Blog series: Psychological Therapies

Part 1 A: Cognitive Behavioural Therapy (CBT) 

There are various psychological therapies that supports clients with various conditions. This blog series discusses their use in practice. This time around I'm focusing on CBT. CBT views mental health problems as exaggerations of normal processes, (the continuum principle) and focus on supporting current difficulties for effective therapy (the here-and-now principle).   

Psychological Theory underpinning CBT 

  CBT is based on the two key theories: 

1. Cognitive Theory 

This theory states that our cognitions (our thoughts, mental images, beliefs and interpretations) about ourselves or an event or situation strongly influence our emotions and behaviours. (If you're still puzzled about what I am saying, don't worry, I will give you an example below) 

An extra thing to add, Emotions cause bodily sensations to match the emotion, such as when relaxed, our body's heart rates lower, while anxiety causes uncomfortable feelings like stomach pains. 

1)    Behavioural Theory - Learning theory

This states that people acquire behaviours through environmental conditioning, affecting emotions and cognitions through actions. Basically, our behaviour or responses to our behaviour in a situation will change or maintain our emotions and cognitions.

For example, suppose you are person 1. Because of your anxiety, you start avoiding her and others due to worries about messing up in conversation and being called dull or stupid. Avoiding situations can provide relief from fear and reduce anxiety symptoms. However, continuous avoidance may lead to a false belief that anxiety symptoms are decreasing due to threats. You also don't get to discover if your thought is true, and you underestimate your ability to interact with others. The negative self-perception and the feeling that you learnt from your behaviours is how your behaviours maintain your anxiety.

CBT Model:

The model states that we develop core beliefs and assumptions which allow us to make sense of our world and find a way through it. As a result of our experiences, we create a range of functional and dysfunctional beliefs, with the functional ones allowing us to cope reasonably well most of the time. 

However, when facing an event/multiple events that contradict our core beliefs or cannot be handled by our more helpful beliefs (sometimes called a critical incident), unhelpful assumptions can become active, triggering more unpleasant negative thoughts and emotional states like anxiety or depression.

The interactions between negative thoughts, emotions, behaviour and physiological changes may then result in persisting dysfunctional patterns, and we get locked into vicious cycles that maintain the problem (which I will refer to as maintaining processes later)

CBT formulation:

So not everyone knows what a “Formulation” is, so I will first explain what it is before going into the CBT formulation. In simple terms, a formulation is an understanding or hypothesis of a person’s current difficulties (don’t worry, I will do a whole separate blog on formulation because it is a big topic). 

The CBT formulation uses the CBT model to develop:

·       a description of the current problem(s);

·       an account of why and how these problems might have developed;

·       an analysis of the key maintaining processes hypothesised to keep the problems going.

Example of CBT Formulation:

This formulation below is an example of why a client has separation anxiety from their Mum

The key maintaining factors in this scenario are his negative thinking (worst-case scenario thinking), i.e. Mum is going to die when she leaves the house and the safety behaviours he does to manage his negative thoughts, i.e. Over texting/Calling Mum and Avoiding situations where he’s separating from Mum. This is because their Negative thoughts can increase their worry or fear, causing them to do Safety behaviours that stop them from directly testing their anxieties, and the untested fears will continue to arise in the future.

Assessment and Intervention in CBT:

When going through therapy in general there are 3 stages.

The Assessment stages

The Formulation stages

The Intervention stages

Throughout the Assessment stage of CBT, you and the clinician are building a formulation of your current problem. The treatment stage of CBT is supporting you to be your own therapist by helping you to understand and change maladaptive thinking and behaviour patterns by providing tools to change these patterns. (don’t worry again, in a separate mini-blog, I will explain some of the tools used).

So based on previous blogs, you can kind of guess what my stance on CBT is, but I thought I would just outline below the key pros and cons of CBT

CBT Pro’s

·       It has scientifically been proven to be as effective as medication in treating some mental health disorders. 

·       It is an Evidenced –Based treatment for various ages and presentations. It is delivered in a short time compared to other talking therapies.

·       The highly structured nature of CBT means it can be provided in different formats and manualised, including in groups, self-help books and computer programmes. It is also easy to train staff on this approach.  

·       The Skills you learn in CBT are useful, practical, and helpful strategies that can be incorporated into everyday life to help you cope better with future stresses and difficulties, even after the treatment has finished.

CBT Con’s

·       CBT focuses on the individual's capacity to change themselves (their thoughts, feelings, and behaviours) and does not address wider problems in systems or families' relationships which can often significantly impact an individual's health and well-being.

·       The model this therapy is based on was developed by a certain demographic of people - white, British, upper-middle-class male, and is this generalisable to everyone. 

·       CBT only addresses current problems and focuses on specific issues; it does not address the possible underlying causes of mental health conditions, such as an unhappy childhood.

·       It involves confronting your emotions and anxieties; you may experience initial periods where you are more anxious or emotionally uncomfortable.

Lastly,

What are your reflections on this blog?

What your views about CBT?

Any questions you want answered?

Comment your views below