Cognitive Behavioural Therapy (CBT)

What is cognitive-behavioural therapy?

You will have no doubt heard the question "is the glass half full or half empty?". This taps into the central principle of CBT that our cognitive appraisal of any given situation, that is, the way we think about, perceive or interpret incoming data will govern our mood and behavioural responses to that situation. 

Research has shown that specific types of emotional distress have a unique trademark in the types of thinking patterns and behaviours that reinforce distress over time. For example with depression typical thinking patterns include all-or-nothing thinking, disqualifying the positive, or personalising and reinforcing behaviours can include isolation, hopelessness or 'giving up', and procrastination. So going back to the question of is the glass is half-full or not, if we feel depressed, we are more likely to see it as half-empty and feel disappointed.

In the NHS, CBT continues to be the treatment of choice for many psychological problems based on recommendations by NICE, the National Institute for Clinical Excellence: https://www.evidence.nhs.uk/search?q=NICE+cognitive+behavioural+therapy.

What does CBT involve?

The assessment: Unpacking the different elements of your difficulty will provide you with an understanding of which thinking styles, behaviours and core beliefs (longstanding views about yourself, others, the world) play a central role in reinforcing your distress over time. A common way to understand or ‘formulate’ from a CBT perspective is with the ‘5 Ps’ framework:

• Presenting problem: specific details of your current difficulties, onset, coping to-date
• Predisposing factors: past vulnerabilities, past traumas, core negative beliefs about yourself, others the world
• Precipitating factors: recent triggers for your problem incl. relationship breakdown, work stress, adversity
• Perpetuating factors: specific negative beliefs and behaviours, external factors e.g. interpersonal problems, debt
• Protective factors: positive coping skills, social support

Interventions: Armed with this insight you can then learn specific techniques to develop more balanced ways of thinking and skills for behavioural change. Common CBT techniques to help you overcome your difficulties include: evidence-testing for negative thoughts, changing unhelpful core beliefs through reattribution, role-play, activity scheduling, exposure, relaxation strategies and social skills training.

Both my Masters’ degree and Doctoral Training were CBT-based enabling me to specialise in this technique early on in my career. I now work with the more advanced CBT models including schema therapy and mindfulness-compassion focused therapies. As these adapted models were borne out of CBT, the cognitive and behavioural techniques remain integral in these approaches.