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It is a way of talking about:
- How you think about yourself, the world and other people
- How what you do affects your thoughts and feelings.
CBT can help you to change how you think ("Cognitive") and what
you do ("Behaviour)". These changes can help you to feel better.
Unlike some of the other talking treatments, it focuses on the
"here and now" problems and difficulties. Instead of focussing
on the causes of your distress or symptoms in the past, it looks
for ways to improve your state of mind now.
It has been found to be helpful in:
- Anxiety
- Depression
- Panic
- Agoraphobia and other phobias
- Social phobia
- Bulimia
- Obsessive compulsive disorder
- Post traumatic stress disorder
- Schizophrenia
How does it work?
CBT can help you to make sense of overwhelming problems by
breaking them down into smaller parts. This makes it easier to
see how they are connected and how they affect you. These parts
are:
- A Situation - a problem, event or difficult
situation
From this can follow:
- Thoughts
- Emotions
- Physical feelings
- Actions
Each of these areas can affect the others. How you think about a
problem can affect how you feel physically and emotionally. It
can also alter what you do about it.
An example
There are helpful and unhelpful ways of reacting to most
situations, depending on how you think about them:
| Situation: |
You've had a bad day, feel fed up, so go out
shopping. As you walk down the road, someone you know walks
by and, apparently, ignores you. |
| |
Unhelpful
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Helpful
|
| Thoughts: |
He/she ignored me - they don't like
me |
He/she looks a bit wrapped up in themselves - I wonder if
there's something wrong? |
| |
Emotional:
Feelings |
Low, sad and rejected |
Concerned for the other person |
| Physical: |
Stomach cramps, low energy, feel
sick |
None - feel comfortable |
| |
| Action: |
Go home and avoid them |
Get in touch to make sure they're OK |
The same situation has led to two very different results,
depending on how you thought about the situation. How you
think has affected how you felt
and what you did.
In the example in the left hand column, you've jumped to a
conclusion without very much evidence for it - and this matters,
because it's led to:
- a number of uncomfortable feelings
- an unhelpful behaviour.
If you go home feeling depressed, you'll probably brood on what
has happened and feel worse. If you get in touch with the other
person, there's a good chance you'll feel better about yourself.
If you don't, you won't have the chance to correct any
misunderstandings about what they think of you - and you will
probably feel worse.
This is a simplified way of looking at what happens. The whole
sequence, and parts of it, can also feedback like this:
This "vicious circle" can make you feel worse. It can even create
new situations that make you feel worse. You can start to believe
quite unrealistic (and unpleasant) things about yourself. This
happens because, when we are distressed, we are more likely to jump
to conclusions and to interpret things in extreme and unhelpful
ways.
CBT can help you to break this vicious circle of altered
thinking, feelings and behaviour. When you see the parts of the
sequence clearly, you can change them - and so change the way
you feel. CBT aims to get you to a point where you can "do it
yourself", and work out your own ways of tackling these
problems.
"Five areas" Assessment
This is another way of connecting all the 5 areas mentioned
above. It builds in our relationships with other people and
helps us to see how these can make us feel better or worse.
Other issues such as debt, job and housing difficulties are also
important. If you improve one area, you are likely to improve
other parts of your life as well.
A Five Areas Assessment
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Life situation,
relationship or practical
problems
(e.g. a problem/difficult
situation/event occurs)
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Altered thinking
with extreme and unhelpful
thoughts
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Altered emotional feelings
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Altered physical
feelings/symptoms
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Altered behaviour
(reduced activity, avoidance or
unhelpful behaviour)
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What does CBT involve?
The sessions
CBT can be done individually or with a group of people. It can also
be done from a self-help book or computer programme. If you have
individual therapy:
- We will usually meet for between 5 and 20, weekly, or
fortnightly, sessions. Each session will last between 30 and 60
minutes.
- In the first 2-4 sessions, We will check that you can use
this sort of treatment and you will check that you feel
comfortable with it.
- The therapist will also ask you questions about your past
life and background. Although CBT concentrates on the here and
now, at times you may need to talk about the past to understand
how it is affecting you now.
- You decide what you want to deal with in the short, medium
and long term.
- You and the therapist will usually start by agreeing on what
to discuss that day.
The Work
- With the therapist, you break each problem down into its
separate parts, as in the example above. To help this process,
your therapist may ask you to keep a diary. This will help you
to identify your individual patterns of thoughts, emotions,
bodily feelings and actions.
