Cognitive Behavioral Therapy

cartoon image of psychologist teaching CBT
Dr Elaine Ryan
Written by Dr Elaine Ryan Psychologist and Founder of MoodSmith® Elaine obtained her Dr in Psychology from the University of Surrey and has worked in psychology for 20 years. Dr Ryan specialises in Intrusive Thoughts, OCD and anxiety-related conditions.


This page is to introduce you to Cognitive Behavioural Therapy, often referred to as C.B.T. Your doctor might have suggested you undertake this form of therapy as according to C.B.T. theory, how you are currently feeling is influenced by both how you are thinking, and the things that you are doing. 

Cognitive Behavioural Therapy (C.B.T.) is a type of talking therapy that focuses on what you are thinking and what you are doing. This focus is essential, as your thoughts and behaviours (what you do) play a large part in how you are currently feeling, e.g., sad, happy or anxious.  

C.B.T. is used to help people with

This page will outline the model of therapy, but if you would like to read more on how CBT can help with specific conditions please see the following

Experiment: The impact of your thoughts. 

I shall start by explaining how your thoughts can be either helping or hurting you. First, you can watch the following short video that shall demonstrate the impact of your thought processes.

You will have discovered in the video above that your thoughts are not neutral. They can have a genuine impact on your physiology; the video explained how thinking about food could result in saliva in your mouth. Your thoughts did this!

If you undertook this simple experiment and found that your thoughts could change your physiology, just imagine what your thoughts are doing to your mood.

For example, if you spend your day worrying about things, then chances are, you will start to feel this in your body.

You might feel nervous or on edge. It may even prevent you from doing things.

Take a moment and think if you do any of the following things.

If you argue with someone, do you think about it afterwards? Do you imagine it in your head, having conversations with the person about what you would like to say?

Do you sometimes feel yourself getting angry because of the conversations you are having with yourself (and the other person) in your head?

IMPORTANT. You do not need to be in a real conversation with the person to feel something in your body; we are perfectly capable of upsetting ourselves with our thought processes!

The point to note in the above examples is that you can be sitting in a comfortable, safe environment, and feel angry or anxious, not because of what is happening in reality, but rather, you are upset by the thoughts in your head.

Thoughts processes essential to C.B.T.

When you first start CBT you will be introduced to both

  • Automatic Thoughts
  • Negative Automatic Thoughts

Automatic Thoughts

If you take a minute and try to observe the thoughts in your head. You should become aware that there is always some sort of chatter going on, most of the chatter you did not decide to think about; it can be a random dialogue of thoughts and images in our heads at any given time. These are known as automatic thoughts. Think of it as a train with carriages full of random thoughts chugging through your mind!

Negative Automatic Thoughts

Negative Automatic Thoughts, sometimes referred to as N.A.T.’s are the ones you will hear a lot about if you undertake C.B.T. An important point to note is that it is not the thought or image that is negative; rather, it is the meaning that you give to the thought or image that is of concern in C.B.T.  

If I asked you why you were unhappy and you told me it was because you are at home alone on a Saturday night. It is common for people to think that the cause of their feeling is the result of an event, e.g. being alone on a Saturday night.  

However, if this were true, that would mean all people would be unhappy being alone on a Saturday night and there would be no need for therapists. Everyone would know that to avoid unhappiness, means being with other people on Saturday night.

Hopefully, you can see by the example above, that blaming events for how you are feeling, will not be helpful for you. A more likely scenario would be thinking;

  • No-one likes me
  • Nobody cares enough to invite me out
  • My friends hate me
  • I’ll never find love

These type of thoughts are what we call Negative Automatic Thoughts, as they help to give some meaning to the event, i.e., being alone on a Saturday night.

According to Cognitive Therapy, depression and anxiety are maintained by negative automatic thoughts. 

  • ” I always fail.”
  • “Nothing I do is ever good enough.”
  • “I will never be able to do it.”
  • “I can’t cope.”
  • “Other people seem to manage everything, just fine. I’m hopeless.”
  • “Nothing ever works out for me.”

The problem with how our minds work is that we take these thoughts at face value and assume that they are real. In C.B.T., we do not make that assumption; we check them out, looking for errors and correct them.

