Theory and Practice of Cognitive Behavioural Therapy (CBT)

How and Where CBT Is Used

CBT tends to be used short-term (when the length of therapy is limited), and has been much researched using randomised controlled trials. It is widely used by the National Health Service in the UK, sometimes as an alternative to – and often in combination with – medication for anxiety (including obsessive-compulsive disorder and post-traumatic stress disorder) and/or depression (including bipolar disorder). It can also be useful for clients with eating disorders, relationship difficulties, chronic pain, insomnia or body dysmorphic disorder – and to support smoking cessation.

 

Theory of CBT

The idea is that modifying dysfunctional thinking and behaviour improves symptoms – and that modifying the dysfunctional beliefs that underlie dysfunctional thinking leads to longer-lasting change.

CBT practitioners believe that negative emotions are triggered by cognitive processes developed through the influences of learning and personality. Adverse life events elicit negative automatic thoughts (deriving from our understanding of ourselves, others and the future); these thoughts are believed to cause mental-health difficulties.

CBT examines the client’s cognitive beliefs, helps the client identify the cognitive errors they are most likely to make, and develops rational responses to negative automatic thoughts.

 

Negative Automatic Thoughts

These happen spontaneously in response to situations, and often occur in the form of words or images; they are irrational, follow no logical sequence, are hard to turn off, and may be difficult to articulate.

These thoughts often follow similar patterns, as clients tend to make consistent errors in their thinking, for example:

• emotional reasoning, in which the client believes feelings to be facts
• catastrophising, in which the client believes the worst is bound to happen
• all-or-nothing thinking , in which the client thinks that everything must be completely good or bad, with no ‘shades of grey’
• mind-reading, in which the client assumes they know what other people are thinking
• personalising, in which clients feel responsible for things outside their control.

 

Core Beliefs

Negative automatic thoughts are underpinned by core beliefs, which influence how clients process information and organise their understanding of their experiences. These core beliefs may not be evident until they are activated by stress or difficult life events. There are three key categories of core beliefs, with the client believing they are:

• helpless – e.g. incompetent, powerless, weak or inferior
• unloveable – e.g. unwanted, unattractive, boring or defective
• worthless – e.g. bad, toxic or undeserving of life.