- Together you will look at your thoughts, feelings and
behaviours to work out:
- if they are unrealistic or unhelpful
- how they affect each other, and you.
- The therapist will then help you to work out how to change
unhelpful thoughts and behaviours
- It's easy to talk about doing something, much harder to
actually do it. So, after you have identified what you can
change, your therapist will recommend "homework" - you practice
these changes in your everyday life. Depending on the situation,
you might start to:
- Question a self-critical or upsetting thought and replace it
with a positive (and more realistic) one that you have developed
in CBT
- recognise that you are about to do something
that will make you feel worse and, instead, do something more
helpful.
- At each meeting you discuss how you've got on since the last
session. Your therapist can help with suggestions if any of the
tasks seem too hard or don't seem to be helping.
- We will not ask you to do things you don't want to do - you
decide the pace of the treatment and what you will and won't
try. The strength of CBT is that you can continue to practice
and develop your skills even after the sessions have finished.
This makes it less likely that your symptoms or problems will
return.
How effective is CBT?
- It is one of the most effective treatments for conditions
where anxiety or depression is the main problem
- It is the most effective psychological treatment for
moderate and severe depression
- It is as effective as antidepressants for many types of
depression
What other treatments are there and how do they compare?
CBT is used in many conditions, so it isn't possible to list them
all here. We will look at alternatives to the most common problems -
anxiety and depression.
- CBT isn't for everyone and another type of talking treatment
may work better for you.
- CBT is as effective as antidepressants for many forms of
depression. It may be slightly more effective than
antidepressants in treating anxiety.
- For severe depression, CBT should be used with
antidepressant medication. When you are very low you may find it
hard to change the way you think until antidepressants have
started to make you feel better.
- Tranquillisers should not be used as a long term treatment
for anxiety. CBT is a better option.
Problems with CBT
- If you are feeling low and are having difficulty
concentrating, it can be hard, at first, to get the hang of CBT
- or, indeed, any psychotherapy
- This may make you feel disappointed or overwhelmed. A good
therapist will pace your sessions so you can cope with the work
you are trying to do
- It can sometimes be difficult to talk about feelings of
depression, anxiety, shame or anger
How long will the treatment last?
A course may be from 6 weeks to 6 months. It will depend on the
type of problem and how it is working for you.
What if the symptoms come back?
There is always a risk that the anxiety or depression will
return.
If they do, your CBT skills will make it easier for you to control
them. So, it is important to keep practicing your CBT skills, even
after you are feeling better.
There is some research that suggests CBT may be better than
antidepressants at preventing depression coming back. If necessary,
you can have a "refresher" course.
So what impact would CBT have on my life?
Depression and anxiety are unpleasant. They can seriously affect
your ability to work and enjoy life. CBT can help you to control the
symptoms. It is unlikely to have a negative effect on your life,
apart from the time you need to give up to do it
Cognitive Therapy is well known for being effective for
depression (it’s twice as effective as medication in
preventing relapse) and it’s also been
shown to work for many other disorders — but why? How does
it work? A major clue to how Cognitive Therapy affects the
brain came out in
this study two years ago — researchers were interested in
seeing how Cognitive Behaviour Therapy affected the brains of
depressed people as compared to medication. They hypothesized
that since both CBT and medication were effective for
depression, both treatments would affect the same part of the
brain. Using brain imaging technology, they scanned
participants’ brains before and after the course of treatment.
And they were in for a surprise. Researchers found that
antidepressants affected one part of the brain among depressed
patients, and CBT treatment affected another part altogether.
Antidepressants dampened activity in the limbic system
— the emotional center of the brain. Conversely, CBT calmed
activity in the cortex — the brain’s seat of reason.
In other words,
antidepressants reduced emotions, whereas CBT
helped patients process their emotions in a healthier manner.
Which explains why those on antidepressants have a much
higher likelihood of relapse if they go off of their meds —
negative emotions can flood back in. But with CBT, patients gain
the skills to respond to their emotions more effectively — for
long-term benefits.
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If you would like to know more on Cognitive Behavioural Therapy
and how it can help you please feel free to call me (David) on 01923
613 414 As I run a busy practice my answer service
may well take your call. please leave your details and I will call
you back.
Alternatively please feel free to email me at
CBT@watfordhypno.co.uk
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For the very best treatment and training in Hypnotherapy,
NLP and Cognitive Behavioural Therapy in Watford, Northampton,
Milton Keynes and from Spring 2007 Cambridge University
CONTACT US ON:
01923 613 414
(answer phone when in session)
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