What is CBT?

CBT or Cognitive Behavioural Therapy is a talking therapy. It is the most evidence based psychological therapy, meaning it is the therapy that has had the most research studies which shows it is effective. It is recommended by both the World Health Organisation and the National Institute for Health and Care Excellence and is used extensively throughout the NHS in the UK.

 

What mental health difficulties can CBT help with?

CBT is known to be helpful with a range of mental health problems including but not limited to: depression, anxiety, panic, obsessive compulsive disorder, worry, phobias, PTSD, social anxiety, health anxiety, chronic pain, chronic fatigue, stress, low self-esteem, managing emotions, perfectionism and sleep difficulties.

How does CBT work?

The main concept in CBT is that it is our thoughts or appraisals of situations that cause our emotional responses, not the situations themselves. An example of this is to imagine you are lying in bed at night, alone in the house and you hear a crashing sound. If your immediate thought is someone has broken in, then you will feel anxious and you might lock yourself in the bathroom or try to flee the house. If your thought is that it is just the cat, you will feel neutral and go back to sleep. The situation is the same, but your appraisal/thought about it is different and creates a very different feeling and behavioural response.

In CBT we are particularly interested in thoughts (cognitions), feelings and behaviours and how they interact with each other to create unhelpful patterns or vicious cycles that keep us stuck. These vicious cycles can get in the way of us living our lives the way we want to or can make us feel stressed, overwhelmed and unwell.

What happens in CBT?

CBT is known as a collaborative therapy. We work together to develop a shared understanding of your own individual difficulties or vicious cycles, we call this a formulation. Your formulation can be made into a document that can be shared with you. It can look a bit like a map or diagram, that helps us understand what has contributed to your difficulties and what is keeping them going. It is not unusual to have numerous vicious cycles within a formulation and they may all be linked to the same underlying beliefs.

Once we have done this we can see what parts of the unhelpful cycle we need to work on. We might use cognitive strategies, like thought evaluation, to help you identify more helpful realistic thoughts about yourself, other people or situations. This isn’t about turning a negative thought into a positive one. It is about looking at the evidence for the negative belief and exploring alternative perspectives. Is there another way of seeing something?

Let’s look at a simple example of a person experiencing low self-esteem. Imagine they are walking down the street and wave at a friend who doesn’t wave back. An automatic unhelpful thought might be 'I must have done something wrong, they don't like me'. This will lead to feelings of anxiety and sadness and they might then isolate themselves or avoid that person which just makes them feel worse. CBT helps us notice we are doing this and zoom out to look at the bigger picture and explore alternatives. What is the evidence I've done something wrong? Is there another possible explanation? Maybe they didn't see me, maybe they have a lot on their mind? Instead of feeling anxious or sad they would feel more neutral and they might contact that person and ask how they are and arrange to meet up.

We might use behavioural strategies, like behavioural experiments, to try doing things that were previously avoided in a graduated way that feels more manageable. Let’s think about someone who gets anxious about having to be perfect at everything and spends hours ensuring everything about them is perfect because they fear if they don't, people will judge them negatively. As a result, they never learn that they don't have to do this and are not rejected. We might try doing things in a less than perfect way and seeing what happens. Hopefully, over time, they will learn it is ok for things to be good enough, and that they are good enough without having to strive for perfection.

When working with someone with depression, one of the first things we might do is use an activity schedule to see how someone is spending their time. This is because we know that when we are depressed we can end up in a vicious cycle of negative thoughts about ourselves.  Thoughts such as thinking we are useless, which make us feel low and sad and we can end up not doing much. Doing anything can feel overwhelming or pointless. This in turn makes us feel worse so we have less motivation to do anything and our negative thoughts about being useless are reinforced. By starting to build in activities that give us a sense of achievement and pleasure, we can improve our mood with a view to then working on our unhelpful thoughts. This would all be done in a planned and supportive way.

Depending on the nature of the difficulties, it may be that factors from someone's past might be influencing how they feel and behave now. In such cases it may be helpful to spend some time exploring this further in order to understand how this affects them so that they can begin to move forward. It might also be appropriate to do some trauma processing for previous traumatic experiences.

CBT is very much about making changes in your life.  Therefore, early on in treatment we would make a list of your goals and what you would like to be different in your life. Sessions are structured with an agenda which would include checking in with how you are and how your week has been. Then we would have some main items on the agenda which relate to your goals and treatment plan. This might include developing your formulation and psycho-education to help you understand your symptoms. At other times we might discuss different aspects of your vicious cycles to help gain new perspectives. Some sessions might focus on learning new skills and techniques to practice in your real life and to help you work towards your goals.   

One of the aims of CBT is for people to learn to become their own therapist.  CBT skills and techniques I can teach you can help you to maintain your mental wellbeing in the future. I can also work with you to develop a Relapse Plan to help support you in the future. This is a document for you to keep that we work on together towards the end of therapy. It includes skills and concepts you have learnt in therapy, early warning signs of relapse so you know what to look out for and when to ask for help. We also include a plan of how to cope with any potential situations you think you might struggle with in the future.

If you would like to discuss if CBT might be helpful to you please feel free to contact me. I am a fully accredited CBT Therapist with the BABCP.

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ROMINA SCARAMAGLI - PSYCHOTHERAPIST atlantictherapies@gmail.com 07707 876 440

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