The What and Why of CBT (Cognitive Behavioural Therapy)

Before I studied cognitive behavioural therapy, I had heard of it, certainly had it recommended by friends... But no one had ever taken the time to explain what it actually was. Since I spent the time finding out more, I thought I'd share the fruits of that research here, to support you in your understanding. 

No one can definitively say that CBT is the right therapy for you, but it helps to know a little more about the process and its intentions, so that you can make a more conscious choice about whether it might help you.

First, A Little History

Aaron Beck developed Cognitive Therapy (note the lack of 'behavioural' at this stage), one of the foundational components of CBT, as an alternative to Psychoanalytic Therapy in the 1960's, as he believed the latter lacked the structure and scientific backing that compelled him. Cognitive Therapy focused on understanding mental processes, including thinking, memory, and perception (Cherry, 2020).

He later pulled from the work of early Behaviourists, such as B.F. Skinner and John B. Watson, contributing to the understanding of learning principles, conditioning, and the role of reinforcement and punishment in shaping behaviour, to form the Behavioural element of the finalised idea behind this therapeutic technique.

Beck's work focused on identifying and challenging distorted thought patterns and beliefs that contribute to emotional distress and behavioural problems. Beck's Cognitive Therapy aimed to help individuals become aware of their negative thought patterns, reframe them, and replace them with more balanced and rational thoughts.

This cognitive restructuring process is a key element of CBT, which can then be coupled with behavioural therapy techniques for utmost effect. The combination of the two elements into one style of Therapy has been proven very effective for the treatment of a range of mental health conditions, which emphasises the interconnectedness of thoughts, emotions, and behaviours, upholding the core concept of CBT; that our thoughts, feelings, and behaviours are interconnected and influence each other (Cherry, 2023b).

"“[CBT is] rooted in the idea that thoughts impact feelings and feelings impact behavior,” says Sarah Kaufman, LMSW. “Therefore, if we can reframe our thoughts, we can subsequently change our feelings and then our behavior.”" (Vogel, 2011).

How Do I Recognise CBT?

Cognitive Behavioural Therapy (CBT) is a broad category of therapeutic approaches that share several key characteristics.

CBT often uses the ABC model, developed by Albert Ellis (1957) to explain how thoughts, emotions, and behaviours are connected:

• A (Activating Event): Something happens in the individual's environment.
• B (Beliefs): The individual's beliefs or thoughts about the event.
• C (Consequences): The emotional and behavioural consequences that result from those beliefs.

By understanding this model, individuals can see how their interpretations of events (B) can lead to different emotional responses and behaviours (C), and they can work to change these beliefs to achieve more positive outcomes (McLeod, 2019).

The ABC model can be used to form the basis of further interventions, despite being seen as a potential intervention in itself, by allowing the client to recognise and take ownership of the root causes of their problems themselves.

CBT is typically focused on the present moment and is goal-oriented. Instead of delving extensively into past events, the therapy concentrates on current issues and aims to help individuals develop SMART (Specific, Measurable, Achievable, Relevant, Time-bound) goals for behaviour change. For example, a person with social anxiety might set a goal to attend a social gathering for a specific duration within the next two weeks (Cherry, 2023b).

Another common characteristic is that the process usually involves collaboration between the therapist and the individual seeking treatment. It is an active and participatory process where individuals are encouraged to take an active role in their therapy. Therapists and clients work together to identify and address problems, set goals, and develop coping strategies. It is also typically structured and time-limited, with a focus on achieving specific goals within a predetermined number of sessions. The structured nature of CBT helps individuals make progress efficiently and fosters a sense of accountability. (Fenn and Byrne, 2013).

An example of this in practice might be collaboratively developing a thought record or journal where the individual actively identifies and challenges irrational thoughts with the guidance of the therapist. This might also be combined with implementing a structured protocol, like the 16-session protocol for Cognitive Therapy for Depression (BABCP, 2021), where specific issues are addressed in each session within a defined timeframe.

A central component of CBT involves identifying and challenging irrational or negative thought patterns. This process, known as cognitive restructuring, aims to replace maladaptive thoughts with more balanced and realistic ones, ultimately influencing emotions and behaviours.

An example of cognitive restructuring in action could be 'Socratic questioning', to challenge and reframe negative thoughts. For example, challenging the belief that "I must be perfect, or others won't like me" by asking questions like "Is it realistic to expect perfection?" or "Have there been times when you were not perfect, but still well-received?". This is also the approach at play when the therapist addresses catastrophic thinking by challenging the likelihood and severity of feared outcomes, or gradually exposing individuals to positive experiences they may have avoided due to negative beliefs (Quinn, 2022).

CBT is considered an evidence-based approach. Therapeutic interventions and techniques are continually tested and refined based on scientific evidence for their effectiveness in treating specific mental health conditions. (Cherry, 2023b)

Psychoeducation is another key characteristic which is found laced throughout CBT, where individuals are provided with information about their specific mental health issues, the connection between thoughts, feelings, and behaviours, and the skills needed for symptom management and prevention of relapse. (Morrow, 2018)

CBT is adaptable to various mental health conditions and can be tailored to meet individual needs. Therapists may integrate different techniques and approaches based on the unique characteristics of the client and their specific concerns, but all therapies used within CBT are likely to inhibit some or all of the above characteristics.

Summarising The Goals of CBT

Cognitive Behavioural Therapy is a goal-oriented and evidence-based therapeutic approach that aims to help individuals identify and change patterns of thinking and behaviour that contribute to their emotional distress or mental health issues (Beck Institute, 2018). Below, I've broken down the information above in a little more detail as a table, to support understanding:

These goals collectively contribute to the overarching aim of CBT, which is to equip individuals with the tools and skills needed to navigate challenges, improve their mental health, and lead more fulfilling lives.

If you think you can benefit from support with putting the above into practice, please don't hesitate to contact Happy Citta.