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.

http://www.mind.org.uk/mental_health_a-z/8000_cognitive_behaviour_therapy

What type of problems can CBT help with?

CBT can be an effective therapy for a number of problems:

 anger management
 anxiety and panic attacks
 chronic fatigue syndrome
 chronic pain
 depression
 drug or alcohol problems
 eating problems
 general health problems
 habits, such as facial tics
 mood swings
 obsessive-compulsive disorder (OCD)
 phobias
 post-traumatic stress disorder
 sexual and relationship problems
 sleep problems.

CBT does not claim to be able to cure all of the problems listed. For example, it does not claim
to be able to cure chronic pain or disorders such as chronic fatigue syndrome. Rather, CBT
might help someone with arthritis or chronic fatigue syndrome, to find new ways of coping
while living with those disorders.

There is also a new and rapidly growing interest in using CBT (together with medication) with
people who suffer from hallucinations and delusions, and those with long-term problems in
relating to others.
Limitations

It's less easy to solve problems that are severely disabling and long-standing through short-term
therapy. But you can still learn principles that improve your quality of life and increase your
chances of making further progress.

Experts know quite a lot about how they can help people who have relatively clear-cut problems,
eg if you know your problem is a fear of spiders. They know much less about how the average
person may do – somebody, perhaps, who has a number of problems that are less clearly defined.
Sometimes, therapy may have to go on longer to do justice to the number of problems and to the
length of time they've been around.

CBT may be less suitable if you feel generally unhappy or unfulfilled but don't have troubling
symptoms or a particular aspect of your life you want to work on.

What happens in a CBT session?

CBT sessions have a structure. At the beginning of the therapy, you will meet with the therapist
to describe specific problems and to set goals you want to work towards.

When you have agreed what problems you want to focus on and what your goals are, you start
planning the content of sessions and discuss how to deal with your problems. Typically, at the
beginning of a session, you and the therapist will jointly decide on the main topics you want to
work on that week. You will also be given time to discuss the conclusions from the previous
session. With CBT you are also given homework, and you will look at the progress made with
the homework you were set last time. At the end of the session, you will plan another homework
assignment to do outside the sessions.

The importance of structure

This structure helps to use the therapeutic time efficiently. It also makes sure that important
information isn't missed out (the results of the homework, for instance) and that both you and the
therapist have a chance to think about new assignments that naturally follow on from the session.

To begin with, the therapist takes an active part in structuring the sessions. As you make progress
and grasp the ideas you find helpful, you will take more and more responsibility for the content
of the sessions. By the end, you should feel able to continue working on your own.

Learning coping skills

CBT teaches skills for dealing with different problems. For example:

 If you feel anxious, you may learn that avoiding situations actually increases fears.
Confronting fears in a gradual and manageable way can give you faith in your own
ability to cope.
  If you feel depressed, you may be encouraged to record your thoughts and explore how
you can look at them more realistically. This helps to break the downward spiral of your
mood.
 If you have long-standing problems in relating to other people, you may learn to check
out your assumptions about other people's motivation for doing things, rather than always
assuming the worst.

The client-therapist relationship

CBT favours an equal relationship. It is focused and practical. One-to-one CBT can bring you
into a kind of relationship you may not have had before. The 'collaborative' style means that you
are actively involved in the therapy. The therapist seeks your views and reactions, which then
shape the way the therapy progresses. The therapist will not judge you. This may help you feel
able to open up and talk about very personal matters. You will learn to make decisions in an adult
way, as issues are opened up and explained. Some people will value this experience as the most
important aspect of therapy.

Group sessions

CBT is usually a one-to-one therapy. But you may also be offered group sessions. You may find
it helpful to share your difficulties with others who have similar problems, even though this may
seem difficult at first. The group can also be a source of valuable support and advice, because it
comes from people with personal experience of a problem.

How effective is CBT?

Clinical trials have shown that CBT can reduce the symptoms of many emotional disorders. For
some people it can work just as well as drug therapies at treating depression and anxiety
disorders. The National Institute for Health and Clinical Excellence (NICE) recommends CBT
via the NHS for common mental disorders, such as depression and anxiety.

Comparisons with other types of short-term psychological therapy aren't clear-cut. Other
therapies, e.g. inter-personal therapy and social skills training, are also effective. The challenge is
to make all talking therapies as effective as possible, and also, perhaps, to establish who responds
best to which type of therapy.

