Transformational Stories Through CBT

The Power of Personal Stories

Cognitive behavioural therapy (CBT) is a type of highly structured talking therapy that aims to help us identify problematic or negative thoughts and reframe our way of thinking. 

At the core of CBT principles is an idea that our thoughts affect our feelings (emotional and physical) as well as our behaviour and responses. When we feel bad, we can get caught in a damaging cycle of negative thoughts and negative emotions. 

The key aim of CBT is to reframe the way we think and approach problems. Cognitive behavioural therapists will lead sessions with patients and try to help them identify specific, problematic thoughts and find strategic ways to break them down into smaller, more manageable parts in five key areas:

• 1. Situation
• 2. Thoughts
• 3. Emotions
• 4. Physical feelings
• 5. Actions

We know that poor mental health is a growing problem in 2024. Of the more than 2.5 million people in the UK who are economically inactive due to long-term sickness, more than half (53%) cite poor mental health (depression, bad nerves or anxiety) as a primary or secondary barrier to them getting back into the workplace. Mental health problems can usually be treated using medication and therapy, therefore understanding and accessing therapy options is vital if we want to improve Britain’s mental health.

Cognitive behavioural therapy combines aspects of mindfulness into a framework that aligns with traditional therapy and behaviourism. It is now widely accepted as an effective way to deal with a number of mental health conditions, including:

• Depression
• Anxiety
• Phobias

There is also a growing amount of evidence that CBT can help people with some physical conditions, including chronic pain. 

CBT requires a significant amount of effort by participants and is only a route you should try if you are truly committed to overcoming your condition. Cognitive behavioural therapists will often set work to be done outside of sessions to help their patients progress through their programmes, such as:

• Journaling
• Goal setting
• Meditation
• Putting techniques into practice

You will be expected to be involved in your journey to healing and be able to give and receive feedback. 

Although CBT is structured, it can also be highly personalised. Modern psychotherapy uses a highly personalised approach to optimise treatment options for users and improve outcomes. 

Contemporary CBT treatments can be further tailored to individual needs using a combination of:

• Clinical assessment
• Information analysis (including of your out-of-session work)
• Goal setting and progress evaluation
• Rapport and trust building during sessions
• Making judgements based on theoretical frameworks, education and training
• Making changes and tailoring efforts based on patient responses
• Using both human and AI tools to improve treatment decisions

Attending therapy may feel daunting and some people may be reluctant to seek help from a therapist due to fear, embarrassment or bias. Here, we will share some personal stories that aim to provide hope, inspiration and a sense of connection for people who may be facing similar challenges. These case studies may also help to inform those who question the suitability of cognitive behavioural therapy in treating anxiety, depression or phobia.

Case Study 1: Overcoming Anxiety

Zara is desperate to get back into the workplace after being made redundant. After being out of work for six months and struggling to navigate the complex benefits system, she is being pressured to find work by her work coach. Zara’s mental health hit an all-time low after the redundancy and her GP was able to refer her for cognitive behavioural therapy on the NHS. After a 12-week wait, she was offered her first session.

Now she is being pushed back into work, her therapist decides to shift their work from her generalised anxiety (GAD) to thinking more about her anxiety about re-entering the workplace. He helps her to break the situation down into simple, more manageable parts. 

1. Reality of the situation – you have been out of work for six months. Prior to this you had been at the same company for over a decade. You are well educated and qualified. 
2. Thoughts – I will do things wrong and I will make a fool of myself and get sacked again.
3. Feelings – fear, anxiety, loss of motivation, feeling powerless, scared about finances and low self-esteem due to worklessness.
4. Beliefs – I am not good enough. I am too old to learn new things. Other workers will be better than me.
5. Behaviour – lacking motivation, avoidant behaviour (not attending interviews or making applications).
6. Consequences – you want to get back into work as you know this will raise your self-esteem and give you purpose. However, you are letting fear, nerves and anxiety hold you back. Consequently, your benefits are being sanctioned and you are suffering financially which adds to your stress.

Zara’s sessions began to focus on the specifics of the issue – anxiety about interviews and re-joining the workplace – and how her thoughts and feelings were affecting her behaviour and holding her back.

Her therapist used an A, B, C technique:

A is the activating agent – in this case, needing to get back to work.

C is the consequence – not attending interviews, not sending applications, being avoidant.

