Cognitive Behavioural Therapy

As a Chartered Psychologist with over 20 years of experience specialising in OCD and anxiety disorders, I can tell you first hand that Cognitive Behavioural Therapy (CBT) is a truly helpful model of therapy. I have used it with clients with OCD and anxiety, but also with clients who just wanted to improve their life. Throughout my article I will introduce you to CBT and show you how it may help you.

What is CBT?

CBT is a type of talking therapy that focuses on the interplay between our thoughts, feelings, and behaviours. It’s founded on the idea that our thoughts significantly influence our emotions and actions. For example, if we constantly tell ourselves we’re going to fail, we’re more likely to feel anxious and avoid challenges. Conversely, if we cultivate more balanced and realistic thoughts, we can pave the way for greater emotional well-being and more adaptive behaviours.

Experiment: The impact of your thoughts.
I shall start by explaining how your thoughts can either help or hurt you. First, you can watch the following short video demonstrating the impact of your thought processes

You will have discovered in the video above that your thoughts are not neutral. They can genuinely impact 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, 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 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, because you are upset by the thoughts in your head.

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 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!

At the heart of CBT lies the cognitive model, a framework that illustrates how our thoughts, feelings, and behaviours are interconnected. Imagine a triangle, with thoughts at one point, feelings at another, and behaviours at the third. Each point influences the others, creating a dynamic and often cyclical pattern.

Let’s illustrate this with an example from my practice. A client, let’s call him James, struggled with social anxiety. He often experienced negative automatic thoughts (NATs) like, “People will judge me,” or “I’ll make a fool of myself,” before social events. These NATs triggered feelings of anxiety and led him to avoid social situations, reinforcing his belief that social interaction was dangerous.

CBT helps us break these unhelpful cycles by identifying and challenging those 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. a critical point to note is that it is not the thought or image that is negative; instead, 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 were 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 knows 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 types 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 they are real. In C.B.T., we do not make that assumption; we check them out, look for errors and correcting them.

Challenging Negative Thoughts

One of the cornerstones of CBT is learning to identify and challenge those NATs. These are the often-fleeting thoughts that pop into our minds, influencing our emotions and behaviours. Imagine, for instance, a client I worked with who, after a social gathering, would ruminate on thoughts like, “I said something stupid,” or “No one really likes me.” These NATs fueled his social anxiety and led him to avoid social situations altogether.

Through CBT, we explored the validity of these thoughts, examining the evidence for and against them. He gradually learned to replace those unhelpful thoughts with more balanced and realistic ones, such as, “I may have felt awkward at times, but I also had some enjoyable conversations.” This process, known as cognitive restructuring, empowered him to step out of the grip of anxiety and engage more fully in his life.

Negative Automatic Thoughts

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 discuss 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 continue 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 know it or feel it, 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. I shall discuss below to help you understand their purpose.

Mind Readin

You assume that you know what the other person is thinking without having concrete evidence that they think 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 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 people’s 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 complex if you believe no one likes you, so I would encourage you to think of just one person who might like you, even a little bit. This is what is known as rational thought.

You might be wondering how this could 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 beliefs 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

While challenging thoughts is crucial, CBT also emphasizes the importance of changing behaviours. Behavioural experiments are a key tool in this process. They involve testing out our beliefs in real-life situations. For example, if someone believes they will have a panic attack if they speak in public, a behavioural experiment might involve giving a short presentation to a small group. This allows them to gather evidence that challenges their fear and build confidence.

Exposure therapy, a specialized form of behavioural experiment, is particularly effective for anxiety disorders like phobias and OCD. It involves gradually confronting feared situations or objects in a safe and controlled environment. Research consistently demonstrates the effectiveness of exposure therapy in reducing anxiety and improving quality of life (Foa & Kozak, 1986).

The Collaborative Nature of CBT

CBT is not a passive process. It requires active participation and a willingness to experiment with new ways of thinking and behaving. The relationship between the therapist and client is crucial. It’s a collaborative partnership, where both parties work together to identify goals, develop strategies, and monitor progress.
Further Reading NHS. MIND