So what is CBT …. ?
Our lives are affected by our genes and our accumulated experiences. These learned and unlearned influences exert a strong pull on how we think, feel and act, but they’re not immutable. We can in fact change how we think and act in the world, and thereby change how we feel. Change may be hard, we may need to unlearn long established patterns, but it’s certainly possible.
Our emotions are significantly affected by our thinking. If we view all dogs as threats, we’ll experience fear in the presence of any particular dog. If we see dogs as loving friends, we’ll feel affection and joy in the company of that dog. The dog in question is or is not safe to be with – that’s just a fact. The difference in emotion is a function of the difference in perception, a matter of thinking not fact, which explains why two people can have entirely different emotional responses to the same dog.
Our actions also have an impact on our emotions. If we avoid all dogs in all circumstances, we can be sure of safety. But we can also be sure of remaining fearful of all dogs; there will be no way of learning from experience which dogs are factually safe and which factually unsafe. In fact, we will most likely become more scared by avoiding all dogs – we’re likely to attribute our safety to our avoidance (a factually inaccurate conclusion), rather than to the (factually accurate) reality that the vast majority of dogs are harmless. If instead of avoiding, we go carefully towards dogs, we would gain experience from which to assess which are safe and which unsafe, and would learn by practical experience how to ensure that even in the presence of unsafe dogs we can remain unharmed. We learn how to assess facts accurately from experience, from how we act in the world. Our actions affect our thinking, our thinking affects our actions, and both affect our feelings.
In the same way that we can become emotionally disturbed by how we think and what we do (or don’t do), we can use our thinking and our actions to reverse our emotional disturbances. If we want to feel differently, we can change our thinking (“Cognition”), learning to think more accurately, and we can change what we do or don’t do (“Behaviour”). This is the essence of Cognitive Behavioural Therapy. CBT teaches us how to think about our thinking, how to see ourselves and the world more accurately and helpfully, and how to change how we feel by changing what we do.
Here and now, the present, is the only life we have. The past has gone and the future doesn’t yet exist. The only changes we can make are to the only life we have, the life that is here and now. The present is therefore the primary focus of CBT. Of course, it wouldn’t be sensible to ignore the past. We may need to look into our past in order to understand our present, how we have learnt to think and behave in ways that maybe were once sensible and helpful, but may not be helping us now. Whilst we can’t change the past, we can change how we think about it and how we understand it, so that we respond to the present world as accurately and helpfully as possible.
CBT has evolved over recent decades through research science. Some of its ideas are not so new. It turns out that the hard 21st century science confirms some elements of Buddhist teaching. The ancient Greek philosopher Epictetus was onto the link between our thoughts and our emotions 2,500 years ago: “[People] are disturbed not by things, but by their interpretation of things.”). What’s historically new is the research science and experimental evidence which are at the heart of CBT practice. CBT therapy is entirely evidence-based, meaning that its principles are built on scientific method, research and fact, not on bare untested or untestable hypothesis, theory, or philosophy. CBT techniques are supported by decades of randomised controlled trials, the gold standard of clinical efficacy, showing their effectiveness across a very wide range of psychological and emotional difficulties.
Whilst science and evidence are the DNA of CBT, other features also distinguish it as a psychological therapy:
CBT places a strong emphasis on “psychoeducation” – teaching clients how to become their own CBT therapists. There is no mystique to CBT, no mysterious wisdom that the therapist alone can access and which must remain for ever opaque to the client. The CBT therapist aims to teach the skills and provide the tools that will make the therapist redundant, enabling the client to become her own therapist.
Unlike many forms of therapy which are open-ended and may last for several years, CBT is typically time-limited. Whilst the duration of therapy is dependent on each client and the challenges they bring to therapy, CBT treatment will commonly involve weekly sessions over 12 to 20 weeks.
CBT is practical. It provides pragmatic and effective tools for responding to real-world challenges, such as “how can I regulate my emotions so they don’t overwhelm me”, “how can I manage my anxiety”, “how can I stop worrying”, “how can I climb out of depression, and avoid falling back into it”, “how can I stop my panic attacks”, “how can I get on a plane”, “how can I stop bingeing/gambling/drinking”, “why does this keep happening to me and how can I stop it”.
Oh, and by the way … it can be fun.