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Cognitive Behavioural Therapy (CBT) is a therapeutic intervention that aims to increase mental wellbeing by addressing dysfunctional thought patterns and by increasing positive coping strategies.
The CBT model assumes that individuals have maladaptive views on certain events or situations in their life that influence their emotions and the way they relate to the challenges in their life.
CBT works primarily with the beliefs of individuals and aims to change the maladaptive ones. For this reason, this therapeutic approach is targeted at individuals who have a good awareness of their thinking patterns.
A typical course of CBT ranges between six and twelve sessions. Because it is a relatively short therapeutic intervention, CBT has been proven highly efficient for anxiety disorders, depression, phobias, insomnia, eating disorders, and other mental health challenges.
Its goal-directed, problem-oriented approach makes CBT one of the most effective and popular interventions, which is widely used across healthcare services.
The principles of Cognitive Behaviour Therapy
Any therapeutic intervention should be tailored to the challenges and unique details of the client. However, there are core principles of CBT that can be used to create successful outcomes across all categories of patients.
In order to better explain how the following principles work, we will use a fictional example of a CBT client to illustrate how these principles are applied in clinical interventions.
The main principles are –
- Principle 1 – CBT is based on a tailored formulation of client’s issues and on a unique conceptualisation of each case.
- Principle 2 – Any CBT intervention should be built upon a strong therapeutic alliance.
- Principle 3 – CBT should encourage active collaboration in the therapeutic process.
- Principle 4 – CBT is problem-focused and goal-oriented.
- Principle 5 – Cognitive Behavioural Therapy is focused on the “here and now”.
CBT for children
CBT works efficiently for all ages, including young children. CBT goals will usually be discussed by the therapist with the child and their parents or caregivers. This type of therapeutic intervention can help children understand their negative thoughts and replace them with more positive ones.
CBT can also help children discover other ways of responding to stressful situations or reacting to unexpected events. Furthermore, children can benefit from learning new coping strategies that they can apply at school, at home, or in their interactions with other children and adults. These strategies can serve them as a solid foundation for their development throughout their lives.
Children can use CBT to become more aware of:
- Their daily tantrums.
- Their negative thoughts.
- Their impulsivity.
- Their reactions to outside situations.
They can further replace their negative thoughts and reactions to achieve:
- Healthier coping mechanisms.
- Problem-solving skills.
- Positive social interactions with their peers.
- Increased self-control.
A CBT intervention for children will usually involve a structured approach that will be carried out during a set number of sessions. Children can have as many sessions as they need, starting from as few as six up to even 20.
When it comes to working with children in a therapeutic context, the emphasis should be shifted from talk therapy to tangible steps that children can take to improve their mental health.
Examples of CBT techniques that can be applied when working with children are:
- Play therapy – This is a type of therapy that most children respond best to due to its practical and engaging nature. Play therapy can include arts and crafts, therapeutic games such as role-playing that address the problem the therapist focuses on.
- Modelling – This is a CBT technique that involves the therapist mimicking a desired behaviour that they want to implement in children. For example, a therapist might act out various ways in which a child can respond to aggressive children at school or how to express their emotions with their parents at home.
- Exposure – This technique involves exposing children to situations or triggers that induce their mental health challenges. For example, children with social anxiety might be encouraged to approach a social situation in a progressive way to reduce their social anxiety.
CBT in the workplace
Mental health challenges can significantly impact work-related performance. Symptoms of common mental health challenges like anxiety and depression can translate into low motivation to complete work tasks, antisocial behaviours, difficulty concentrating, and many others.
Situations when CBT can be successfully used in the workplace:
- To improve performance and help employees who are dealing with a chronic mental health problem.
- To help employees who return to work after health-related leave.
- To assist employees who undergo significant transitions in their life (such as divorce, death, relocation, etc.)
For example, people who return to work after a leave due to illness will often face many challenges after a period of low social interactions and limited use of professional skills.
Reintegration in the workplace can be highly challenging for many people, hence why CBT can provide structured interventions that help people become more at ease with their transition back to work.
Types of CBT techniques that can be applied in the workplace
There are many issues that employees can encounter in their workplace. They might deal with difficult relationships, burnout, stress, or low motivation.
CBT can provide various techniques that individuals can use in their professional life to enhance their performance and improve their wellbeing.