I attribute the success of CBT to the skills of my therapist; my starting therapy at a time when I
was motivated to change; a structured programme tailored to my individual needs; and my
determination.

http://www.mind.org.uk/mental_health_a-z/8000_cognitive_behaviour_therapy

Is CBT for me?

CBT is more likely to be helpful to you if can relate to its ideas around thought and behaviour
patterns, its problem-solving approach and the need for homework. People tend to prefer CBT if
they want a more practical treatment – where gaining insight isn't the main aim.

The importance of doing homework

The sessions provide invaluable support. But most of the life-changing work takes place between
sessions.

You are most likely to benefit from CBT if you are willing to do assignments at home.

For example, if you experience depression you may feel that you are not able to take on social or
work activities until you feel better. CBT may introduce you to an alternative viewpoint – that
trying some activity of this kind, however small-scale to begin with, will help you feel better. If
you are open to testing this out, you could agree to do a homework assignment, say to go to the
cinema with a friend.

You may make faster progress, as a result, than someone who feels unable to take this risk.

Making a decision

If you are referred for a treatment through the NHS, you will usually be assessed before you are
allocated a treatment or a therapist. The assessor will check out what your problems are, and can
then decide with you if CBT is likely to be helpful for you.

If you choose to see a therapist privately, many will offer a free consultation, so you get a chance
to discuss directly with the therapist what you want help with. You can then decide if you feel
this therapy might be right for you.

Don't be afraid to ask questions during the assessment. It will be helpful for both you and the
therapist if you raise any concerns before therapy starts.

http://www.mind.org.uk/mental_health_a-z/8000_cognitive_behaviour_therapy

Cognitive-Behavioral Therapy...
is a form of psychotherapy that emphasizes the important role of thinking in how we feel and what we do.

Cognitive-behavioral therapy does not exist as a distinct therapeutic technique. The term
"cognitive-behavioral therapy (CBT)" is a very general term for a classification of therapies with
similarities. There are several approaches to cognitive-behavioral therapy, including Rational Emotive
Behavior Therapy, Rational Behavior Therapy, Rational Living Therapy, Cognitive Therapy, and Dialectic
Behavior Therapy.

However, most cognitive-behavioral therapies have the following characteristics:

1. CBT is based on the Cognitive Model of Emotional Response.
Cognitive-behavioral therapy is based on the idea that our thoughts cause our feelings and behaviors, not
external things, like people, situations, and events. The benefit of this fact is that we can change the way
we think to feel / act better even if the situation does not change.

2. CBT is Briefer and Time-Limited.

Cognitive-behavioral therapy is considered among the most rapid in terms of results obtained. The
average number of sessions clients receive (across all types of problems and approaches to CBT) is only
16. Other forms of therapy, like psychoanalysis, can take years. What enables CBT to be briefer is its
highly instructive nature and the fact that it makes use of homework assignments. CBT is time-limited in
that we help clients understand at the very beginning of the therapy process that there will be a point
when the formal therapy will end. The ending of the formal therapy is a decision made by the therapist
and client. Therefore, CBT is not an open-ended, never-ending process.

3. A sound therapeutic relationship is necessary for effective therapy, but not the focus.
Some forms of therapy assume that the main reason people get better in therapy is because of the
positive relationship between the therapist and client. Cognitive-behavioral therapists believe it is
important to have a good, trusting relationship, but that is not enough. CBT therapists believe that the
clients change because they learn how to think differently and they act on that learning. Therefore, CBT
therapists focus on teaching rational self-counseling
skills.

4. CBT is a collaborative effort between the therapist and the client.

Cognitive-behavioral therapists seek to learn what their clients want out of life (their goals) and then help
their clients achieve those goals. The therapist's role is to listen, teach, and encourage, while the client's
roles is to express concerns, learn, and implement that learning.

For excellent cognitive-behavioral therapy self-help and professional books,

audio presentations, and home-study training programs, please click here.

5. CBT is based on aspects of stoic philosophy.

Not all approaches to CBT emphasize stoicism. Rational Emotive Behavior Therapy, Rational Behavior
Therapy, and Rational Living Therapy emphasize aspects of stoicism. Beck's Cognitive Therapy is not
based on stoicism.

