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24 November, 2009

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Cognitive behaviour therapy

Psychotherapy is a form of treatment for emotional and psychological problems where a person talks with a mental health professional such as a psychiatrist, psychologist or counsellor. Cognitive behaviour therapy (CBT) is a form of psychotherapy that helps a person to change unhelpful or unhealthy thinking habits, feelings and behaviours.

CBT involves the use of practical self-help strategies, which are designed to bring about positive and immediate changes in the person’s quality of life.

A range of applications
CBT is used to treat a range of psychological problems including:

Anxiety
Anxiety disorders such as social phobia, obsessive-compulsive disorder or posttraumatic stress disorder
Depression
Low self-esteem
Uncontrollable anger
Irrational fears
Hypochondria
Substance abuse, like smoking, drinking or other drug use
Eating disorders
Insomnia
Marriage or relationship problems
Certain emotional or behavioural problems in children or teenagers.

CBT is also used to help many more psychological problems. In some cases, other forms of therapy used at the same time may be recommended for best results. Talk to your doctor for further information and advice.

The interaction of thoughts, feelings and behaviour
The core philosophy of CBT is that thoughts, feelings and behaviours combine to influence a person’s quality of life.

For example, severe shyness in social situations (social phobia) may stem from the person thinking that other people will always find them boring or stupid. This automatic belief causes the person to feel extremely anxious at social gatherings.

Their behaviour may include stammering, sweating and other uncomfortable symptoms. The person then feels overwhelmed with negative emotions (such as shame) and negative self-talk (‘I’m such an idiot’). Their fear of social situations may become worse with every bad experience.

CBT aims to teach people that it is possible to have control over one’s thoughts, feelings and behaviours. CBT helps the person to challenge and overcome automatic beliefs, and use practical strategies to change or modify their behaviour. The result is more positive feelings, which in turn lead to more positive thoughts and behaviours.

CBT is a combination of two techniques
CBT focuses on changing unhelpful or unhealthy thoughts and behaviours. It is a combination of two therapies: ‘cognitive therapy’ and ‘behaviour therapy’. The underlying belief of both these techniques is that healthy thoughts lead to healthy feelings and behaviours. Some of the underlying theories of these two approaches include:

Cognitive therapy – the aim here is to change the way the person thinks about the issue that’s causing concern. Flawed or distorted thoughts cause self-destructive feelings and behaviours. For example, someone who thinks they are unworthy of love or respect may feel withdrawn in social situations and behave shyly. Cognitive therapy challenges these flawed thoughts. Many techniques are available. One technique involves asking the person to come up with evidence to ‘prove’ that they are unlovable. This may include prompting the person to acknowledge the family and friends who love and respect them. This evidence helps the person to realise that their underlying belief is false. This is called ‘cognitive restructuring’. The person learns to identify and challenge flawed thoughts, and replace them with more realistic thoughts.
Behavioural therapy – the aim here is to teach the person techniques or skills to alter their behaviour. For example, a person who behaves shyly at a party may have negative thoughts and feelings about themselves. They may also lack social skills. Behavioural therapy teaches the person more helpful behaviours. For example, the person may be taught conversational skills which they practise in therapy and in social situations. Negative thoughts and feelings ease as the person discovers they can enjoy themselves in social situations.

CBT has a good success rate because it combines the techniques of these two very effective therapies.

What to expect from therapy
The specifics of treatment vary according to the person’s problem. However, CBT typically includes the following:

Assessment – this may include filling out various questionnaires to help you describe your particular problem and pinpoint distressing symptoms. You will be asked to complete forms from time to time so that you and the therapist can plot your progress and identify problems or symptoms that need extra attention.
Person education – the therapist provides written materials (such as brochures or books) to help you learn more about your particular problem. The adage ‘knowledge is power’ is a cornerstone of CBT. A good understanding of your particular psychological problem will help you to dismiss unfounded fears, which will help to ease your anxiety and other negative feelings.
Goal setting – the therapist helps you to draw up a list of goals you wish to achieve from therapy; for example, you may want to overcome your shyness in social settings. You and the therapist brainstorm practical strategies to help fulfil these goals.
Practise of strategies – you practise your new strategies with the therapist. For example, you may role-play difficult social situations or come up with realistic self-talk (how you talk to yourself in your head) to replace unhealthy or negative self-talk.
Homework – you will be expected to actively participate in your own therapy – for example, the therapist may ask you to keep a diary – and you are encouraged to use the practical strategies during the course of your daily life and report the results to the therapist.

Medication issues
Medication is not always needed. For example, CBT can be as effective as medication in the treatment of depression and anxiety. In other cases, you and your therapist may decide that medication, together with CBT, would produce the best results. For example, people with bipolar disorder usually benefit from medication that helps control their mood swings.

Issues to consider
Before choosing CBT, issues you may like to consider include:

CBT may not be the best form of therapy for people with any type of brain disease or injury that impairs their rational thinking.
CBT requires you to actively participate in treatment. For example, you may be asked to keep detailed diaries on thoughts, feelings and behaviours. If you are not prepared to put in the work, you may be disappointed with the results of therapy.
CBT involves a close working relationship between you and your therapist. Professional trust and respect is important. If you don’t like the therapist at the first interview, look for another one.
While CBT is considered a short-term form of psychotherapy, it may still take months or longer for you to successfully challenge and overcome unhealthy patterns of thinking and behaviour. CBT may disappoint you if you are looking for a ‘quick fix’.

Where to get help

Your doctor
Psychologist
Psychiatrist
Counsellor or psychotherapist – search the PACFA National Register to find a practitioner near you www.pacfa.org.au
Local community health centre
Australian Psychological Referral Service Tel. (03) 8662 3300 or 1800 333 497
Anxiety Recovery Centre Victoria HelpLine Tel. (03) 9886 9377

Things to remember

Cognitive behaviour therapy (CBT) is a type of psychotherapy that helps the person to change unhelpful or unhealthy habits of thinking, feeling and behaving.
CBT involves the use of practical self-help strategies, which are designed to affect positive and immediate changes in the person’s quality of life.
CBT can be as effective as medication to treat depression and anxiety.

You might also be interested in:
Anxiety - treatment options.
Borderline personality disorder.
Claustrophobia.
Mental illness treatments.
Obsessive compulsive disorder.
Social phobia.
Stress can become a serious illness.

Want to know more?
Go to More information for support groups, related links and references.

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