Cognitive Behavioural Therapy in a Nutshell
LUCIA AGULLA, MA, RCC, VITALITY COLLECTIVE VANCOUVER THERAPIST & REGISTERED CLINICAL COUNSELLOR
Cognitive Behavioural Therapy (CBT) is a type of talk therapy that focuses on how you think and what you do, trying to help you change those thoughts and behaviours to feel better. In this line of therapy, your therapist will explore your thoughts about yourself, the world and other people and how your behaviour affects your thoughts and emotions. CBT focuses on the “here and now” problems and difficulties, but this doesn’t mean your therapist won’t ask you questions about your past. There will be times when talking about the past will help you and your therapist understand how it is affecting you now.
The aim of CBT is to help you make sense of overwhelming problems by breaking them down into smaller parts. By doing this, it’s easier to realize how the different parts are connected and how they affect you. These parts are Situations, Thoughts, Emotions, Physical sensations, and Actions. These areas are connected in a way that each one can affect the others (i.e., how you think about a problem can affect how you feel physically and emotionally). A certain situation that you see as problematic can generate an altered thought, which in turn can create an altered emotional state, altered physical sensations and altered behaviour. As you can see, the way you interpret and think about a certain situation will have a strong effect on your reaction, and much of the work in CBT consists of reframing and reinterpreting events. Let’s see an example:
Situation
Difficulty breathing because of a cold
Thoughts
I could die asphyxiated
I am having a hard time breathing due to the cold, it will end soon
Emotions
Fear
Neutral
Physical sensations
A racing heartbeat, chest tightness, shaking, dizziness
Tiredness, difficulty breathing
Actions
Assure that I’m going to die due to a heart attack and going through a panic attack
Resting and taking time to mediate
As you can see, the same situation led to two very different results, depending on how the person is thinking about it. Notice how the thought on the left column led to uncomfortable feelings and actions that make the situation even worse, and this usually creates a vicious circle that is difficult to break. CBT can be helpful to end this loop of altered thinking, emotions and behaviour. When you see the parts of the sequence clearly, you can work to change them.
CBT is a “hands-on” kind of therapy, which means you will be working hard towards your goals not only during sessions but also with homework in between sessions. It is of the utmost importance for you to apply the changes you are making during the sessions in your everyday life. Your therapist will help you do this, for example, by questioning unhelpful, negative thoughts - like the one we saw in the example - and replacing them with healthier and more realistic ones.
During the first sessions, your therapist is going to go through the informed consent and is going to develop a treatment plan. They are going to inform you of that as well, checking that you agree and feel comfortable with it. This lets you and your therapist track your progress and evaluate if any treatment changes are needed to achieve your goals. It’s also important for you to know that you are an active agent in this process, so it is your decision what are the issues that you want to deal with in the short, medium and long term.
Finally, there has been a lot of research about CBT and its effectiveness in different types of problems. It has been shown that CBT can help people with anxiety, depression, panic, phobias, stress, bulimia, obsessive-compulsive disorder, post-traumatic stress disorder, bipolar disorder and psychosis. Especially when it comes to anxiety and depression, this line of treatment has shown to be one of the most effective treatments.