Cognitive-behavioral therapy does not tell people how they should feel. However, most people seeking
therapy do not want to feel they way they have been feeling. The approaches that emphasize stoicism
teach the benefits of feeling, at worst, calm when confronted with undesirable situations. They also
emphasize the fact that we have our undesirable situations whether we are upset about them or not. If
we are upset about our problems, we have two problems -- the problem, and our upset about it. Most
people want to have the fewest number of problems possible. So when we learn how to more calmly
accept a personal problem, not only do we feel better, but we usually put ourselves in a better position
to make use of our intelligence, knowledge, energy, and resources to resolve the problem.

6. CBT uses the Socratic Method.

Cognitive-behavioral therapists want to gain a very good understanding of their clients' concerns. That's
why they often ask questions. They also encourage their clients to ask questions of themselves, like,
"How do I really know that those people are laughing at me?" "Could they be laughing about something
else?"
7. CBT is structured and directive.
Cognitive-behavioral therapists have a specific agenda for each session. Specific techniques / concepts
are taught during each session. CBT focuses on the client's goals. We do not tell our clients what their
goals "should" be, or what they "should" tolerate. We are directive in the sense that we show our clients
how to think and behave in ways to obtain what they want. Therefore, CBT therapists do not tell their
clients what to do -- rather, they teach their clients how to do.

8. CBT is based on an educational model.

CBT is based on the scientifically supported assumption that most emotional and behavioral reactions are
learned. Therefore, the goal of therapy is to help clients unlearn their unwanted reactions and to learn a
new way of reacting.

Therefore, CBT has nothing to do with "just talking". People can "just talk" with anyone.

The educational emphasis of CBT has an additional benefit -- it leads to long term results. When people
understand how and why they are doing well, they know what to do to continue doing well.

9. CBT theory and techniques rely on the Inductive Method.

A central aspect of Rational thinking is that it is based on fact. Often, we upset ourselves about things
when, in fact, the situation isn't like we think it is. If we knew that, we would not waste our time upsetting
ourselves.

Therefore, the inductive method encourages us to look at our thoughts as being hypotheses or guesses
that can be questioned and tested. If we find that our hypotheses are incorrect (because we have new
information), then we can change our thinking to be in line with how the situation really is.

10. Homework is a central feature of CBT.

If when you attempted to learn your multiplication tables you spent only one hour per week studying them,
you might still be wondering what 5 X 5 equals. You very likely spent a great deal of time at home
studying your multiplication tables, maybe with flashcards.

The same is the case with psychotherapy. Goal achievement (if obtained) could take a very long time if
all a person were only to think about the techniques and topics taught was for one hour per week. That's
why CBT therapists assign reading assignments and encourage their clients to practice the techniques
learned.

http://www.nacbt.org/whatiscbt.htm

The range of methods of behaviour modification is very wide and includes:

56
Positive reinforcement: presentation of a reinforcer contingent on a response to
increase the frequency of that response.
Negative reinforcement: increasing the strength of a response by removal of an
Aversive stimulus.
Extinction: withholding of the positive reinforcer for a response until its frequency
declines to a specified level (which may be zero).
Satiation: repeated presentation of a positive reinforcer until it loses its reinforcing
effect.
Fading: transfer of a conditioned response from one stimulus to another in
progressive steps.
Punishment: response-contingent presentation of an aversive stimulus, to decrease
the strength of the response.
Response-cost: a form of punishment: response-contingent removal of positive
reinforcement.
Overcorrection: a form of punishment; contingent on certain unwanted responses,
an alternative behaviour chain is set in motion which this has two forms (a)
restitution, (b) positive practice.
Time out: a response-contingent removal of positive reinforcement, in which the
person is temporarily placed in a minimally reinforcing environment.
Differential reinforcement: this has several variants; each uses positive
reinforcement to increase the frequency of some behaviour other than (DRO) or
incompatible with (DRI) the behaviour to be reduced.
Backward chaining: training a complex series of stimulus-response units
commencing with the final one and working in reverse order.
Successive approximation: approaching a behavioural target by shaping responses
in a series of pre-determined steps, each sequentially closer to the final target.
Behavioural assignment: a task to be performed by an individual, between
treatment sessions, involving performance of a specified behaviour.
Behavioural contract: an agreement between individuals (usually client and
therapist) specifying behavioural expectations, and consequences of performance or
non-performance.
All of the above involve external manipulation of environmental events or of responses
themselves, though as far as possible this should be done with the agreement of all parties
concerned.

