Cognitive Behavioural Therapy (CBT) is sometimes explained using the metaphor of a mountain or iceberg. Whilst we see the tip of these, their foundations bury for miles underground (in the case of mountains, the roots are upto 5.6 times greater!). In CBT, the behaviour that we show can be seen as the tip of the problem – buried underneath, out of sight, are the triggers, thoughts and feelings which lead to this. CBT can help with a range of problematic behaviours created by strong emotions. This may include avoidance, panic attacks or obsessive behaviours due to anxiety; conflict with others due to anger; isolating oneself or struggling to cope at work because of depression or stress.
Imagine that you are asleep, and you are woken suddenly by a big ‘bang!’. What would you think it was? and would other people think the same? Why might one person roll over and go back to sleep, whilst another feels scared and jumps out of bed? This is a regularly used example to help us understand CBT.
Firstly, we can consider the thoughts we hold that impact on how we interpret an event. These thoughts will develop based on our past experiences and the current situation. With the bang in the night, someone who has been burgled a number of times previously may react with more fear and believe they are being burgled again (past experience). Their thought may be ‘I’m being burgled, I need to protect myself’. Someone who has a cat or children who often make noises may assume the bang is due to this (current situation) – ‘not the cat going mad again’ – and so have a very different reaction.
Buried even further below these thoughts are ‘core beliefs’. These are our outlook on life which develop from our experiences, especially those from childhood. These can be imagined as the ‘glasses’ we wear in which we view and interpret the world. They are often unconscious and so we have no idea that they are effecting our day to day lives.
Core beliefs could include ‘Others are untrustworthy’ or ‘People will hurt me’. We might believe ‘I am a failure’ or ‘I am unlovable’. Another example is ‘the world is a dangerous place’. Core beliefs can also be positive, for example, viewing ourselves as ‘competent’ or ‘caring’, or others as ‘trustworthy and good’. It is usually our negative core beliefs which are triggered in situations where we behave in ways that cause us pain.
Imagine how different it would feel for someone to go into a room full of strangers at a social event if they had a core belief of ‘I am unlovable, others will hurt me’ compared to ‘I am a good person, people are caring’. Before even getting to the event they are likely to interpret the event differently, and have differing emotions – one may be anxiety, the other excitement. It is a mixture of the triggering event, the current context, our core beliefs and thoughts about the situation that will decide the emotion that we feel, and how strong this is. The diagram below helps to demonstrate these ideas:
How does the Therapy work? CBT aims to help a person understand the problematic behaviour by looking at the activating events, thinking, feelings which led to this at the time. It also explores the core beliefs behind their reactions, and how life experiences may have formed these. Different methods are used to look at changing the behaviour.
Cognitive techniques involve identifying the ‘thinking errors’ which underlie our behaviours. For example:
- ‘Catastrophising’: where everything seems worse than it actually is
- All or Nothing’ thinking: Where you either love or hate something, things are great or awful.
- ‘Mindreading’: thinking you know what others think of you without the facts. You then will look at ways to challenge such errors, and think about situations in a more balanced, positive way.
Behavioural techniques focus on helping with emotions and behaviour. It may include techniques to reduce emotions such as anger or anxiety – including relaxation or problem solving. Another technique used is to set ‘behavioural experiments’ where you test out different ways of doing things, to see if it helps. In the case of anxiety behaviours you may also use ‘exposure’ techniques, where you develop a hierarchy of things which make you feel anxious and then expose yourself to these (starting with the least problematic).
Who can benefit from CBT?
CBT has a strong evidence base for many emotional and psychological problems. It is most notably used for: – Anxiety- Depression- Anger issues- Obsessive Compulsive Disorder- Post-Traumatic Stress Disorder (PTSD). It is often offered as a shorter term therapy, of around 10 sessions. For individuals who have experienced significant trauma in their lives, or may want to work on personality factors, other longer term therapies that have been adapted from CBT can help. These include Schema Therapy, Dialectical Behaviour Therapy (DBT) and Cognitive Analytic Therapy (CAT).