Cognitive behaviour therapy (also often referred to as cognitive behavioural therapy or CBT) is a form of psychotherapy that has, through scientific research, been proven to help with a number of problems, such as stress, low self-esteem, anger and phobias.
Does CBT work?
It is recommended in the guidelines of the National Institute for Health and Clinical Excellence (NICE) for treatment of depression, anxiety, eating disorders, insomnia, self-harm, obsessive compulsive disorder, and post-traumatic stress disorder as well as schizophrenia, among other things. Aside from medication, CBT is the number one treatment offered by the NHS for depression and anxiety, for which it is found to be particularly effective.
Why does CBT work?
The way we interpret events is of key importance to how we think, particularly as problematic thoughts lead to negative emotion and/or unhelpful behaviour. One of the central aims of CBT is to identify how we appraise events and this is achieved in CBT by analysing thoughts, behaviour and emotions using a technique known as the ABC model. See the illustration below of the 'ABC model' in use.
A = Activating event
Your manager asks whether you have completed a work assignment
B = Beliefs
You think: 'She thinks I'm slacking', 'She is checking up on me', 'She thinks I'm not up to the job'
C = Consequences
You behave: Defensively and lie saying you have nearly finished it when in fact there is still a lot to do. You feel: stressed, angry and annoyed
This demonstrates that to feel better and change your behaviour, you have to start by changing your thoughts.
Different types of CBT
Mindfulness based cognitive therapy (MBCT)
Mindfulness is concerned with the ability to focus on the present and how we're feeling right now, both internally and externally, on a moment to moment basis. MBCT is based on traditional CBT techniques in combination with mindfulness and mindfulness meditation. Like CBT, MBCT maintains that negative thoughts trigger depression and that a repeated episode of depression results when we return to these thoughts. MBCT teaches us to observe and accept these thoughts and reflect on them, and other incoming stimuli, rather than react to them.
Mindfulness-based cognitive therapy has been shown to be effective for people who suffer repeated bouts of depression. Research has shown that the chances of depression returning for clients undertaking MBCT, who have been clinically depressed three or more times (sometimes for 20 years or more) are halved.
Acceptance and commitment therapy (ACT)
Acceptance and commitment therapy, or ACT as it is commonly called, is a form of CBT that employs a combination of mindfulness, behavioural-change strategies, defusion or distancing techniques such as acceptance of these internal processes, and commitment to values-based living. Although relatively new in terms of research, ACT has been shown to be effective in the treatment of workplace stress, burnout, chronic pain, addictions, smoking cessation, depression, anxiety, self-harm, body dissatisfaction, eating disorders and psychosis, to name a few.
Like MBCT, ACT teaches us to notice, accept and embrace negative thoughts, feelings, and private events, rather than control them, paying particular attention to those that are unwanted. In learning to free ourselves from these processes and merely observing and experiencing them, we can discover what is really important and how we want our lives to be.
Compassion focused therapy (CFT)
CFT, also known as compassion mind training, employs CBT techniques to encourage self-soothing behaviour and the development of self-compassion in those of us who are prone to high levels of shame and self-criticism. These characteristics are often prevalent in clients experiencing depression and anxiety and this form of therapy has been shown to be effective in treating these problems, as well as eating disorders. More generally, CFT is believed to benefit everyone as it encourages us to be non-judgmental and improves emotional regulation and tolerance to distress.
CFT, which originates from Mahayana Buddhist psychology, considers compassion and mindfulness of crucial importance in healing the mind, as well as the development of four key skills, namely: compassionate attention, compassionate thinking, compassionate behaviour, and compassionate feeling.
Much like ACT, CFT helps us become aware of our automatic responses but also encourages us to increase our understanding of these in terms of how experiences are learned from early childhood and how they have evolved in humans over millions of years.
The aims of CFT are to increase our awareness of our problems and needs and to inspire us to care for our own wellbeing in a way that develops self-understanding and warmth towards ourselves.
Regardless of the form CBT takes, its aim is to get us to a point where we can 'do-it-ourselves' and work on tackling our own problems.
- Sessions are structured, goal-oriented and time limited
- Therapy focuses on the here and now and not the client's past
- Therapist and client work collaboratively to understand difficulties and develop strategies to enable change for the better
- Homework is a central element
- Clients acquire new skills through practice and experience for self change
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