Earlier in the year I completed a short course on cognitive behaviour therapy (CBT) at Birkbeck. I wanted to understand how the therapy works in order to apply some of the tools and techniques in my coaching. I believe it has the potential to be useful for everyone.
So what is CBT?
CBT is based on Beck’s cognitive therapy model, developed in the 1970s. It is actually an umbrella term for a collection of empirically grounded therapies, structured, short term, cost-effective therapies which teach clients to become their own therapists. The therapy works on the premise that there is an event or a situation, leading to beliefs or thoughts, which then have consequences i.e. feelings or actions resulting in a behaviour. CBT interacts at the belief stage to teach the client to recognise unhelpful thought patterns and put in place alternative ways of thinking. The therapy largely focuses on the present and does not tend to delve into the past. It is an empirically based grounded in well-established and validated theories. It is generally problem-orientated and goal focused, structured and time-limited (usually 10-12 sessions). In CBT it is always important to consider 4 dimensions: emotions, thoughts, behaviour and physical attributes when assessing an individual.
Why is CBT needed?
Mental health issues, as we all know, are prevalent in our society and research has shown that over 1 in 4 people in the UK will experience a mental health problem each year. CBT is proven to be an effective treatment for many mental health conditions across a variety of populations. For example, anxiety and depression, eating disorders such as bulimia, addictions, obsessive compulsive disorder, anger control and general stress. As a result of the robust evidence base for the effectiveness of the therapy, and the cost-effectiveness of the treatment, CBT has been rolled out extensively in the NHS and by other primary care providers in many other countries. It has been incorporated into many treatment guidelines such as the American Psychiatric Association.
What are the CBT tools?
There are many practical tools which can be used in CBT I have outlined 3 here:
- The worry tree: One of the most useful tools I still use today, and often teach my clients, is the worry tree. A simplistic but effective visual which encourages us to deal with worries and anxious feelings in a proactive fashion by doing something about them or forgetting about them:
- Thought diary: Another useful tool I have used with success in my coaching is the thought diary. This allows the client to write down an event, followed by thoughts, emotions and physical sensations they may be experiencing. I find this is particularly effective if a client is overly self-critical. It allows the client to identify thinking errors which may be present. It also allows for patterns of behaviour to be recognised over time and for the client to start to recognise the critical inner voice in their head. We can then work together to build in tools for encouraging more helpful thinking and/or increase self-compassion to quieten the critical voice.
- Thoughts are clouds: a useful metaphor I like to use is to encourage the client to see their mind as a clear blue sky with thoughts as clouds floating by. This encourages the client to understand that their thoughts come and go and do not define them. Some days there can be dark thoughts which seem to want to stay forever but the dark clouds and the storm will always clear eventually. It can be really helpful to focus on this idea of shifting moving thoughts in the midsts of a difficult moment.
An example of CBT in action
How many times have you been in a situation where you have interpreted an event in a negative way only to realise later that it was not as you had initially thought?
For example:
- The event or situation: it is lunchtime, you have gone for a stroll and you see a colleague who you are usually friendly with a frown on their face. They do not look at you as you walk right past you.
- Spiralling thoughts: You see this as a reflection on you, you must have done something to annoy them and therefore they do not want to speak to you. You are a bad person as you have offended them. No one likes you in the office and you do not have any friends. You are bad at your job and nobody wants you to be in their team.
- Emotions: you feel sad, unworthy, unloved and generally demotivated.
- Behaviour: you may withdraw into yourself, become sullen, quiet and subdued.
- Physical: your body language is closed, you avoid eye contact, you shut yourself away from others.
In this instance CBT techniques would question each part of this scenario to allow you to step outside of your perspective and see things from another angle. For example, could there be another reason why your colleague is feeling down and frowning? Perhaps, they had had a bad day, they had received some bad news, they were feeling stressed and just wanted to get out for a walk and they simply didn’t see you. Maybe they did see you but they thought they looked angry so they didn’t want to say hello. Or they could have be upset and felt it would be unprofessional to say anything. How would your thoughts change in this situation? There could be a number of different scenarios at play here. Perhaps you would shift to a stance of concern and be worried about your colleague, perhaps you would ask them if they feel OK when you see them later in the office. Is there anything I can do? Shifting to a mood of empathy and concern and therefore your emotions and behaviour would change to a general sense of compassion and concern for your colleague and your body language would be welcoming and open.
I think that everyone can probably benefit from the techniques and tools available through CBT techniques. I shall look forward to exploring and incorporating into my work with clients.