Thinking Errors

Cognitive Behavioural Therapy does not assume that your thoughts represent the truth. In most cases, your thoughts stem from deeply held core beliefs about yourself, and I shall talk about that later.

In undertaking C.B.T., you might find it helpful to think of yourself as a scientist or detective, trying to uncover the truth about your thought processes.

I am continuing with the example of feeling unhappy while spending a Saturday night alone. If you had the thought; no-one likes me, if I were undertaking C.B.T. with you, I would ask first to give me evidence for that thought.

You might tell me that you just know it, or feel, but I would be asking you for cold hard evidence that would stand up in a court of law; can you prove to me that nobody likes you? Even if you said, someone said this to you yesterday or last year that still does not mean that no-one likes you.

Accepting that you might not have evidence for the thought, I would encourage you to identify if you are making a mistake in your thinking.

Common Thinking Errors in C.B.T.

There are many common thinking errors noted in C.B.T., and I shall discuss a few below to help you understand their purpose.

Mind Reading

You assume that you know what the other person is thinking without having concrete evidence that they are thinking what you believe.

Shoulds

I should not have done that; I should have known better.

Emotional Reasoning

When you assume that what you are feeling is a reflection of reality. For example, I feel unlovable; therefore, no-one likes me or could love me.

Labelling

I always think of this one as name-calling, as it refers to labelling yourself or others, usually in a negative way. I’m stupid; I’m a terrible person.

These thinking errors, or if you want to give them their more formal name in Cognitive Behavioural Therapy, Cognitive Distortions, are one of the first steps in looking at your thought processes in C.B.T.

You can probably see the thought ‘no-one likes me’ can fall under mindreading, as you are assuming what other peoples actual ideas about you are, without having concrete evidence to prove it. It could also fall under emotional reasoning if you just felt horrible or unlovable and then decided that no-one could ever like an awful person like you.

Once you can identify that you did not have evidence for your thought of nobody likes me, that you were mindreading and using emotional reasoning, I would ask you to come up with a more reality-based thought.

This reality-based thought can be difficult if you believe that no-one likes you, so I would encourage you to think of just one person that might like you, even a little bit. This is what is known as the rational thought.

You might be wondering how this could ever make you feel better, by changing a thought, but the idea is that you will gather a mountain of evidence for your thought processes, and in doing so you shall start to see a pattern emerge.  

You might discover that your mindread regularly, that you do it automatically, but over time you can learn to change this into more helpful thought processes. Note that I said more helpful, and not positive, as I do not want you to think that C.B.T. is about positive thinking, as it is not.

C.B.T. is about reality-based thinking and identifying and changing deeply held core believes about yourself.

Core Beliefs

Typical core beliefs people hold include

  • I’m not likeable
  • I’m not loveable
  • I’m a terrible person
  • I’m stupid
  • I’m a failure.

Having an understanding of how your thoughts and feelings interact can set you on your way to changing your mood. 

So far, I have spoken to you about the cognitive aspect of C.B.T., and now I want to discuss the behavioural component.

Behavioural Aspect of CBT

In C.B.T., Behaviour refers to what you do and what you do not do. What you say and what you do not say.

In addition to your thought processes, your behaviour may also be contributing to how you are currently feeling.

I am returning to the example of feeling unhappy being alone on a Saturday night and having the thought that no-one likes you. In C.B.T., you would be encouraged to undertake behavioural experiments.

These experiments would involve looking for evidence for and against the thought of no-one likes me, in all different kinds of situations.

Why?

Your brain likes to show you things that you expect. If you believe that no-one likes you, you will find many examples of this, and very few if any, cases that would suggest that someone does like you.

The behavioural experiments help you to look and search for evidence.

Behavioural experiments may also ask you to do things differently, many of which might be outside of your comfort zone. These experiments are essential as if you believed that no-one liked you; you might not want to go out on a Saturday night. Not going out, leaves you alone with your thought processes, that are currently negative, and keeps you on the cycle of reinforcing your core belief that no-one likes you.

You might be asked to make arrangements to go out, or to make a list of things that you might enjoy and start to make just one of them happen.

Further Reading NHS. MIND

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