These techniques can be related to:
- Identifying thought patterns related to workplace stress.
- Keeping a diary of daily thoughts.
- Addressing the causes of low self-confidence.
- Exploring ways to strengthen relationships with work colleagues.
Types of CBT techniques that can be applied in the workplace
A CBT-based intervention in the workplace would involve breaking down issues into a few different areas:
- Physical feelings.
By encouraging employees to keep a log of their thoughts, emotions, and behaviours, employers can encourage healthy stress management, problem solving, and work-life balance.
When employees are more aware of their negative thoughts that affect their productivity and their relationships with colleagues, they can begin to proactively replace them with adaptive ones and to work towards improving their mental health.
CBT for work-related stress
Stress is one of the most common causes of work-related burnout. Since CBT aims to challenge dysfunctional thoughts and assumptions, CBT-based solutions at work can help individuals decrease their stress levels and deal with challenges more efficiently.
CBT interventions for stress can be applied in the form of:
- Mood monitoring – This is one of the most important goals of CBT. This technique helps individuals process their feelings related to a given event or situation and encourages reflection on their behavioural patterns and responses to challenges. In the workplace context, this CBT technique can be successfully applied to help employees become aware of their underlying moods and emotions. When they find themselves stressing about work tasks or ruminating about certain events, people can take a break and journal about stressful or upsetting events and about their feelings in relation to those.
- Shift focus on the things that individuals can control – This is another principle highly reinforced by CBT. Since it is so easy for people to feel overwhelmed at work, they might focus too much on factors that are not in their control. This leads to anxiety and to decreased wellbeing. Employees can make use of CBT techniques to shift their attention on controllable events.
- Reframing – This technique refers to seeing a certain negative situation from an altered perspective. For example, someone who did not achieve a promotion at work and is distressed about this can instead perceive this event as an opportunity to consolidate their knowledge in their current position, which will allow them to achieve better results.
- Developing healthy coping strategies for highly stressful situations – CBT is highly efficient for structuring action plans in stressful or distressing situations. For instance, an employee facing a tight deadline at work might feel extremely pressurised and anxious. They might use maladaptive coping strategies such as skipping on sleep or isolating themselves to work on their project. CBT can provide solutions for better management strategies, such as using relaxation techniques, asking for help from friends and family with daily chores, or organising workload into small chunks.
- Prioritising workload – CBT can also provide practical solutions for work-related stress. It can encourage individuals to organise their schedules in a more efficient way, which will make them more relaxed about their deadlines and projects.
CBT for mental health
CBT has been proven by research studies as a highly efficient technique for various mental health issues. This therapeutic intervention works for mental health challenges in the following ways:
- It teaches clients how to reframe their challenges.
- It encourages clients to learn adaptive coping strategies.
- It works with the client’s underlying assumptions about themselves and about the world.
- It encourages relaxation to allow clients to deal with their problems from a more relaxed perspective.
Mental health issues often manifest in a distorted view on reality, dysfunctional thinking patterns, dysregulated emotions, and unhealthy behaviours.
For this reason, CBT addresses all of these aspects when treating clients’ mental health challenges.
CBT interventions aim to decrease the frequency of negative thoughts and maladaptive behaviours by directing clients towards more functional strategies.
Mental health challenges often vary in complexity and intensity, hence the difference in the length and strategies of the applied CBT interventions.
CBT for anxiety disorders
Anxiety is a complex mental health condition that often has multiple underlying causes. CBT therapists can adopt different approaches when treating, for example, generalised anxiety disorders (GAD) from social anxiety or other related phobias.
Research shows that CBT interventions show significant results from the first sessions. Most people tend to show an improvement in their symptoms within 8-10 sessions. The process by which CBT approaches anxiety symptoms works in the following way:
- Step 1 – Identify the thoughts that create and maintain anxiety. Most clients who struggle with anxiety have deep-seated fears about an event or situation. These fears are often unrealistic and continue to persist only as long as they remain undiscovered and unchallenged. The goal of CBT is to find those irrational fears and to challenge them.
- Step 2 – Question the negative assumptions and the irrational fears. This stage aims to remove the validity of the client’s negative assumptions. This process takes the power away from the negative thoughts, as the client begins to realise that their thoughts are not always true.
