2.1 Cognitive Behavioural Therapy

Talking therapies, especially CBT (Cognitive Behavioural Therapy), can be useful in a range of mental health problems, for example depression, anxiety, post-traumatic stress, panic disorder, obsessive-compulsive disorder and body dysmorphic disorder. You will recall one of the parents talking about her daughters mental health in Session 1 and how she benefited from CBT. Although CBT is usually conducted face-to-face on a one-to-one basis, it is increasingly offered online, usually as an adjunct to appointments with a therapist, and has been found successful (van der Zanden et al., 2012; Spence et al., 2011).

The idea behind CBT is that a young person is helped to examine and to challenge the way they think as well as what they do. Thoughts, emotions, physical symptoms and actions (behaviour) interact in all directions. Briefly familiarise yourself with the diagram below and then move on to the activity.

Figure _unit9.2.1 Figure 3: What is CBT?

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An illustration of a flow chart with questions that lead to other options. At the top, the box states ‘Feeling’ ‘I feel anxious’. There are then two options. On the right, the option is ‘Thoughts’ ‘I can’t do this’ ‘What is wrong with me’, ‘Everyone is looking at me’. On the left, the box has ‘Behaviour’, ‘Get away from the situation’, ‘Avoid it in future’. Below this is another, seperate box that has ‘feeling’ ‘I feel low/depressed’. There are then two options. On the right, a box with ‘Thoughts’, ‘I’ve let everyone down’, ‘They’ll be angry with me’, ‘I’m not a good friend’. On the left is a box with ‘behaviour’ ‘Withdraw from others’, ‘Avoid friends’. The two sets of three boxes all have arrows interlinking to one another within the set of three.

Figure 3: What is CBT?

Activity _unit9.2.1 Activity 4: Making sense of CBT

Timing: Allow about 15 minutes

Imagine that a young person you are caring for or supporting has been referred for CBT. They don’t think talking will help and complain that they don’t want to ‘lie on a couch discussing their dreams’. Watch this video and make a note of some of the things you can say to help address their concerns and convince them to give therapy a go.

Download this video clip.Video player: Video 2: What is CBT? | Making Sense of Cognitive Behavioural Therapy

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Transcript: Video 2: What is CBT? | Making Sense of Cognitive Behavioural Therapy

Making sense of CBT. A guide to what CBT is and how you can decide whether it’s best for you.

If you’re living with a mental health problem, it can be hard to know which way to turn or what to do to feel better. You might go to your GP, and one of the first things they might offer is CBT, which stands for cognitive behavioral therapy. It combines cognitive therapy, examining the things you think, and behavioral therapy, examining the things you do.

The word therapy might make you think of laying on a couch talking to a man with spectacles and a beard about your childhood while he analyzes your dreams, but CBT is actually a very practical type of talking therapy, which focuses on goals and focuses mostly on the present day and things that are affecting you in your life now.

The theory behind CBT is that the way we think about situations can affect the way we feel and behave. It does this by dealing with how your thoughts affect your feelings and behaviors, and teaches you coping skills for dealing with different problems.

For example, you might make a simple mistake like, say, burning the dinner. This might make you think bad things and it might make you feel worthless and inadequate, which could lead you to do things like withdrawing, snapping at your family, or trying to avoid things which you think might go wrong.

Or perhaps you’ve been invited out for drinks with some friends and you start thinking negative things. This might make you feel anxious and scared, which might make you do something like saying no to the invite, avoiding your friends completely, or using drink and drugs to cope with the situation.

Over time, whether it’s years, weeks, or months, this cycle of thoughts, feelings, and behaviors may have happened so many times it’s become like a habit. You start avoiding situations more and more or automatically blame yourself if something goes wrong. And the more you do these things, the worse it can get.

A CBT therapist will help you break this cycle and figure out what sorts of negative feelings, thoughts, and behaviors might be contributing to the problems you’re experiencing. They will help you deal with your negative thinking and help you change your behavior, both of which will lead to an improvement in your mood. CBT can be helpful for people with nearly every diagnosis you can think of, and can be delivered through one on one sessions, in groups, self-help books, online, or through a CD-ROM.

That doesn’t mean that CBT works for everyone though. Some people struggle with it because they find it just too hard to talk about their feelings. CBT is usually quite a short term treatment. And so you may find that your problems are too complex to deal with in the time. It can also be quite hard work. Your therapist will probably set you homework, and you have to really practice the skills they teach you to see a difference in how you’re feeling.

If you don’t think CBT is the right treatment for you, you should be able to talk to your GP about what alternatives there are. The Mind website also has lots of information about the different treatments that are available for a wide range of mental health problems. And Mind’s infoline can also talk to you about what you might find helpful.

End transcript: Video 2: What is CBT? | Making Sense of Cognitive Behavioural Therapy

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Video _unit9.2.1 Video 2: What is CBT? | Making Sense of Cognitive Behavioural Therapy

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Discussion

It’s about helping a person to manage their mental health challenges while staying in the present, and teaching coping skills. It can help the young person understand how their negative thoughts are affecting the way they feel and act. If CBT turns out to be unhelpful, there is no shame in asking to try alternative approaches.

A key skill for CBT practitioners is active listening. You will remember addressing skills in listening in Session 6. You may have noticed in the video that the therapist’s questions follow closely from the patient’s descriptions of his feelings, gently prompting exploration of his beliefs. CBT therapists need to listen carefully and attentively so that they can ‘tune in’ effectively to the patient.