When people are struggling with different challenges in their lives they may do a quick google search to look for psychological support – often this search will be for ‘counselling’ rather than the wordy ‘Cognitive Behavioural Therapy’. Given the scientific and alien-sounding name it is understandable that it’s a less popular or common term amongst the general public. However the fact CBT is recommended by the NICE (National Institute of Clinical Excellence - the people that recommended different forms of treatment to the NHS based on research) as the psychological treatment for a range of anxiety disorders and depression should make it surprising that it is a lesser known therapeutic entity.
In a nutshell CBT is all about how people’s thoughts, feelings and behaviours are interlinked and have a reinforcing impact on one another. The ‘cognitive’ part is a psychological term for thought processes and this part of therapy looks at how the way we think and the beliefs we have affect how we feel and how we respond. The ‘behavioural’ part relates to our actions - this part of therapy explores what we do or don’t do and how some behaviours can be unhelpful to us and keep us feeling and thinking in a negative way.
Take the example of someone you know ignoring you when you see them in the street; the thoughts you have about this will influence how you feel and how you respond but likewise how you respond will influence subsequent thoughts and feelings.
One person in this situation might think ‘how dare they ignore me, who do they think they are’ causing them to feel angry and leading them to ignore the person next time they saw them and likely staying angry with them. Another may think ‘they mustn’t like me/have I upset them?’ causing them to feel down, ruminate and withdraw from that person thus reinforcing the feeling of sadness. Someone else might have the thought ‘they might not have seen me, they might have a lot going on’ leading to them feeling indifferent about the situation and getting the person’s attention to say hello. This illustrates how one event can be interpreted in a number of ways and the way it is interpreted will have ongoing influence over our emotions and behaviour.
An important thing to remember is; the thoughts guiding our interpretations are opinions and not facts. We can only assume the reason for that person’s lack of acknowledgement. Yet when we are low or anxious our thoughts become more negative – it’s as if we have a negative mental filter that only allows in information to support our negative thoughts such as; ‘I saw her/him look at me so they must have recognised me and ignored me on purpose’. I for one know that I often walk around ‘in my own world’ and it wouldn’t surprise me if I had inadvertently ignored a familiar face on occasion. The thing with depression and anxiety is; the negative thoughts we experience generate such a negative feeling that the opinions we have start to feel real and we take them as fact. However the reality is we never know what someone else is thinking and there are usually a number of possible alternative perspectives on any given situation where we don’t have all the facts.
This is where CBT comes in. CBT helps with this by teaching people to identify their unhelpful thought processes and start looking for actual evidence to support or disconfirm their thoughts. Considering the evidence allows the negative thoughts to be challenged and the generation of more rational interpretations/perspectives. Once you stop taking negative thoughts as facts you are no longer reinforcing negative feelings and unhelpful behaviours. Therefore challenging your thinking can help you break free from the vicious negative cycle maintaining your depression or anxiety.
I hope this post goes some way to explain what CBT is all about and helps it seem a little less mysterious and obscure. Whilst it's name can make it sound complicated it's really all about how the way we think and behave affects our emotions.
In a later post I will talk more about the unhelpful role of certain behaviours and how behaviour can make it difficult to challenge and change negative beliefs.