CBT (Cognitive Behavioural Therapy)

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Thinking Better - Feeling Better

Cognitive Behavioural Therapy (CBT) works on the principle that we always have a thought before an emotion or action and by capturing our thoughts and examining them we have a mechanism for improving how we think and respond. We do not have to keep on repeating the same mistakes or feeling the same way. CBT can take a number of forms but all have that simple idea at their core. It isn't what actually happened that disturbs us but our belief about what has happened. Because I think about what happened in a particular way, it does not mean that is the only way of thinking about it. That may strike a chord with you as sometimes you may think about something one way and later see it in a different light - think about it in another way and then feel about it differently.

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Taking a walk with Philippe Petit Let us look at an example. Philippe Petit was a 25 year old French visitor to New York. He planned to go for a short, early morning walk. He had been looking forward to and planning his walk. He had been up all night and although he was a little tired, still he looked forward to seeing the City in the early morning light. His walk lasted about 45 minutes and apart from the early morning mist and there being a slight breeze, Philippe really enjoyed his walk he did not meet or talk to anyone but still he was really happy and elated and has fond memories of it and enjoyed the sights.

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Walk on the Wild Side Do Philippe's thoughts, his belief seem appropriate? Philippe's emotions were that he was happy and elated, do Philippe's emotions after his walk seem reasonable to you? Would you like you go for a walk like that Philippe took? Philippe Petit took his walk on the 7th August 1974. He walked between two New York skyscrapers just over a quarter of a mile above the street below him. He had no safety net or harness he just walked on a cable less than 2cm thick back and forth between the two buildings.

Would you like you go for a walk like Philippe's?

What are your thoughts and emotions about doing it?

Do Philippe's emotions after his walk seem reasonable to you?

It is not what happened that disturbs us but our own thoughts regarding the event. Philippe thinks about his walk differently from us and therefore feels differently about it. It is not a new idea. Here is a quote from the Greek Philosopher Epictetus.

"People are disturbed, not by things, but by the principles and notions which they form concerning things." Epictetus wrote in The Enchiridion, 135 BC, translated by Elizabeth Carter http://classics.mit.edu/Epictetus/epicench.html

That's fine to tell you "Think about it another way" but what if you are really feeling down and just cannot see things another way, then maybe it is one thing after another and you are spiralling downwards. Let's see what can be done.

The First Step in Helping Recall CBT holds that you do not get an emotion or take an action without a thought causing it. If you now visualise walking across that thin, twisting, swaying rope the thought might come to you "I'll fall!" Then maybe you will feel anxious or see yourself falling. And of course something set off the thought, my suggestion to visualise walking high above the street on a rope.

The chain to an emotion (good or bad) or an action (helpful or unhelpful) starts with a trigger. The trigger can be anything you see, hear, smell, remember etc. But in the case of unhelpful, depressive thoughts, this trigger, whatever form it takes, leads you to a negative thought which you do not dispute, it automatically becomes a 'belief', it is held to be true in your mind. The 'belief' is not even examined or challenged. It is obviously true as it came from within you, your own thoughts. And so the downward spiral begins, negative thought to negative feeling to more negative thoughts and so on down.

CBT addresses negative chains:

Trigger - Negative Belief - Negative Emotion

and works on challenging and disrupting destructive or distressing chains most commonly by substituting more realistic and positive thoughts and beliefs.

Same Trigger - Realistic Belief - Positive Emotion

Consider a simple example, Villette texts her friend with an invitation and then puts her mobile down on the table. Some time passes and Villette looks at her mobile and she feels anxious, her friend normally replies straightaway and it's unusual not to get a reply. Villette may even tell the story that way missing out the thoughts involved. "I phoned a friend today and didn't get a reply and I've felt anxious all day." The Trigger was Villette not getting a reply and the consequence (emotion) was Villette feeling anxious.

If you had been there with Villette and were quick enough and asked her what was passing through her mind just at the moment she looked at her mobile she would say "I wondered if she still liked me." And that thought was what made her anxious. We might ask, "Villette, is it probable?" Could there be a more likely explanation? How come when nothing has happened to disrupt your relationship you fly to this anxious thought? Is this a pattern in your thinking "People will reject me". But you would have to be quick because a moment later the thought was gone and forgotten. Villette was unaware of the fleeting thought but was left in an anxious state.

During psychological distress a person's thinking becomes more rigid and distorted, judgements become over generalised and absolute, and the person's basic beliefs about the self and the world become fixed.

When we are down, depressed or anxious we are less able to think as flexibly as when things are going well for us. We find it difficult to see things as passing and not for ever, or not the end of the world or being partly good and partly bad. They are all bad and bad for ever and ever.

In CBT we work with the client to identify and then examine their thoughts about a distressing event to see if they are still applicable and relevant.

If they are not, we work with the client to modify or reject the distorted thought and to find more relevant and helpful patterns of thinking about events in their life.

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