B is the beliefs that are causing the consequences – you have already decided that you will fail so you don’t try. You assume that others will judge you negatively but you have no evidence of that. In fact, you have a proven track record of success at work and you lost your previous job through no fault of your own.

To help Zara, her therapist used some of the following techniques:

• Relaxation methods including meditation and progressive muscle relaxation (PMR) to relieve anxiety and promote peace.
• Role-playing activities to help Zara feel more comfortable in interview situations.
• Identifying and reframing thoughts, so what if they all hate me and I get sacked became I have the ability to make a great first impression and I have a skillset that will impress my new boss.
• Keeping a diary of distorted thoughts. At each session Zara presented them and was eventually able to discuss why each one was not true.
• Highlighting the gaps between her anxieties and her actual experience of being in a workplace.

The therapist then set small tasks for Zara to work through that started with simply logging on to job sites, to browsing jobs, to making an application, to making several applications to finally attending some interviews. 

Zara was back at work within a year of being made redundant and is thriving. She continues to use the techniques she learnt during her CBT sessions when she feels anxious or stressed.

Case Study 2: Battling Depression

Colin is a middle-aged man who has shown signs of depression since the breakdown of his marriage and losing custody of his children. He has a highly pressurised job in finance. His doctor prescribed antidepressant medication but due to unpleasant side effects Colin went back to ask about other options. His doctor suggested CBT and as Colin was in a financial position to pay for it, he began private sessions almost immediately.

Colin’s therapist used a traditional, two-fold approach to CBT for depression:

1. Cognitive restructuring – this is where the patient’s thinking pattern is changed and restructured to make it more helpful and positive.
2. Behavioural approach – assessing what behaviours and daily activities can have an impact on mood. In a similar way to exposure to phobias, activities are ranked from least difficult to most difficult. These will range depending on the severity of the client’s depression. These activities will form the backbone of Colin’s action plan. The idea is that as he begins to conquer harder activities, he will regain a semblance of control and his low mood will gradually increase with each perceived success.

After clinical assessment, Colin’s therapist noted the following:

• Critical incidents – marriage breakdown, loss of custody of children.
• Assumptions and negative beliefs – I will never get my children back. My wife never loved me. I am a failure.
• Unhelpful thoughts – I am a failure. Things will never get better.
• Unhelpful behaviour – drinking too much, not sleeping, not performing well at work.
• Emotions associated with thoughts and behaviour – sadness, low self-esteem, loneliness, lack of motivation.

Colin was using alcohol to cope with his depression. The therapist identified this as a particularly problematic behaviour. The following negative thought/behaviour cycle was identified:

You feel down so you drink – You feel worse the next day because you have a hangover – Your work is impacted because you drank the night before – You go home and drink because you feel bad about your performance at work and are depressed – You wake up with a hangover – You perform badly at work or call in sick – You feel down and depressed so you drink. And the cycle continues.

After his initial assessment, Colin’s therapist helped him to identify some goals:

1. Short-term goal: Drink less and find healthy coping mechanisms – recommended to join a gym.
2. Medium-term goal: Improve your output at work. Focus on what is positive, i.e. your executive position where people rely on and look up to you. Consider work a separate entity.
3. Long-term goal: Set up a visitation schedule with your ex-wife and build a relationship with your children.

Colin struggled to stay motivated due to his preconceived notions about therapy and dropped out after three sessions. However, after being told by his work to take some paid leave as he was performing so poorly, Colin took the brave step to give CBT another try. 

Cognitive behavioural therapy requires significant participation from patients and if you are not willing to commit to it fully, then you are unlikely to get good results.

On his second attempt, Colin and his therapist went through the same steps they had before and he committed to his goal oriented action plan. He also had to keep a weekly diary marking off the days he had managed not to have a drink and the days he had attended the gym or done other exercise. 

Taking some time off from work allowed Colin time to regain his composure and re-evaluate his life. Through identifying some of his unhelpful thoughts, he and his therapist devised new ways to approach them:

I will never get my children back became I have the power to make the necessary changes to get visitation with my children.

My wife never loved me became Sometimes relationships don’t work out and that is okay. We can still be great parents.

I am a failure became I need to work hard to continue to succeed at work because people look up to me and rely on me. One day I may even find love again.

