When you hear the words "psychotherapy", what comes to mind? A patient lying on a couch having their dreams interpreted, or being hypnotised? In reality, there are many kinds of psychotherapy today, and one of the most common approaches is Cognitive Behavioural Therapy (CBT).
How does Cognitive Behavioural Therapy work in principle?
As the name suggests, Cognitive Behavioural Therapy works on our thinking and our behaviour. The approach is built on understanding how our thoughts, beliefs and attitudes shape our emotions and actions. The theory behind it rests on two assumptions. First, we are all influenced by Automatic Thoughts — meaning we tend to rely on the same patterns of thinking, and may overlook the reality or other factors in our external environment. If we develop automatic negative thoughts, we will automatically think from a pessimistic angle, and may dwell too heavily on the negative side of things. Second, our physical reactions, behaviours and emotions all stem from our thoughts. For example, a student who believes their results will be poor before grades are released may feel anxious (emotion) and notice their heart racing (physical sensation), and might even cope by binge eating (behaviour). By contrast, someone who believes they will do well is less likely to experience this kind of reaction.
When we react differently to the same event, what shows through is not objective fact but our own subjective "thoughts". If we hold certain negative thoughts and think in automatic patterns, we become more likely to experience negative emotions and behaviours, and more likely to sink, over time, into a vicious cycle.
What can Cognitive Behavioural Therapy be used for?
Cognitive Behavioural Therapy has clinical evidence behind it and can effectively help with a range of emotional difficulties. These include depression, panic disorder, obsessive-compulsive disorder, social anxiety disorder, and more. It may also help with anger, low self-esteem, and physical problems such as chronic pain or fatigue.
How is Cognitive Behavioural Therapy carried out?
In Cognitive Behavioural Therapy, the therapist works together with the client to address the client's psychological difficulties. CBT can be delivered one to one or in small groups.
At the start, the therapist will assess you and analyse your difficulties with you — including your thoughts, behaviours and emotions, and how these affect your psychological state and daily life. Over the first few sessions, you and your therapist can also work out together whether this approach is suited to your particular difficulties.
CBT focuses mainly on resolving the situation in the here and now. So while the therapist may, depending on the circumstances, decide to ask about your past or childhood experiences, these are generally not the main focus.
During therapy, the therapist and client set goals and devise solutions together. The plan may include discussing short-, medium- and long-term goals and agreeing on the topics to be covered in each session. When it comes to actually tackling a problem, the therapist will usually first help the client recognise how they view different situations, and how those views affect their mood, behaviour and daily life. The therapist and client then work together to come up with solutions that target these unhelpful thoughts and behaviours.
Of course, the client also has to put in effort, actively applying these techniques in everyday life (this is the "homework") — for example, filling in a record sheet to note down their own thoughts, so they can replace the thinking that troubles them with more helpful or more objective thinking, improve how they manage their emotions and behaviour, and discuss with the therapist how well these methods are actually working in order to adjust as needed. In this way, you can reduce how often the problems and symptoms recur.
Who can I turn to for Cognitive Behavioural Therapy?
Cognitive Behavioural Therapy is generally delivered by clinical psychologists, psychiatrists or other mental health professionals who have received specialist training and have relevant experience. You can start by seeking help from your family doctor, who can refer you to these professionals.
Reference
Beck, A. T. (1967). Depression: Clinical, experimental, and theoretical aspects. University of Pennsylvania Press.
Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461-470.
Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. Social phobia: Diagnosis, Assessment, and Treatment, 41, 22-3.
Salkovskis, P. M. (1985). Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23, 571-583.
https://www3.ha.org.hk/cph/imh/mhi/article_04_03_01_chi.asp
https://www3.ha.org.hk/cph/imh/doc/information/psychiatrists/F2.pdf
https://www.egps.hk/cognitive-behavioral-therapy
http://www.mindguide.hk/chi/psy2.php?product_id=1#.Xx_4ISgzaM8
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