Cognitive Behavioural Therapy is a therapy that works on three levels:
- Feelings and,
It’s a practical therapy that takes a problem in the present and helps people break the problems down into manageable chunks with specific exercises to try and change it.
As the name implies, CBT has two main therapy components, Cognitive and Behavioural therapy. Behavioural therapy is a form of action learning. Behaviourists pay virtually no attention to what someone is thinking or what their childhood was like and instead focus on what someone is doing. A behaviourist would say that you can think and try and understand how to ride a bike for as long as you like but you probably won’t make a fraction of the progress of someone who is given stabilisers and encourage to start practicing the *behaviour* of riding a bike. Some years ago I was lucky enough to hear one of the co-founders of CBT, Albert Ellis, tell a story of his shyness as a young man in New York and how the only way he could overcome this was to make himself gradually talk to more and more strangers in the park until he overcame this shyness. As someone who had previously trained as a classical analytical psychotherapist (therapists who focus on trying to understand the ‘why’ of personality and behaviour from childhood), Ellis really made quite a reversal in his thinking at this time. He realised it didn’t really matter *why* he had been shy. What mattered to him was that when he took the ‘action’ of talking to strangers his shyness lessened.
Thus CBT is fundamentally a practical therapy with action or ‘Behaviour’ at it’s core.
Cognitions are what CBT therapists call thoughts and Cognitive therapy focused on recognising how to recognise certain types of automatic thought and change them before they go on to escalate into damaging feelings and actions. It is the repetition of these damaging thoughts feelings and actions which form damaging ‘core beliefs’. Albert Ellis formulated extensive ideas about how beliefs and personal philosophy contributed to emotional pain. In CBT this came to be thought of as ‘core beliefs’ He believed that our personal philosophy such as thinking that ‘life should be fair’, for example, could cause us pain. As a therapist, he would directly confront people about their beliefs and philosophy, saying, for example, ‘who says life should be fair?’ He is amusing to watch because his forthright style (he is every bit a New Yorker!) can seem a great odds with our traditional impression of what one might expect a therapist to look and sound like but behind this apparently brash front (and great sense of humour), Ellis would get people to challenge beliefs that would otherwise have kept them stuck in pain and thereby offered them another way of looking at life as it is, and not necessarily how they expected it should be.
The other cofounder of CBT was another disaffected ‘analytic’ psychotherapist, Aaron T Beck. He integrated his observations that many automatic thoughts were not unconscious (as analytic therapists like Freud had taught) but were in fact accessible so people could practically work on them and change them. Ellis’s Rational Emotive therapy combined with Aaron Beck’s Cognitive Therapy that combined to form the ‘Cognitive’ component of CBT.
CBT holds that all of a person’s core beliefs can be categorised into three components:
- other and,
You can see right away that, unlike most therapies, there is no reference made to the past.
CBT helps us recognise unhelpful patterns of thinking. As we become depressed our thinking style can become altered so that new unhelpful patterns of thinking become prevalent which drive us further into the depression. By recognising when we are falling into such a patterns of thinking we can use CBT tools to change them so they don’t damage us further. Indeed, we can even replace some of these negative patterns with positive ones. Even just recognising that a painful thought has come from a distortion can give us some relief. The process of changing a distortion into the positive is called Cognitive Restructuring.
Some examples of unhelpful distortions are:
This isn’t a definitive list by any means and I’m sure you can find your own personal distortions. There are many different types of distortion and it really helps to bring these into our awareness and then practice turning them around (Cognitive Restructuring).
A good way to recognise these patterns is to keep a diary of behaviour thought and feelings. These can then be analysed to discover possible distortions and create restructuring cognitions.
CBT was an evolution of the ideas of Behavioural therapists and the development hasn’t stopped there. In the 80s and 90s a ‘third wave’ of behavioural therapies have appeared such as DBT (Dialectical Behavioural Therapy) and ACT (Acceptance and Commitment Therapy). CBT has rightly gained a lot of popularity but it is interesting to see how these other therapies have evolved some of these principles further and so they shall be the focus of our next article.