His second attempt at CBT was a success because Colin believed in himself and the process this time. He was able to return to work and continues to be a successful executive. After seeing the work he has put in, including completely stopping drinking, Colin’s ex-wife has allowed supervised access to the children with the goal of unsupervised access once they both feel comfortable. 

Colin recommends to others that they should suspend their prejudice about self-help and therapy and give it a go if they need help.

Case Study 3: Conquering Phobias

Hayley-Ann is a 24-year-old student who moved to America to study from overseas. She had always suffered from symptoms of anxiety but the move magnified her symptoms and she found herself struggling to leave her apartment and began missing class. This had a serious impact on her grades. She also began to experience panic attacks and overwhelming feelings of fear when she went out to the grocery store or shopping mall. 

On one occasion, she had been so gripped by fear she had not even been able to exit her car in the shopping mall car park and had simply driven home. She felt convinced that if she went inside something terrible would happen and she would not be able to get out. On another occasion, she had found herself having palpitations and hot sweats when she accompanied a friend on a shopping trip. Hayley-Ann froze at the bottom of the escalator and kept repeating that she needed to count all of the emergency exits before she could continue; her friend drove her home.

To avoid crowded places or enclosed shops, Hayley-Ann began ordering only takeaway foods, which affected her weight and overall wellbeing. She withdrew from her friends and became more isolated.

After being referred to a specialist, Hayley-Ann was diagnosed with social anxiety disorder (SAD) and a specific phobia situational type (in this case agoraphobia). Her anxiety around being in crowded stores had been significantly heightened after watching a news item about a mall shooting. 

Hayley-Ann’s parents were able to pay for her to have one session of CBT every two weeks for three months. Due to her increasing social anxiety and agoraphobia, sessions were initially offered online – this is sometimes called teletherapy or e-therapy. 

Some of the CBT techniques used included:

Self-monitoring – Hayley was given ‘homework’ to complete right from her first session. She was asked to monitor her thoughts, feelings and behaviours in an online journal and note any changes. It included rating her feelings of anxiety and phobia on a scale of 1 to 10. Self-monitoring is extremely helpful in CBT as it gives the therapist an insight into their patient’s thoughts and feelings and it gives the patient an opportunity to reflect. In Hayley-Ann’s case it was additionally beneficial as it gave her something to concentrate on rather than her obsessive and intrusive thoughts.

Cognitive restructuring – this aims to help patients to identify and reframe their negative and unhelpful thoughts. In Hayley-Ann’s case It is dangerous to go outside was reframed as It is occasionally dangerous to be outside but it is usually not. If something goes wrong there are people who will help me. 

If I go into the mall and there is an emergency and I can’t get out I could die was reframed as It is statistically unlikely that there will be an emergency in the mall and these structures are built with health and safety in mind, including emergency exits and mall security.

Hayley-Ann also kept a record of her dysfunctional thoughts for five weeks which she discussed with her therapist at each subsequent session. 

Assertiveness training – many sufferers of SAD lack assertiveness and tend to fall into passive roles in life. Hayley had never been assertive, in part due to attending a strict boarding school as a teen that frowned on self-expression and placed unrealistic expectations on pupils. Through role play, she learned how to assert herself and take control of situations rather than letting them control her which improved her social anxiety symptoms significantly. 

To deal with some of her symptoms such as shallow breathing and fast heart rate, her therapist suggested that Hayley try mindfulness. She was to learn the techniques first at home, then in nature, then in an enclosed area. Focusing on the present and tuning out the chatter slowly helped Hayley-Ann to calm her thoughts and demeanour when out in public.

The second half of her sessions focused specifically on her phobia. Together she and her therapist designed a hierarchy of gradual exposure for Hayley-Ann to work through and report back on.

Hayley-Ann’s fear hierarchy for crowded spaces:

1. Looking at an image of the outside of a mall
2. Looking at an image of the inside of a mall
3. Watching a video of a mall
4. Driving past a mall with a friend 
5. Walking past a mall alone
6. Visiting the parking lot of a mall alone or with a friend
7. Entering a mall with a friend
8. Visiting the first floor of a mall with a friend 
9. Visiting the second floor alone for 5 minutes
10. Entering a store with a friend for 5 minutes
11. Entering a store and making a purchase alone

During her final session, Hayley-Ann reported that she was feeling more comfortable with being inside the mall and able to mostly control her intrusive thoughts. She had also stopped watching the news as it was adding to her fears and giving her an additional worry that wasn’t needed.