Behaviour therapies entail a variety of methods, including the following:

58
Relaxation training: exercises for helping individuals reduce levels of emotional
arousal; the most common method is Progressive Muscular Relaxation developed
by Edmund Jacobson in 1938, though others such as Autogenic Training (a form of
suggestion) may also be used.
Systematic desensitisation: application of relaxation in controlled stages to replace
maladaptive responses, using a hierarchy of stimulus situations presented in
imagination to the client.
Exposure training: progressive presentation of a stimulus or situation which
arouses strong negative emotion, in progressive and controlled steps, using
relaxation or other coping responses at each stage.
Response prevention: physical prevention of a response which has been linked by
an individual to reduction of a negative emotional state.
Flooding: reduction of emotional distress by extinction of avoidance responses. A
normally avoided situation is presented for a prolonged period, with avoidance
being prevented, until the emotional distress is reduced and the conditioned
response is extinguished.
Covert sensitisation: reduction of a behavioural excess by repeated pairing with an
aversive stimulus in imagination.
Thought stopping: a procedure in which individuals learn, through a succession of
training stages, to use verbal prompts to interrupt and reduce unwanted patterns of
thought and behaviour.
Assertiveness training: a complex treatment programme involving a combination
of methods to enable individuals to replace anxiety and similar emotions with
positive coping responses in social situations.
Rational-Emotive Therapy
This approach to therapy, originated by Albert Ellis, has been developed by him and his
colleagues into a wide-ranging account of personal difficulty and disorder. Its fundamental
tenet is that distress is caused by sets of negative, dysfunctional or maladaptive statements
which individuals make to themselves concerning events. This position is common to almost
all forms of cognitive therapy. However, the Rational-Emotive Therapy (RET) approach goes
further than this. It is held that these statements are in turn a product of more deeply-held
beliefs, of a completely irrational nature, which inform the way individuals live. It is also
claimed that for the most part, individuals rarely examine these beliefs and as a result almost
never question them.
For example, many people live their lives in terms of a series of ‘ought’ or ‘should’ statements,
which may be expressed consciously as articles of faith but which far more often are not fully
articulated. Their effect on feelings and behaviour is nevertheless pervasive. In other cases,
beliefs can cause highly distorted perceptions of events and correspondingly disproportionate
emotional reactions. Individuals are judging themselves, or have expectations of the world
around them, on a basis that is misconceived and irrational. The aim of RET is to unearth these
beliefs and modify them and to replace them with more rational and realistic sets of values and
expectations.
The principal method used in this form of therapy is a form of Socratic discourse and direct
questioning in which clients are asked to justify statements they have made. Under repeated
and often very pointed questioning, the onus is placed upon them to provide evidence for their
statements, or demonstrate to the therapist why they hold the views they express. Ellis states
that there are certain fundamental irrational beliefs which emerge during therapy (at one stage
in his writings, he provided a list of twelve such basic beliefs).
Until recently there was (despite claims by its adherents to the contrary) a dearth of firm
evidence concerning the efficacy of RET. Recent reviews have, however, provided sound
support for many of Ellis’s claims (Lyons and Woods, 1991). RET is a highly appropriate
therapeutic approach for certain kinds of difficulty. However, in itself it may have limited
scope in work with offenders, and its use requires special training in the forms of Socratic
dialogue in which therapists must be able to engage.
Cognitive therapy
Possibly the most widely-used therapy which can be subsumed within the cognitive behavioural
framework is the form of cognitive therapy developed by Aaron Beck and his
associates. This has generated considerable quantities of evaluative research, especially in the
treatment of depression, including clinical trials in which the therapy has been used in
conjunction with psychotropic medication. The central proposal underpinning this form of
therapy can be succinctly presented in a single statement by Beck and his co-authors that “ ...
the primary pathology or dysfunction during a depression or an anxiety disorder is in the
cognitive apparatus”.
A substantial repertoire of techniques is used in cognitive therapy, but its basic procedures
revolve around the identification and modification of dysfunctional thoughts. These are elicited
from clients in interviews, and also in self-observational diaries and schedules, most notably
the daily record of dysfunctional thoughts or dysfunctional thoughts diary. An adapted version
of this, called a thinking report, was used by Bush (1995) in his work with violent prisoners.
Individuals may require initial help to recognise that some thoughts are automatic, i.e. they
occur very swiftly and without apparent prior cogitation, in response to events or stimuli which
may be external or internal in origin. Having recorded some thoughts of this kind their levels
of belief in them are assessed, before embarking on a therapeutic process in which the contents
of thoughts are altered or replaced by more functional, or reality-based, or coping material. As
a part of this, a number of well-established cognitive errors, discovered by Beck and his
associates in their work, may be pinpointed. They include:
Arbitrary Inference or Filtering: a tendency to focus on some (usually negative)
aspects of a situation whilst ignoring others.
Catastrophising: expecting the worst and interpreting events as evidence of
impending disaster.
Over-generalisation: drawing conclusions from a single incident or a limited range
of events.
Dichotomous thinking or polarisation: an insistence that events, people, etc. must
be in one class or another, with no ground in between.
Personalisation: a tendency to assume inappropriately, that others are referring to
oneself or to make endless comparisons with them.
Mind-reading: an assumption that one knows what others are thinking without
asking them or hearing them speak.
Blaming: an assumption that there must be someone to blame for an event, either
others, or oneself.
Shoulds: a fixed set of expectations, with no realistic basis, concerning the
behaviour of others or of oneself, causing distress when violations occur.
Emotional reasoning: a belief that if someone (including oneself) feels a certain
way, it must be true.
Heaven’s reward: a view that pain and sacrifice will be rewarded, and an
experience of dismay when they are not.
The above patterns (there are others) may be introduced and described to clients, and explained
to them as part of an attempt help them clarify their own thoughts. Clients are required to
monitor the process of using their newer, more adaptive thinking patterns, alongside other
aspects of their daily living.
http://www.justice.gov.uk/downloads/publications/inspectorate-reports/hmiprobation/other-
reports/cogbeh1-rps.pdf

