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What is Cognitive Behavioural Therapy (CBT)?
Cognitive Behavioural Therapy (CBT) is a common treatment for a range of mental health issues, such as anxiety, depression, and other mood disorders. It is considered to be a present-focused form of therapy, as it focuses on the here-and-now, rather than delving into your past. As a talking therapy, CBT concentrates on how your feelings and actions are directly influenced by your thoughts, beliefs, and attitudes.
Essentially, the theory behind CBT is that how we think about situations directly affects the way we feel and behave. For example, if you have a negative outlook on an event, then you might feel bad as a result, and consequently, behave in an unhealthy way. If this negative outlook isn’t challenged, then you might accept it as fact. Thus, it will continue to impact your thoughts, feelings, and behaviours, eventually becoming a continuous cycle that can be difficult to break.
How does CBT work?
CBT consists of two components; the cognitive therapy element which examines the way you think (your negative thinking), and the behaviour therapy element which examines your actions (unhealthy behaviours). Although CBT is present-focused, the root of your negative thinking might stem from childhood, as your past experiences could be affecting your current outlook on the world. Therefore, if you experience maladaptive thoughts such as “I’m a terrible person – I’ll never be good enough” then your therapist might explore issues such as your relationship with your parents.
Together with your therapist, you will work at identifying your negative thoughts, which are usually automatic, and how they impact how you feel and behave. Once you have done this, you can both figure out how best for you to challenge these thoughts, so that you no longer just accept them as fact.
The history of CBT
The influence of CBT is evident throughout the field of modern psychology, but its foundations can be traced back to as early as 1913 in the work of behaviourist John B. Watson.
Before CBT existed, behaviour therapy was used to manage mental health issues such as anxiety and depression. Essentially, behaviourism is based on the idea that all behaviours are learned through positive and negative interactions with your environment. In time, this led to the theory of positive and negative reinforcement to encourage healthy, adaptive behaviours. This was expanded on in the 1950s by Dr Albert Ellis, in his work on Rational Emotive Behaviour Therapy (REBT), where he proposed that once people can identify their negative thoughts it is then possible to challenge them and move on to more rational and accurate ones.
Aaron T. Beck founded CBT in the 1960s as a response to the earlier work in the fields of behavioural and cognitive psychology. He noticed that depressive patients tended to have streams of negative thoughts without any clear origin and assigned them to three different categories:
- Having negative thoughts about yourself
- Having negative thoughts about the world
- Having negative thoughts about the future
Beck referred to these three categories as The Cognitive Triad and used it to help his patients develop healthier thoughts which enabled them to successfully manage day-to-day tasks. After a series of trial and error experiences in the development of the programme, CBT eventually grew in popularity and in the mid-1970’s it started to be used for mood disorders such as anxiety and depression.
The CBT model continued to expand and absorb other models to increase in efficiency and treatment outcomes. This included The Tripartite Model which suggests that there is a similar frequency and distribution of symptoms between anxiety disorder and depression. Even today, CBT is still expanding and developing as a result of new research findings, making it one of the most efficient methods of treating mental health problems available.
How does an ABC analysis work?
The ABC model is a basic CBT technique that relies on the idea that you don’t have to change your environment to be happy, but instead, you should challenge your outlook and reactions. Proposed by Dr Albert Ellis in 1979, the ABC model helps you to understand how your thoughts can trigger unhealthy feelings and cognitive distortions. It, therefore, aids you in challenging and restructuring them more healthily.
An ABC analysis involves directly observing and recording the circumstances around a problem behaviour. ABC refers to the individual components of the model:
A – antecedent (what happens before the event occurs)
B – behaviour/belief (how you choose to respond to A based on your conscious and subconscious thoughts)
C – consequence (the response to the behaviour)
A – you give a child a box of building blocks and ask them to assemble them (the antecedent)
B – the child responds to your request by throwing the box and all its pieces on the floor (the behaviour)
C – they are given a time-out and made to pick up all the pieces before they can return to the activity (the consequence)
During therapy, your therapist will help you to unpick any automatic thoughts or beliefs that might be underlying your responses to an antecedent. They will also guide you in re-evaluating your responses and help you to understand why they might be inaccurate. Over time, you may start to recognise your thoughts and beliefs around events that you see as a problem, and, with your therapist, learn how to respond in more constructive ways.
What areas does CBT treat?
One of the main reasons for CBT’s wide popularity is its ability to be adapted to suit a wide range of issues, from mental health problems to physical issues, to a combination of both. The National Institute for Health and Care (NICE) advocates the use of CBT for anxiety and depression in particular, but it’s also suitable for use with many other mental health issues.