One month later in a follow-up session her therapist discovered that although she did not feel ready to attend classes again, Hayley-Ann had been able to attend a friend’s birthday party at a local restaurant and could complete a full grocery shop if accompanied by a friend. She had decided to enrol in online classes and was continuing to practise mindfulness regularly. She had also bought a small dog who she was taking out on daily, mindful walks!

Goal Achievement

CBT is highly goal oriented. This can make it easier to benchmark your progress against your initial objectives, measure improvements and make you feel more empowered and in control.

As this type of therapy is often designed with specific goals in mind, it also helps you to decide when you have completed your journey. This avoids wasting time on unnecessary sessions which has an economic benefit if you are paying for private therapy. 

CBT also teaches you long-term strategies and coping mechanisms to deal with your issues. However, as we saw with Colin, CBT requires commitment from both the therapist and the participant. It took strength for Colin to admit that he was struggling and wanted to give therapy another go. Stigma and prejudice act as a barrier for many people who need help with their mental health, so it is important that as a society we normalise help-seeking behaviour regardless of age, gender or social class.

Family and Relationship Dynamics

Cognitive behavioural therapy techniques can be useful in solving problems within family and relationship dynamics. 

Examples of cases where this may be helpful include:

• Helping someone to stop blaming themselves or feeling inadequate after their partner has had an affair
• Helping a couple struggling with co-parenting dynamics (including working through feelings of resentment, lack of control and failure)
• Reframing negative thought patterns caused by cultural or family prejudice (such as feelings of guilt over your sexuality or gender identity)
• Facilitating growth through identifying and disrupting negative patterns of thought, feelings and behaviour that have been learnt in childhood. This may be especially valuable to people with low self-esteem, anxiety or addiction issues.

We witnessed through one of our case studies how CBT can help people make the necessary changes (internally and externally) to help promote a more positive family dynamic. As we saw, cognitive behavioural therapy isn’t a magic wand and requires commitment and participation in order to work. 

CBT empowers participants and teaches coping mechanisms, but once sessions are complete, it is up to us to continue to use what we have learnt in a positive way or all of the good work can be undone.

CBT can help people of all ages work through relationship difficulties and family issues, including understanding the past, identifying negative thought cycles in the present and teaching coping mechanisms for the future.

Resilience and Post-traumatic Growth

Cognitive behavioural therapy can help to build resilience. Having resilience means that we are more able to cope with the challenges that life throws at us. 

CBT helps to cultivate resilience and personal growth as it is:

• Goal oriented and gives us a sense of achievement
• Helps us to feel more positive and reframe negative thoughts
• Gives us back control and helps us feel less like a victim
• Helps us replace negative coping mechanisms and behaviours with ones that are healthier for us

Often, negative thoughts and feelings come from past trauma of bad experiences we have had in the past or during our childhood. By identifying the root cause of our negativity, CBT can help promote healing and acceptance which can help us to move forward. 

Trauma-focused CBT uses a range of psychological techniques that may help you to understand and come to terms with a traumatic event or set of circumstances. It can involve gradual, safe exposure to triggers or reminders of past trauma. It can also help you to deal with any feelings of fear, guilt or shame that you have in relation to trauma that you have experienced.

Empowerment and Self-Discovery

Cognitive behavioural therapy can help us to learn more about ourselves and may mean that we have to confront some uncomfortable truths along the way. Through its techniques, CBT may help us to:

• Understand why we have certain thoughts, feelings and behaviours
• Find coping mechanisms to deal with negative thought cycles
• Make long- and short-term changes to our behaviour
• Think more clearly and rationally
• Accept who we are, boost our self-esteem and feel happier

Humans are often fascinated by the why. We need to understand why things happen or why people act a certain way. By learning to understand how our thoughts, feelings and behaviours interact, we can gain a deeper understanding of who we are and why we think the way we think and act the way we act.

CBT can also help us to understand that we have agency and can effect change, as well as encourage us to be kinder to ourselves.

CBT can be a powerful tool in dealing with a range of mental health disorders and other issues. The transformational power of CBT is in the techniques that it teaches and, used correctly, these techniques will act as the building blocks for long-term resilience, empowerment and personal growth.

Conclusion