-term therapy right for me? If you have severe or complex problems, you may find a short-term therapy like CBT is less helpful. Sometimes, therapy may need to go on for longer to allow you to talk through the issues you have without worrying you are running out of time.
Am I comfortable thinking about my feelings? CBT can involve becoming aware of your anxieties and emotions. Initially, you may find this process uncomfortable or distressing.
How much time do I want to spend? CBT can involve exercises for you to do outside of your sessions with a therapist. You may find this means you need to commit your own time to complete the work over the course of treatment, and afterwards. These are an important part in how well the therapy will work, so you need to be confident you can commit to these tasks in order to get the maximum benefit the therapy can offer.
Do I have a clear problem to solve? You may find CBT is 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
I recently worked with David, who presented with very low mood. He had recently completed his degree and broken up with his girlfriend. He described feeling lost and very depressed. We looked at how a vicious cycle had developed where he thought nothing he ever did was good enough - his way of dealing with this was to withdraw and ruminate about how useless he was. We worked backwards to discover he had developed very high expectations about success in all areas, academic as well as social. This meant that he had begun to believe that he was only worthy if he had a top job, successful relationship and was busy all the time. We challenged these rules he had developed, and together we began to make some changes in his beliefs and his behaviours where they became more realistic and helpful. After 12 sessions of CBT, David had reintegrated himself into a positive friendship group, had begun to go to interviews and his mood was no longer depressed.
Dr Jane McNeill is a doctor of counselling psychology and works in London. She is an experienced and highly empathetic psychologist who works with young people and adults with often complex mental health problems.
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