What is Cognitive Behaviour Therapy?

CBT is a structured talking therapy based upon examining, and understanding, the relationship between thoughts, emotions, behaviours and physiological sensations (or how we feel in our body). The premise is that all four are locked in a continuous feedback loop - also interacting with our environment, such as situations, places or certain triggers. Most people come to therapy due to emotional difficulties, or wanting to shift something about how they feel. The problem is ‘feelings’ are not directly under our ‘control’. However, CBT suggests that, if we experiment with changes in how we think, act and feel physically, we can influence and guide how we feel emotionally. 

CBT focuses on looking at our thoughts with both depth and objectivity - understanding that thoughts are just perspectives and not facts. As such we look for errors, patterns, inaccuracies in how we think and experiment with different perspectives. Like emotions, our thoughts are not under our ‘control’ as such - we cannot command or silence them - but we can understand them better and, with better understanding, shift how we respond to them, The same is true of physiological sensations - we cannot command our hearts to stop beating so fast, or our faces to stop blushing - but we can educate ourselves to understand and to respond more helpfully to these sensations. This directly impacts how we feel and even the intensity of the sensations themselves.

CBT also assumes that our behaviours - whilst heavily influenced by habit and various other factors - are within our control. We don't have the power to control our emotions but we can take a structured, helpful, long term outlook on what we do. 

A common and simplistic CBT informed cycle might be as follows; we have a thought, this leads to an emotion, to ‘manage’ that emotion we engage in a behaviour. The difficulty is that when this emotion is challenging, the behaviour is often focussed on obliterating that challenging emotion as quickly as possible. Although successful in the short term these behaviours often have longer term costs, which perpetuate the initial negative thinking. Take the example of giving a presentation at work. You might have anxiety driven thoughts about the presentation, resulting in catastrophised images of yourself tripping over your words, blushing or even forgetting your ideas altogether. As a result you feel anxious, self conscious - you might even start to panic in advance. If these thoughts and images are given too much headspace and become too dominant you might begin to think of behaviours to quell the emotions - ways to avoid the presentation such as asking a colleague to take over or even calling in sick.

CBT aims to interrupt these negative cycles, firstly identifying any patterns to the triggers (Do you always feel this way about public speaking? Since when? Have there been any exceptions?). We then look at either unhelpful or inaccurate thinking styles (‘Everyone will laugh at me’, ‘I totally messed that up’) and consider ways to challenge or reframe them. We also look at the physiological sensations that follow those thinking styles, to better understand the relationship between how we think and how we feel in our bodies. The more panicked you feel in your body, the greater the messaging of danger to brain - our brains cannot distinguish between a potential threat and a realised one. 

Simultaneously we look at the behaviours you are tempted to engage in to manage your emotions, considering less reactive and intense ways of coping. We also look at short term and long term consequences. For example - If you didn’t give the presentation you would feel less anxious in that moment - but what would that do for your anxiety over time? The irony is that whatever behaviour we engage in to 'run from' difficult emotions in the short term, tends to ignite that very emotion over time. Finally, we collaboratively find ways to experiment with responding differently - behaviourally - to certain situations to test the outcomes and what we can learn from them.

The example above is simplistic in itself - and doesn't do full service to the work also included in CBT, that looks at past and formative experiences, as well as deeply held beliefs to understand the relation between these and the thoughts we have day to day. (This is partly because public speaking is an act that tends to invoke some level of fear in most people who - and this is key! - have not had considerable exposure; in this respect it would be an example where looking at at past experiences might be less relevant). With that said, in many respects CBT is a often a straight forward form of therapy - applying a degree of knowledge and understanding that many of us have, but can get lost on the day to day rush and confusion of every day life.

If you haven't yet had CBT and are curious about it could offer I would encourage you to use the 'Contact' page to request my five basic worksheets that can give you a taste of the principles. I would also welcome you to enquire about a discovery call, if one to one therapy would be of interest, and you are interested in a more personalised approach and/ or deeper dive into your current state of mind.