Evaluating the key concepts of Cognitive Behavioural Therapy
Hi guys and welcome to my latest blog, here we take a brief look at CBT and how it may be used, hope you enjoy.
To understand the key concepts of Cognitive Behavioural Therapy, we much first understand what Cognitive Behavioural Therapy or CBT to give it its more common name is and how it came to be. CBT, like person centred or psychodynamic therapy is a talking therapy. The evolution of CBT can be traced back to as early as 1913. The work of John B. Watson laid the foundation for later advancement in the field by people such as Albert Ellis and Dr Aaron T Beck in the 1960’s. CBT can help people who are experiencing a wide range of mental health difficulties such as anxiety, stress, addiction relapse and many more. CBT is based on the principle that what people think can affect how they feel and how they behave, this is to say in a very basic term that if you think sad thoughts you feel sad and if you think happy thoughts you feel happy, although now there is also research to say the opposite is true as well as the way an individual behaves affects how they feel. However this is not really the area of CBT and I will only mention it briefly here to give balance to the evaluation of this approach. The cognitive part of CBT refers to how people think about and create meaning about situations, problems and events in their lives. CBT uses techniques to help people become more aware of how they reason and the kinds of automatic thought they have when a situation occurs. The main drive behind making a client aware of these thought processes is in the hope that with CBT work, the client will be able to alter these patterns and live a life free from the issue that brought them to therapy or at the very least have the tools to deal with this thought pattern or situation if it occurs again. Like any approach to therapy, CBT has pros and cons. The pros to this approach are such things as it can be effective over a short period of time, it can be used with almost any age group, CBT focuses on altering thoughts and behaviours, can be helpful in treating some mental health disorders where medication has not helped and it can be provided In many different ways including in-person, online and even written communication. Despite these pros, the CBT approach does have cons as well these are such things as, it does not fully address possible underlying issues, it can prove more difficult for people suffering from severe mental health difficulties or those with a learning disabilities, it can sometime prove a short fix and if the client stops practicing the learned techniques it’s very possible for a relapse to occur and finally as with all forms of therapy, it just isn’t the right fit for some clients, certainly those that wish to explore the deeper issues at the root of their problems often find CBT to be too “therapy light” to meet their needs.
Apply this theory to practice
When working with a client from a CBT based approach a therapist will look to change the way a client thinks about an event or look to give the client the ability to change their thinking around certain situations. Andrew Reeves describes this in ‘An introduction to Counselling and Psychotherapy’ as “CBT can be seen as a particular bespoke approach to working with clients, with emphasis on individual therapy plans targeted at specific problem area, albeit within a wider behavioural and cognitive frame” ( P. 82). An example of this would be if a client presents with severe anxiety which is causing anxiety attacks, commonly referred to as panic attacks. A common approach to working with this client would be to first teach them some breathing exercises and then helping the client to understand the triggers that cause a thought pattern to develop that ultimately leads to the anxiety attack. So let’s look at this client in more detail, it is likely that when this client first comes to therapy they will be anxious as therapy may well be a new experience for them and they may not know what to expect. To calm this client, the therapist may well do some simple breathing exercises to help the client become more relaxed, they may also explain briefly how they work and what the client can expect. Once this has been achieved and the client is in a more relaxed state, the therapist may ask the client to tell them about the last time they experienced one of these attacks. It is important here that the therapist manages this part of the session well as the last thing you would want to happen is to send this client back into that situation too deeply and cause them to have another attack in the therapy room, this could lead to them linking the therapeutic space to a negative feeling and would seriously hinder the progress that could be made in the current or future sessions. Ideally the client will be able to recall how they were feeling and thinking at this time just before the attack happened and together with the therapist they will be able to identify the triggers and situations that cause these to happen. This may take some time to achieve or possibly may be achieved in the first session; this very much varies from client to client. Once these situation and thought patterns have been identified, the client and therapist will work together to find a way that the client can manage these events in a more productive way, this may be simple steps such as getting the client to notice particular situation that trigger the anxiety and when this happens if possible get the client to remove themselves from the situation and give themselves a five or ten minute break in which then can compose their thoughts and practice a quick breathing exercise. Another commonly used tool if the client cannot remove themselves from the situation and is forced to face it head on, is to teach them to think the word ‘change’ whenever they notice the thought pattern reoccurring. This helps make the client be fully aware of the present situation and makes it easier for them to deal with what’s in front of them instead of being taken over by the automatic anxiety response they have trained themselves to do. The hope with this technique is that once the client has used this enough times, they will eventually teach themselves this response as an automatic action and this will override and replace the anxiety response that was there before it. These two simple techniques can be very powerful and have amazing results in a relatively short period of time, they are also often paired with asking the client to keep a journal of their thoughts and feelings at the end of each day. The action of committing their thoughts to paper is often very therapeutic in itself and allows the client to process what they have experienced that day in a safe and controlled way. This is designed to help the client experience an emotional release at the end of a day and will hopefully prevent these feeling and thoughts from rolling over into the following day as if they do this can become overwhelming and result in the return of the anxiety and repetitive negative thought pattern.
The above is just one example of how CBT may be used in practice, there are many different ways of applying CBT and this can differ from therapist to therapist and client to client. Some therapist like to introduce work sheets, some like to use games and picture cards, it all depends on finding what is right for the individual sat in the clients chair.
That’s it for this one guys, hope you enjoyed this brief look at CBT and how it may be used.
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Until next time,