self-de·feat·ing (s lf d -f t ng)
adj.
Injurious to one's or its own purposes or welfare: "American officials will find it harder than ever
to ward off self-defeating protectionist measures" (George R. Packard).
self-de·feat·ing
[self-di-fee-ting, self-] Show IPA
adjective
serving to frustrate, thwart, etc., one's own intention or interests: His behavior was certainly self-
defeating.

Being Stuck
Whether it's a reason you come in or something we discover during the process, being stuck in
patterns – particularly self-defeating ones – is a very common characteristic of people who are
not happy with their lives. It's normal to struggle with difficult issues and sometimes choose a
response you later regret, but when the same maladaptive behavior begins to crop up over and
over and over again, then it's getting in your way. What does repeated self-defeating behavior
mean? We could say that this kind of "stuckness," is any behavior that occurs frequently and
keeps you from getting what you want in your life.

The range of behaviors is enormous and ranges from minor habits, say, at work or at home, to
major life choices. It's impossible to list them all, but I'll mention some of the more common
ones. If you don't recognize yourself in any of them, it doesn't mean they don't exist, it just
means that yours are unique to you, and have probably become so much a part of you that you
may not even be aware that they're a problem.

Common self-defeating behavior patterns (in no particular order)

 Procrastination
 Blaming others instead of accepting responsibility for mistakes
 Not listening
 People pleasing
 Always being right
 Making excuses, major and minor, for failure to (for example), complete a project, show
up on time, stop at the store as promised
 Needing to be perfect (e.g., obsessing so long over the exact right words in your report
that it's late)
 Blowing things out of proportion to the reality of the situation
 Holding grudges forever, especially over minor infractions, and bringing them up in
arguments ("You always...")
 Frequent self-sacrifice, and then feeling sorry for yourself that you never get to have fun
 Being a victim
  Being attracted again and again to people who will mistreat you even though they seem
"different" at first
 Being uninterested in or not attracted to people who treat you well
 Not allowing yourself pleasurable experiences or being drawn to situations in which you
suffer
 Rejecting help or refusing to ask for it
 Being unwilling or afraid to make a career change or change within your career that
would be beneficial

http://www.therapycanwork.com/index.php?
option=com_content&view=category&layout=blog&id=56&Itemid=94