- Step 3 – Choosing positive ways of perceiving the world. This step involves changing the negative thoughts with more positive ones and promoting new ways of looking at the word. CBT aims to educate clients about the importance of accurate, realistic thinking and about different ways they can achieve this. During the therapy course, clients are also encouraged to alter their perception on situations that cause them distress and to question all the dysfunctional thoughts that might arise in their mind.
- Step 4 – Changing behavioural outcomes. Clients suffering from anxiety might be afraid to make changes in their lives or to start a new initiative. For this reason, CBT aims to promote skills that empower clients to change their behaviour. For example, individuals with social anxiety might have difficulties meeting people for the first time. A CBT therapist will help them take small steps towards becoming comfortable and confident in new social situations.
Treating depression with CBT
Depression is a common mental health challenge that creates persistent feelings of sadness, low moods, and motivation, and associated physiological symptoms such as changes in sleep and eating patterns.
Depression can range from mild symptoms (such as having a bad day or low mood for a few weeks) to serious changes in perception and to feelings of deep hopelessness. Individuals might experience recurrent depression episodes or might deal with chronic depression for several years.
Although it is not entirely clear what causes depression, healthcare professionals and researchers state that people get depressed as a result of a major life incident, sudden change, a serious loss, or a traumatic event. However, depression can also be caused by genetics or adverse childhood experiences.
Common symptoms of depression manifest as:
- Recurrent feeling of sadness.
- A loss of interest or enjoyment in activities.
- Irritability and feelings of guilt without an apparent reason.
- Decreased self-esteem.
- A tendency to cry without a trigger.
- Suicidal thoughts.
- Low or lack of motivation.
- Thoughts of self-harm or attempt towards it.
CBT therapists use a range of techniques to help clients with symptoms of depression alleviate their low moods:
- Thought recording – This strategy helps clients become aware of the negative thoughts around life situations and themselves. Negative thinking patterns maintain clients in a vicious cycle of depressive symptoms and rumination.
- Behavioural activation – When someone becomes highly depressed, they might become inert or unable to carry out things as normal. This state of inertia fuels depression even more and keeps individuals stuck in vicious cycles. Behavioural activation aims to break this cycle by setting relevant goals and action plans that will lift the client’s moods and feelings. Most of the activities that are chosen for this step are enjoyable and engaging, so that clients associate them with an increased mood and wellbeing.
- Behavioural experiments – A major part of CBT is carrying out experiments that change the client’s association with certain situations in their life. Someone with depression might not believe that physical activity can improve their mood, hence why a CBT therapist can ask clients to carry out an experiment in which they will do any form of exercise and record how it makes them feel afterwards.
CBT for relationship issues
Although CBT is most commonly used for individual problems, this therapy approach can be effectively used to treat relationship challenges. Couples might encounter difficulties due to communication problems, unrealistic expectations, or by their inability to solve problems in a healthy way.
CBT can help couples resolve these issues by helping them understand how their individual thoughts and attitudes manifest into the relationship with their partner. It also encourages couples to adopt proactive ways of addressing their conflicts and manage those in an adaptive and functional way.
Some techniques that a CBT therapist could help couples resolve adversity in their relationships are:
Identifying each person’s expectations and perceptions of their partner
Usually, a relationship conflict is caused by unmet needs or expectations or by the faulty perception of the other person. CBT can help both partners voice their feelings and wants, with the aim to help the other person become more aware of them.
Exploring common triggers of conflict
Couples who have a long history of conflict can become very sensitive to triggers that recreate conflictual or difficult situations. They might also have a tendency to track their partner’s behaviours or to be hypervigilant of the actions of their partner.
This creates a negative behavioural cycle that results in even more conflict. CBT will work with both partners to identify the main sources of conflict and to explore underlying reasons from which tensioned situations might stem from.
Encouraging partners to practise new behaviours based on shared values and preferences
A CBT therapist will actively work with a couple to transform their conflictual situations into opportunities to work on positive goals.
By designing specific interventions that will help both partners remove their negative behavioural patterns, the therapist will aid them into creating new behaviours that are based on common values of the partners, such as respect, integrity, and trust.
The focus of the partners on positive aspects of their relationship will facilitate significant change and transform their relationship.