CBT In Practice

Cognitive-Behavioural Therapy (CBT) combines basic theories about how people learn, with theories about the way people think and interpret events in their lives (cognitive). CBT is now firmly established as a beneficial psychological treatment for many mental health conditions.

In CBT, the therapist and the client work together to identify unhelpful patterns of thinking and behaviour. For example, someone might only notice the negative things that happen to them and not notice the positive things, or someone might set unrealistic standards for themselves such as “making mistakes at work is unacceptable”. It is important to identify unhelpful behaviours that maintain symptoms, such as avoiding certain situations and withdrawing from others.

The client and the therapist also look at how thoughts and behaviours impact feelings. For example, if someone believes that nothing will work out for them in life, they may withdraw from others and avoid new opportunities. This, in turn, can lead to feelings of increased sadness, emptiness and anxiety. This is could be called a “vicious circle” of thoughts, feelings and behaviours.

Carefully constructed exercises are used to help a client evaluate and change their thoughts and behaviours. Some aspects of treatment focus more on thoughts while some aspects focus more on behaviours. If a client has difficulty identifying and challenging negative thoughts, the therapist might focus on addressing behaviours such as avoidance, withdrawal or poor social skills. On the other hand, if such behaviours are not as noticeable, the therapist may focus on challenging unrealistic thinking.

Common CBT interventions include:
• setting realistic goals and learning how to solve problems (e.g. engaging in more social activities, learning how to be assertive)
• learning to manage stress and anxiety (e.g. learning relaxation techniques such as deep breathing, positive self-talk such as “I’ve done this before, just take deep breaths”, and distraction)
• identifying situations that are often avoided and gradually approaching feared situations
• identifying and engaging in enjoyable activities such as hobbies, social activities and exercise
• identifying and challenging negative thoughts (e.g. “things never work out for me”)
• keeping track of feelings, thoughts and behaviours to become aware of symptoms and to make it easier to change thoughts and behaviours.