Cognitive behavioural therapy (CBT) was developed by the psychiatrist Aaron Beck in the 1960s. He observed the link between thoughts and feelings and recognised that, in changing one, the other changed. He coined the term automatic thoughts to describe the emotional-filled thoughts that come unbidden, often bringing strong negative feelings. Beck realised that, often, the thoughts went unrecognised – only the feelings were observed. He found that identifying and challenging these negative automatic thoughts was key to helping clients overcome their difficulties and reducing their distress.
How CBT works
The fundamental concept underpinning cognitive behavioural therapy is that our thoughts, behaviours, emotions and physical sensations are all interconnected. So, if you change any one of them, the others change too.
It’s all too easy to become trapped in a repeating pattern of unwanted feelings driving unhelpful behaviours and fuelling negative thoughts. These thoughts, in turn, lead to more, often stronger, negative emotion and so the cycle continues. Cognitive behavioural therapy works by challenging unhelpful thinking and modifying behaviours, breaking the cycle.
Here is an illustration I often use to show the extent to which our thoughts can drive our feelings, body responses and actions:
- Imagine you’re walking down a road late at night and you hear footsteps coming up behind you. If you think it’s someone coming to attack you, how would you feel? What would you do? Maybe your heart would be pounding, and you would breathe more quickly and shallowly. You might feel afraid and want to run away or anxious and turn to fight.
- Now consider the same situation, walking down a road late at night, hearing footsteps approaching from behind. This time imagine it’s a friend hurrying to greet you. What would you feel? How would you react? Maybe you’d feel warm and safe, turning to greet them. You probably wouldn’t run away.
In both cases, the facts are the same: someone is approaching you from behind. But your feelings, body responses and behaviours are likely to be very different. Yet all that changed was the immediate thought in response to hearing someone approach: everything else changed as a result of changing that initial thought.
CBT, therefore, aims to help you deal with your current difficulties, which might seem overwhelming, by breaking them down into more manageable, smaller parts. Then, looking at the negative patterns that are causing distress and helping you find ways to change them, thus improving how you feel.
CBT often focusses on your current problems, as you are experiencing them today, rather than concentrating on the issues from your past which may be underpinning them.
What CBT looks like
We would generally see you either weekly or fortnightly, for sessions lasting around 50 to 60 minutes. At the beginning of our work together we would agree our overall goal(s) and develop a plan for the work. Each session we would target a particular issue or aspect of what you want to achieve, according to our plan.
Most sessions would start with a review of the previous week, including any ‘homework’ you right have been given. We would then agree on the focus of the session, targeting some particular aspect of whatever is troubling you. Towards the end of each session, we might agree upon some ‘homework’ for you to do before the next appointment. Sometimes this might be completing a thought or mood diary, or trying out a different way of handling a situation. It could also be a behavioural experiment – trying out a different way of being and observing the result. The aim of the homework is often to help consolidate what you are learning and integrate it into your life.
Is cognitive behavioural therapy right for me?
CBT is one of a range of talking therapies recommended by the NHS. Its structured approach is ideally suited to conditions such as anxiety and panic attacks, obsessive-compulsive behaviours, depression, addictions and drug or alcohol problems.
Beck A.T. (1979). Cognitive Therapy and the Emotional Disorders. Plume
Branch, R. Willson, R. (2010). Cognitive Behavioural Therapy for Dummies. For Dummies
Dobson, K.S. (2019). Handbook of Cognitive-Behavioral Therapies (Fourth ed.). Guilford Press
Martin, B. (2019). In-Depth: Cognitive Behavioral Therapy. Psych Central.