Cognitive behavioural therapy (CBT)
Cognitive Behaviour Therapy (CBT) may sound daunting but what it actually means is that you and your therapist work with your thoughts and beliefs (the cognitive bit), and aspects of your behaviour that might be maintaining your stress
Jen Popkin is a mediator, coach, counsellor and trauma support worker
Cognitive Behaviour Therapy (CBT) may sound daunting but what it actually means is that you and your therapist work with your thoughts and beliefs (the cognitive bit), and aspects of your behaviour that might be maintaining your stress. It has been the therapy of choice, along with Eye Movement Desensitisation Reprocessing (or EMDR), by the National Institute for Health and Care Excellence for depression, anxiety and trauma.
CBT is a practical approach that involves you as a kind of scientist for your own difficulties; in other words you and your therapist create a hypothesis regarding what might be triggering ways of thinking and behaving that might fuel the stress. An example of the hypothesis can be a negative cognition, such as ‘whatever I do I can never be good enough’ – and in a litigious world the drive for perfect results can exacerbate this self belief. The result can be a change in behaviour such as procrastination which can lead to a psychological ‘paralysis’ affecting various aspects of life - to the point that some people might not be able to function as normal.
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So, what is a CBT session like?
A good CBT session would involve quite a few questions in order to help your therapist understand more about your experiences and how you are dealing with them. This assessment session can be useful at this early stage as not only might it be might be the first time someone has had the chance to speak about their experiences in a safe setting, but in speaking they can already begin to recognise what coping strategies could be helpful.
A CBT session usually involves paperwork, sometimes CBT is criticised for ‘over-manualisation’ when clients want and need to talk about how they are feeling. CBT is only as good as its therapist! If you feel that you are not on the same wavelength then that needs to be fed back. Any homework assignments you are given should be simple and appropriate for the problem you are tackling. I find that the best ideas come from clients and when that happens they are far more willing to have a go at trying a different approach to their issue. For example if someone’s self belief is ‘I am not good enough’ then practising taking compliments, including saying a positive thing about themselves, might be an experimental exercise to do over the week. The essence of CBT is practise, practise, and practise again. Have you ever tried to give up a habit such as smoking or tried to start exercising? It takes time, doesn’t it to get new behaviours embedded into our lives. In the same way, changing distorted thinking patterns will take time and patience. Good CBT will celebrate your achievements and build on them.
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A typical CBT exercise
So, just to give you a flavour of a typical CBT exercise, here’s the STOPP card:
1) If you find yourself in a stressful situation, just STOP!
2) Breathe – I usually breathe out first then in – you get a better breath that way
3) Observe your thoughts and feelings
4) Put in place a ‘helicopter view’ in other words try to see the bigger picture, perhaps imagine what your own best friend or mentor would advise you
5) Practise what works over and over again until it is natural for you to defuse potential stress before it becomes overwhelming
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