The following are the mental health issues that CBT can help with:
CBT can also help with the mental-health-related issues of:
- Drug and alcohol abuse
- Problems with sleeping
- Anger management issues
- Relationship issues
The following are the physical health issues that CBT can help with:
- Chronic pain
- Chronic fatigue syndrome
- Bad habits such as skin picking or facial tics
- Overall general health issues
Are there any disadvantages to CBT?
Whereas there are many advantages to CBT, including the fact that it’s time-effective in comparison to many other forms of talking therapy, and it can be done over a range of different formats, it would be remiss to presume that CBT is suitable for everybody.
Generally, CBT requires clients to have the ability to recognise and talk about their thoughts and feelings, and distinguish between them. However, if a client has difficulties reflecting in this way, the psychologist can support him/her to increase his/her ability by offering a trial of a few sessions to explore whether the client can adopt himself/herself to this approach.
CBT requires the psychologist to work with the client to maintain structure during the sessions, meaning that they might talk more than other psychologists in the beginning. However, much of this talking is in the form of questions, especially at the beginning of the therapy. As the therapy sessions progress, the client has more responsibility to work with the psychologist – this may include completing homework tasks between sessions.
What is the cost of a CBT treatment?
One of the thoughts that cross many people’s minds when considering whether they should go down the route of therapy is whether or not they can afford it. CBT has an advantage over many other therapies in terms of cost as it is typically a short-term treatment. This doesn’t mean that it is a quick fix, but it focuses on the present instead of delving into the past, so it helps you to develop the necessary skills for you to manage your issues by yourself. This might mean that you could see a change in approximately 4-6 weeks depending on your specific issues, making it an affordable option for many people.
Depending on where you live, you might be able to get psychological therapies such as CBT included in your national health service. However, if this is not an option for you, or if you would prefer to speed up the waiting time by going private, then the cost of therapy can range between £40 to £100 per session. It might be advisable to check the cost of your chosen therapist before committing to sessions.
How does CBT work online?
CBT has been shown to produce the same benefits for mental health when conducted online as when it is done face to face. Similar to face to face sessions, in online sessions, you will work one to one with a therapist in identifying your problems, but you will be either videoing or typing instead of physically being there. Many people who experience issues with social anxiety find this approach to be considerably less daunting and as a result, they can open up more and address the core of their problems. Online sessions are usually as frequent as face to face ones (typically once a week) and last up to sixty minutes.
However, online sessions should only be delivered by a trained professional in the area of CBT. If you are wondering whether online CBT is right for you, then it might be best to chat with your GP, as they can provide you with a list of approved programmes.
How can I find a licensed CBT therapist?
If you have decided to seek therapy, then you might be feeling unsure about how to choose a therapist.
Licensed CBT therapists have an accredited postgraduate qualification in CBT, as well as a background of experience working in mental health. To be accepted onto a CBT training course they need to have a degree in a related field such as psychology, mental health nursing, or social work. Oftentimes, the background of the therapist can influence the placement of emphasis during sessions, so if you’re wondering which route to take then it may be helpful to seek guidance from a professional such as your GP – they can advise you on the best route to take, or else refer you to a therapist. Just ensure that you choose a therapist that is accredited in your country. In the UK, you can find out if your chosen therapist is accredited by checking www.cbtregisteruk.com.
Can I get CBT treatment through the NHS?
You can get CBT (as well as other psychological therapies) through the NHS. You can also refer yourself to the psychological therapies service through the IAPT (Improving Access to Psychological Therapies) without a GP referral if you live within the UK and are aged over eighteen. The IAPT services can provide talking therapies such as CBT, as well as guidance for mental health issues such as anxiety and depression.
If you decide to go down the private health care route, you might be able to get it subsidised depending on your income. However, if you pay for it upfront, then it might be difficult to get it reimbursed by the NHS. If this is something that concerns you then perhaps you should speak to your GP or another health professional for guidance or a referral.
CBT online at Mindler
At Mindler, we offer CBT treatment via our secure app, regardless of where you live. We provide CBT in over twenty different languages and ensure that we pair you with the best therapist for your issues. From the comfort of your own home, we can offer a service that is tailored to your needs, at a time that suits you. This means that we can give therapy in a non-invasive manner while still achieving change and results. If you’re wondering whether your NHS provider or private insurance might cover Mindler treatment, then follow this link and we can help.
Last updated on: 2021.06.28
Author: Jemma Strain
Reviewed by: Dr. Nahid Karamali