What is cognitive behaviour therapy?
Cognitive Behaviour Therapy (CBT) is a form of talking therapy that combines cognitive therapy and behaviour therapy. It focuses on how you think about the things going on in your life – your thoughts, images, beliefs and attitudes (your cognitive processes) – and how this impacts on the way you behave and deal with emotional problems. It then looks at how you can change any negative patterns of thinking or behaviour that may be causing you difficulties. In turn, this can change the way you feel.
CBT tends to be short, taking six weeks to six months. You will usually attend a session once a week, each session lasting either 50 minutes or an hour. Together with the therapist you will explore what your problems are and develop a plan for tackling them. You will learn a set of principles that you can apply whenever you need to. You may find them useful long after you have left therapy.
CBT may focus on what is going on in the present rather than the past. However, the therapy may also look at your past and how your past experiences impact on how you interpret the world now.
CBT and negative thoughts
CBT theory suggests that it isn't events themselves that upset you, but the meanings you give to them. Your thoughts can block you seeing things that don't fit in with what you believe to be true. You may continue to hold on to these thoughts and not learn anything new.
For example, if you feel low or depressed, you may think, "I can't face going into work today. I can't do it. Nothing will go right." As a result of these thoughts – and of believing them – you may call in sick.
By doing this you are likely to continue to feel low and depressed. If you stay at home, worrying about not going in, you may end up thinking: "I've let everyone down. They will be angry with me. Why can't I do what everyone else does?" Consequently, you may judge yourself as being a failure and give yourself more negative feedback such as: "I'm so weak and useless."
You will probably end up feeling worse, and have even more difficulty going to work the next day. Thinking, behaving and feeling like this may start a downward spiral. It may be part of an automatic negative way of thinking.
By continuing to think and behave in this way, you won't have the chance to find out that your thinking and prediction may be wrong. Instead, the way you think and act can lead you to be more convinced that what you are thinking is true. In CBT, you will learn to recognise how you think, behave and feel. You will then be encouraged to check out other ways of thinking and behaving that may be more useful.
How does negative thinking start?
Negative thinking patterns can start in childhood, and become automatic and relatively fixed. For example, if you didn't get much open affection from your parents but were praised for doing well in school, you might think: "I must always do well. If I do well, people will like me; if don't, people will reject me." If you have thoughts like these, this can work well for you a lot of the time; for example, it can help you to work hard and do well at your job. But if something happens that's beyond your control and you experience failure, then this way of thinking may also give you thoughts like: "If I fail, people will reject me." You may then begin to have 'automatic' thoughts like, "I've completely failed. No one will like me. I can't face them."
CBT can help you understand that this is what's going on and can help you to step outside of your automatic thoughts so you can test them out. For example, if you explain to your CBT therapist that you sometimes call in sick because you feel depressed, the therapist will encourage you to examine this experience to see what happens to you, or to others, in similar situations. You may agree to set up an experiment where you will agree to go to work one day when you feel depressed and would rather stay at home. If you go to work, you may discover that your predictions were wrong. In the light of this new experience, you may feel able to take the chance of testing out other automatic thoughts and predictions you make. You may also find it easier to trust your friends, colleagues or family.
Some of the work we did involved looking at the way I interacted with people, e.g. if somebody had seemed to reject me, I’d write a list of all the reasons against why the way I was thinking might be incorrect. This helped me see things from the other person’s perspective, and realise I might be wrong in my assumptions.
Of course, negative things can and do happen. But when you feel depressed or anxious, you may base your predictions and interpretations on a 'faulty' view of the situation. This can make any difficulty you face seem much worse. CBT helps you to understand that if things go wrong or you make a mistake, this does not mean that you are a failure or that others will see you as a failure.