Cognitive behavioural therapy (CBT) is proven one of the most successful types of therapy for many different mental issues. It is a practical, structured, and goal-focused type of therapy where the client learns how his mind works and practices tools to manage better his difficulties.
In comparison to other types of therapy where the therapist has a passive role, in CBT the therapist guides the sessions a bit more actively and teaches the client tools that he continues practising at home.
There are multiple tools and techniques used in CBT and the CBT therapist adapts each tool to each client, as every person and situation is different. Not every tool works or is appropriate for every person, and that is why it is so important to have an experienced therapist that can listen to the person and adapt the approach used. Below, you have some examples of the tools that can be used in therapy.
Psychoeducation involves learning about the brain, its function, and the different conditions or symptoms impacting the person’s life. By realising how thoughts, feelings, behaviours, and physical sensations work together, the person starts understanding why he behaves and thinks in the way he does. Information is power, and before you can start making changes in your life, you need to understand what is it that needs to be changed.
Hence, the role of the CBT therapist is to teach the person about all these brain mechanisms. This knowledge can also be found in many books that explain different aspects of the human brain. For example, Prisoners of Belief (McKay) is a great book that explains more about our thoughts, assumptions and core beliefs, and teaches how to challenge unhelpful and unrealistic thoughts. Psychoeducation is well used in therapy for OCD, CBT for bulimia, and other mental issues.
The next step is to become self-aware of how all the brain mechanisms are playing in the person. What thoughts is the person thinking often? What feelings and body sensations are the people experiencing as a result? How is the person behaving in reaction to his thoughts and feelings? For example, is the person avoiding doing something because of fear of failure, or is he seeking reassurance constantly?
To become aware of your pattern of thoughts, you can start writing down some information about yourself. Every time you become upset, or your emotions change suddenly as a consequence of something that happened, stop and ask yourself the following:
- Situation: what was the situation that triggered a change in your emotion or body sensations?
- Thought: what was going through your mind at that time?
- Emotion (rate the intensity from 1-10): what emotions/s did you feel and how strong were they?
- Physical sensations: what body sensations do you have as a result of the emotion? Did you feel the tension in your back, your belly, or your chest? Was your heart pounding?
- Behaviour: what did you do as a result? Did you avoid doing something, did you procrastinate, did you compensate by overpreparing, did you start a fight?
Another good way to become more aware of your thoughts, feelings and body sensations is by meditating daily. Meditation offers an opportunity to stop and observe your brain. Be curious about your thoughts and feelings, observe them and learn about yourself. That is very powerful.
Once the person has become aware of his patterns of thought and knows what are the thoughts that negatively impact him the most, the next step is to start evaluating how realistic and helpful those thoughts are. People tend to make these common cognitive distortions and it is important to analyse if this is the case.
Overall, to evaluate the thought the therapist might ask the following questions:
- What is the thought you want to evaluate? How much do you believe this thought, (rate it from 1 to 10)?
- What is the evidence that supports the thought?
- What is the evidence against the thought?
- Is this thought helpful?
- What are the consequences of holding this thought?
Usually, thoughts that cause intense unpleasant emotions are unrealistic and unhelpful. Once the person evaluates the thought by reflecting on the questions above, the therapist asks the person to come up with an alternative thought that is more realistic and helpful. This exercise often decreases the intensity of the unpleasant emotion triggered by the unhelpful thought.
This cognitive restructuring technique requires practice, as we are used to thinking in a certain way, and challenging our thoughts is not something that comes naturally to us.
Behavioural experiments are experiments set up by the therapist and the person in order to test a hypothesis the person has. For example, people with social anxiety might think that they need to use additional make-up to cover up their blushing. They might think that if they don’t do it, people will notice them blushing and will point that out to them.
To prove this hypothesis right or wrong, it is necessary to set up an experiment. Both therapist and client work together to decide what the experiment will be like. They might decide that the best way to prove it is for the client to go to a party without make-up, or with less make-up than usual, and monitor what happens. If the person blushes during that party, he can test whether the rest of the people notice it and point it out, or if nobody sees it. He can also test whether he is going to blush for sure or maybe not.
Here you have a behavioural experiment worksheet as an example.
The solution focus approach aims to offer a strategy to better tackle problems and, therefore, separate the problem itself from the anxious reaction to it. This approach focuses on possible solutions rather than the problem itself, creating more possibilities for solving them.
Literature shows how certain breathing techniques can immediately reduce anxiety. Breathing methods can be practised during therapy sessions. Some of the most popular breathing techniques include deep breathing, box breathing, and 4-7-8 breathing. Science has also shown that longer exhales can lower stress levels.
Worry postponement is a tool to control your worries by setting up a specific time to worry. It aims to reduce stress and anxiety. First, the person set up a worrying time that should be every day at the same time and with the same duration. For example, every day at 4 pm for 30 minutes. The trick is that you can only worry at that time. If a worrying thought pops up at a different time, you gently notice the thought, write it down, and tell your brain not to worry, as you will worry about it at the chosen time. Then, focus your attention on the present moment.
Behavioural activation is a technique used within CBT or as a standalone treatment. It is mostly used to treat severe depression when the person has stopped engaging in any activity and has difficulty getting out of bed and doing things. This technique aims to establish a weekly schedule of activities one has to stick to with the idea that doing activities, even when small, can provide the person with a positive emotional state. The re-introduction of activities is gradual, as someone with depression can struggle with the minimum task. Additionally, the selected activities are chosen based on what the person values in life. For example, if the person values the relationship with his family, behavioural activation would help him to introduce more activities that can nurture these relationships.
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