What is CBT?
Cognitive Behavioural Therapy, or CBT, is a structured, short-term, goal-oriented form of psychotherapy. It seeks to understand and explain psychological difficulties by pulling together different elements of a person’s experience.
This includes identifying recurring negative thoughts, emotions, and coping responses or behaviours (often your current symptoms). It also looks at the historical influences that lead you to develop negative core beliefs about yourself and problematic rules for living.
Here’s an example to illustrate…
Thoughts: ‘I don’t know what I’m doing’ and ‘I’m out of my depth’
Emotion: Anxiety and shame
Behaviour: Perfectionism in the form of excessive self-monitoring and analysing to avoid mistakes, endless lists, and overworking. This leads to burnout, exhaustion, anxiety, and difficulty concentrating. In turn, this means you’re more likely to make a mistake, confirming your core belief.
Core Belief: ‘I’m not good enough’
Rules for Living: I must achieve excellent results and always receive positive feedback.
What Is CBT Used to Treat?
CBT has a huge evidence-base for treating problems such as Obsessive Compulsive Disorder (OCD), panic attacks, social anxiety, health anxiety, and depression.
How Does CBT Work?
CBT involves two distinct phases of treatment. Let me walk you through them…
1. Assessment and Formulation
The assessment phase includes information gathering and identifying key presenting problems. This can take a few sessions depending on the complexity of your difficulties. We will also continue assessing and discovering new information throughout therapy.
Some clients aren’t 100% sure about their presenting problems at the beginning of therapy. While they may know they’ve been struggling or having episodes of feeling really low or panicky, this can be where their awareness ends. The assessment stage of therapy exists to help them achieve clarity. In other words, you don’t need to come to therapy with this from the outset.
Formulation is a collaborative process. It involves putting all the relevant pieces of the puzzle together, so problems make sense. The formulation phase can be a really powerful intervention in its own right. Things start making sense and the path forward becomes clearer. Based on this, we’ll plot out the different elements to create a roadmap to guide treatment interventions.
2. Treatment Interventions
- Psychoeducation
This intervention involves giving you important psychological information about your symptoms to normalise the experience and potentially provide an alternative, less threatening explanation for what you’re going through.
- Cognitive Restructuring
This means identifying and challenging distorted or unhelpful thoughts. As well as asking key questions to help you reflect, I’ll guide you towards seeing things from another perspective and/or reframing your thoughts.
- Behavioural Experiments
The most powerful way to undermine negative thoughts and beliefs is through action. Together, we’ll agree on things that might be helpful to try, either in sessions or outside of them.
Returning to the perfectionism example above, we might design an experiment where the client gives themselves permission to slow down, rest, and only do essential things on low energy days. We’ll discuss their fears around this – they might worry giving themselves permission to slow down will make them lazy, or that they’ll end up not doing anything for the entire week. In this situation, I might present an alternative view that reducing the demands they place on themselves, resting, and disconnecting from work will actually free them up to get on and focus.
Perfectionism is often an early life adaptation that’s connected to deeply held beliefs. This sort of experiment provides lots of information, helping us understand what’s difficult, and possibly even intolerable for the client. Armed with this ‘data’, we’ll be able to work through the issue in a deeper way, eventually shifting firmly established, ingrained patterns of thinking and behaving.
- Homework (Although I Hate Calling it This!)
In CBT, your ‘homework’ involves practicing and trying out ideas we’ve been discussing in session. Although this can feel difficult, it can also be a fun and empowering stage of therapy where you start to reject or move away from the things that have been keeping you stuck. When your homework doesn’t work out, I’ll be there to support and encourage when you come back the following week. When it does, I absolutely love celebrating your wins.
Some CBT therapists also give out thought diaries to complete throughout the week. Personally, I don’t insist on this as I know I would never get round to completing them myself! However, as they’re designed to help you identify patterns of thinking and core beliefs, I do encourage clients to reflect and jot down a few notes when they experience intense emotional shifts during the week.
What are the Benefits of CBT?
CBT is sometimes criticised for being too symptom focused. If you’re having this experience, it might be that your therapist is fairly inexperienced and not using the model flexibly enough. I find CBT can be a massive help to people, and it can be delivered in a way that’s very attuned to your needs.
One of the best things about CBT is that it’s deeply collaborative. As your therapist, I’m not here to tell you what you need – there’s no one size fits all solution. Instead, I’ll guide exploration, offer suggestions, gently challenge unhelpful patterns, and help you plan and reflect on behavioural experiments.
Finally, the effectiveness of CBT can be enhanced by incorporating ideas from other therapeutic modalities such as Compassion Focused Therapy (CFT), Schema Therapy, and Acceptance and Commitment Therapy.
Therapy to Help You Heal
With more than 18 years’ experience in the field of mental health, I help clients understand the patterns of thinking and behaving that have been driving their actions for decades. By connecting past experiences to your present struggles, we create lasting transformation.
I regularly support people experiencing specific psychological difficulties such as PTSD, OCD, panic attacks, and depression. I also help clients struggling with low confidence, excessive worry, burnout, and the sense that the same painful patterns keep repeating. If these things sound familar, please get in touch. I also share mental health education via Instagram.
