What is Cognitive Behavioural Therapy and who is it for?

Cognitive Behavioural Therapy (CBT) is one of a range of talking therapies. It is widely used, well-researched, and it has been shown to work for a lot of people.

CBT is recommended in National Institute for Health and Care Excellence (NICE) guidelines for many different mental health problems. It has a good evidence base for the treatment of depression and anxiety disorders such as obsessive-compulsive disorder (OCD), panic, and social anxiety, as well as more complex disorders including psychosis and PTSD.

CBT is a structured therapy. It is based on the idea that the way you feel depends on your thoughts or beliefs (“cognitions”) and is also strongly influenced by what you do (“behaviour”).

Many of us think that the way we feel is simply because of what happens to us. For example, if I get criticised, I might feel upset. CBT suggests that this misses out an important step. If it was just the event that caused the feeling, then the same event would cause the same feeling in everyone. We know this is not true.

Different people have different reactions to the same event, what makes the difference is the person’s interpretation of the event. So, it is not the event itself that makes me feel upset but what it is taken to mean.

Events are always filtered through our thoughts (this includes images in our mind) and beliefs about them. If I had different thoughts, I may feel quite differently.

In the example, I may feel upset when criticised if I think “I’m useless, I can’t do this”. Whereas if I think “that’s unfair!” I may feel irritated instead.

What you do, or don’t do, (behaviour or actions) also affects your thoughts and feelings.

In the above example, I might withdraw and continue to think I am useless. This may make me feel more upset. However, if I was irritated, I may question the person that criticised me. The person who I felt criticised by might respond positively or apologetically. This may actually change how I feel.

Changing what you do can make a big difference to how you think and feel, by allowing you to discover whether your thoughts are accurate or not.

What does CBT say about what keeps problems going?

When we have strong feelings, our thoughts can mislead us and make things seem much worse than they actually are. In turn, this can lead to behaviour or reactions that help only in the short term but in the long term don’t help us get better.

People who might be vulnerable to difficulties because of their life experiences may easily be triggered by specific situations. This may lead to patterns of thinking that may seem to make sense (to them) at that moment, but ultimately may not be accurate or helpful patterns of thinking.

CBT helps people to look at patterns of thinking to examine how helpful or accurate they are actually and to recognise that thoughts are simply opinions and NOT necessarily facts.

Such thoughts can impact on what we do; people might act as if the thoughts are true. Such reactions can keep people stuck as people lose opportunities to see that their thoughts may not be accurate.  We can get caught up in vicious cycles of unhelpful thinking and actions that simply keep us stuck.

The CBT approach to overcoming and understanding problems

CBT therapists develop a formulation of the problems, firstly by gaining an understanding of ‘here and now’ cycles of unhelpful thinking/ imagery, emotions, bodily sensations, and behaviours. CBT therapists will also look at triggering events which led up to the development of the problems.

You will then be helped to make practical changes to what left you susceptible in the first place and break the unhelpful cycles.

For example, learning ways to question your negative thoughts so that you can think in ways that are more balanced and helpful to you.

You will also learn ways of modifying your behaviour or reactions so that you gain more control over your difficulties.

Once you have made some progress with these changes, you will be helped to work towards re-thinking the set of life rules and beliefs you developed earlier in life as a result of your experiences.

Such beliefs and rules may have been helpful at some point in your life, but may be unhelpful now, and may contribute to you feeling vulnerable.

The overall aim of reviewing deeper held beliefs and rules is to further improve your wellbeing as well as reducing your risk of having similar problems in future, enabling you to lead a more fulfilling life.

What can I expect when I’m in therapy?

• This type of therapy requires both you and your therapist to actively work together.
• A typical course of CBT involves learning new ways of working with unhelpful thought patterns, or experimenting with new ways of responding to your difficulties and checking out whether your concerns were accurate.
• Initially you and your therapist will develop a shared understanding of what is keeping you stuck with your difficulties, often by breaking down your difficulties into smaller parts: situations, thoughts and images, feelings, physical sensations, and behaviours.
• This shared understanding is key and will likely be developed over the course of therapy.
• The therapist will help you identify some realistic goals to work towards and help explore what patterns may be getting in the way of you reaching your goals. You will also be encouraged to think of your strengths.
• Based on the shared understanding, the main focus of the therapeutic work will be negotiated between you and your therapist in order for you to work toward the goals you have identified. You will generally work through a shared agenda agreed at the start of each therapy session.
• Practice both during and in-between sessions will be required, and this is often called ‘home practice’ or ‘homework’.
• In time you may begin to change unhelpful patterns by changing your thoughts or your reactions (behaviours). This in turn can influence how you feel and open up new choices for you.
• Whilst initially CBT may be focused on here and now difficulties, longer standing beliefs and rules (resulting from earlier life experiences) may also need to be worked with in CBT if they continue to affect you in the here and now.

Practical information

CBT may last up to twenty sessions.

Sessions are likely to be weekly to begin with, and typically last between fifty – sixty minutes.

Patient Feedback

“Thank you – I’m very grateful to the NHS + psychological services for providing this treatment for me which I’ve found life affirming.”

“CBT has helped me realign my thinking and see a different perspective. I now feel better able to cope when things go wrong”.

“I have been included in each stage of the decision making in how my CBT sessions should be structured to ensure I can benefit as much as possible. Therefore, I would highly recommend the service based on the experience I have had. On a personal level, I have been treated with kindness, respect, patience, and professionalism at all times and I am very grateful to my therapist.”

How can I contact Psychological Therapies?

Email

Oxon.psychologicaltherapies@oxfordhealth.nhs.uk

Telephone

01865 902 005.

Address

Oxford Health NHS Foundation Trust

Adult Mental Health Team

Psychological Therapies

May Davidson Building,

Warneford Hospital, Warneford Lane,

Headington, Oxford OX3 7JX