November 2, 2015
By Andrea Martin, PhD, Psychologist
If you’ve read about psychology and different types of therapy in the media, you’ve likely come across something that mentions the cognitive behavioural approach, also know as cognitive behaviour therapy (CBT). What the *&*^#% is that?! During my undergraduate studies I became familiar with the cognitive behavioural approach but it was only later, during my graduate studies that I had the chance to study it in greater depth and really start applying its techniques to help clients. I was amazed at how people who were suffering were able to turn things around in a relatively short amount of time using straightforward techniques. It was rewarding to witness such dramatic changes in the people I was working with as they learned to apply these valuable skills that helped them overcome challenges and improve their overall quality of life.
One of the goals of cognitive behaviour therapy is to help people become more aware of the relationships among their thoughts, moods and their behaviour. When people are more aware of this relationship and have a better understanding of the negative impact of their unhelpful thoughts, they are in a better position to challenge them. When we’re aware of our unhelpful or distorted thoughts, we are able to replace them with more balanced thoughts which in turn, have a positive impact on our mood. For example, you might be reading this and think, “Wow, this sounds really cool! I think this is something that can really help me get out of this rut!” Your friend might be reading this and think, “CBT isn’t for me. Nothing is going to help me get out of this rut. It’s not going to work!” Notice how very different thoughts can arise from the exact same scenario (reading the text on CBT). The person who thinks that CBT can’t possibly help them is likely going to feel discouraged and sad, whereas the other person who thinks CBT sounds cool and helpful is more likely to feel optimistic and excited. The way people think and feel will also have an impact on their behaviour. For example, the person who thinks the approach sounds interesting and feels hopeful reading about it will be more likely to get in touch with a psychologist providing CBT or buy a self-help book and give it a try, whereas the other person is more likely to dismiss the idea of CBT and won’t pursue the therapy. The person who tries CBT is more likely to feel better in a relatively short amount of time. In CBT, clients learn new skills to better manage problematic thoughts, feelings and behaviours, which helps them feel better and behave in ways that improve their quality of life.
On average therapy lasts approximately 10 to 15 sessions, depending on the nature of the problem and the needs of the individual. Sessions are structured, with a goal associated with each session and a mutually decided upon task for the week. Applying tools learned in session in between sessions is a unique feature of CBT and helps clients master tools outside of therapy, making it more likely that the client will feel comfortable with the techniques and incorporate them into their daily lives. CBT is collaborative in the sense that the psychologist and the client work together; the psychologist solicits feedback from the client and they explore how the principles in CBT might apply to the clients life and situations they are facing.
In CBT you will learn to become more aware of your thoughts and more accustomed to asking yourself: “what went through my mind just now?” We all have had irrational or self-defeating thoughts at some point. Some common irrational thinking styles (also knows as cognitive distortions) are the “should” (ex. “I should never make mistakes”), catastrophizing thoughts (ex.“my husband is 10 minutes late, something terrible must have happened. He must have been in a car accident!”), all or nothing thinking (“nothing ever goes my way”). CBT helps you learn to evaluate the accuracy and usefulness of your thoughts. If we were to look at one of the examples above: “nothing ever goes my way”, we would explore if there were other ways to look at the situation and the next step would be to examine the evidence for and against the thought. Once you are able to do this, you are better able to challenge the unhelpful or distorted thoughts and replace them with more accurate and less distorted thoughts. When our thinking is more flexible and balanced, we tend to see things more objectively and we feel better.
Another way to challenge unhelpful thoughts is by doing behavioural experiments. Say for example a young woman is shy and avoids talking to attractive men for fear that they will reject her because they think she is boring. As a behavioural experiment, she might try initiating conversations with men she finds attractive and she might discover that the men she approaches respond well and engage in pleasant conversation with her. This would help her challenge the thought that she will be rejected and perceived as boring and help her replace it with something more balanced and accurate such as “some men find me interesting and fun to talk to”. A more balanced way of thinking will help her change her behaviour, reducing her avoidance of initiating conversation and encouraging her to initiate exchanges with men she finds attractive. Its important to note that if she had never done the behavioural experiment, her false belief that men did not find her interesting might be maintained and she would likely continue to avoid them. As a result, she might falsely attribute her lack of connection with attractive men to their disinterest as opposed to her avoidance. Other strategies learned in CBT are skills such as problem solving techniques, behavioural changes, relaxation strategies, etc.
Unlike other types of therapy, CBT is time-limited (short-term) and focuses on the present and future to help individuals work towards fulfilling their goals. Generally ten to fifteen sessions are enough to help people make significant changes. Sessions are collaborative and goal-oriented, aimed at helping people work with their psychologist to develop skills allowing them to cope with future challenges independently and improve their overall quality of life and well-being. Unlike other forms of therapy, the cognitive behavioural approach has been studied extensively in the scientific literature and proven to be effective for many types of psychological difficulties such as depressive disorders, anxiety disorders, eating disorders, chronic pain, low self-esteem, sleep problems and more.
A simple trick to apply a little CBT to your daily life: if you notice a change in your mood, try to ask yourself “what just went through my mind”? You may want to write it down on paper or speak your thoughts into a recording device to better clarify the thoughts you were having. Thoughts don’t come in ones either, you likely had a chain of thoughts so just write down some of the thoughts that you remember thinking. You might even try taking it a step further and writing down the evidence that supports that thought and then any evidence against that thought. Let’s say for example you were to notice you were suddenly feeling sad and lonely. You might have thought to yourself:
“I’m such a loser”
“Its pathetic to be home alone on a Saturday night”
“Nobody likes me”.
If you were to take a minute to look for any evidence for or against those thoughts, you might come up with something like this:
Evidence for the thought:
I’m home alone on a Saturday night
Evidence against the thought:
Two of my friends called me earlier today so see what I was up to I have plans with a friend tomorrow
Taking the time to explore the unbalanced thought by looking for evidence for and against, helps us see things more objectively and replace the unhelpful thought with a more balanced or rational thought. Once that is done you can ask yourself: “is there another way to look at the situation”?
In the example above, you might replace the thought “Nobody likes me” with “It might feel like no one likes me because I am home alone and feeling lonely, but I have many friends who appreciate me, whom I speak to and see regularly because we enjoy each others company.”
Taking the time to examine your thoughts might help you identify and challenge an unhelpful thought that is bringing you down.
If you would like more information on CBT, please don’t hesitate to contact us or check out some of the references below
Burns, David. (1980). Feeling good: The new mood therapy.
Edelman, Sarah. (2007). Change Your Thinking: Overcome Stress, Anxiety, and Depression, and Improve Your Life with CBT.
Hofmann, S.G., Asnaani, A., Vonk, I.J.J., Sawyer, A.T., and Fang, A. (2012). The Efficacy of Cognitive Behavioural Therapy:A Review of Meta-analyses. Cognitive Therapy Research, 36(5), 427-440.
