Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is the most well-studied and widely used form of psychotherapy in Australia. Consisting of numerous strategies and techniques, it can help you learn how to cope better with life’s challenges or be used as a form of treatment for a range of mental health conditions.

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Cognitive behavioural therapy (CBT) is an evidence-based approach to treating a range of mental health conditions. If you’ve been looking into therapy, you may have come across therapists offering CBT. Perhaps you’re not sure what to expect from CBT or whether it’s the right type of therapy for you. 

In this article, we’ll walk you through the basics of CBT, including:

How does CBT work?

CBT is a type of psychotherapy used to treat mental health conditions and challenges. CBT acknowledges that our thoughts, feelings, and behaviour all impact each other. By using CBT, we can start to feel better by either changing our thinking, changing our habits, or changing our behaviour - whichever works best for you.

Watch this video to find out more about how CBT works and whether it might be helpful for you.

Let’s look at an example of how our thoughts, feelings, and behaviours are linked.

If you have bad acne, you might avoid socialising. You might feel embarrassed and ashamed about your skin. You might be scared that your friends will judge your acne, so you avoid hanging out with them altogether. This is an example of how thoughts (that you will be judged), lead to feelings (of shame and embarrassment), and then to specific behaviours (avoiding hanging out).

Equally, this behaviour (avoiding hanging out), reinforces the thought that people will judge you for your acne (because you don’t have the opportunity to prove the thought wrong), and contributes to those feelings (of shame and embarrassment).

At first, avoiding your friends offered a sense of safety. But in the long term, avoidance is an unhelpful coping strategy because it keeps harmful thoughts and behaviours going. How? By not allowing you the opportunity to prove your negative thoughts wrong.

CBT can help in this situation by either:

  • Helping you challenge the thought that “my friends will judge me for my acne” so you feel more comfortable going out
  • Helping you to go out with your friends, which could demonstrate that your friends don’t actually care about your acne.
  • The negative spiral

CBT strategies

There are a range of different strategies and techniques used in cognitive behavioural therapy. A CBT therapist will work with you to find the best approach for you, which will often involve a combination of multiple strategies. Below are some examples of how they can work.

  • Challenging core beliefs

    Core beliefs are the fundamental beliefs we hold about who we are, which are developed over time through our experiences. Core beliefs aren’t usually something we think about very often (or are even aware of) but they can have a big impact on our lives.

    For example, if you had parents with high expectations, you may have developed the core belief that nothing you do is good enough, or that you are not good enough. This belief could have a negative impact on your life in all sorts of different situations. For example, you might:

    • Feel insecure in relationships or friendships because you fear you’re not enough for the other person/people
    • Feel a need for things to be perfect, or put huge pressure on yourself
    • Avoid taking on extra responsibility or trying new things because you fear making mistakes
    • Avoid asking for feedback, or try and do things on your own because you don’t want others to know you need help.

    At a subconscious level, you might fear that these things would confirm your belief that nothing you do is good enough, or you might want to avoid those feelings of ‘not being good enough’ you had in the past.

    CBT based therapy can be particularly helpful in identifying what some of your unhelpful core beliefs may be, how they might be affecting you, and working on ways you can change them.

  • Exposure therapy
  • Behavioural experiments

What happens in a CBT session

CBT therapists will work with you to understand what challenges you would like to work on, and what you would like to achieve. They will then take your circumstances into account, and use one or more different strategies to help you. They might:

  • Help you to understand the link between your thoughts, feelings, and behaviours
  • Help you recognise patterns of thinking and behavior
  • Help you identify and challenge core beliefs
  • Design activities, behavioural experiments, or homework for you to practice between sessions
  • Help you learn new behaviours and techniques you can use.

Together, they will help you find the approach that works for you. It’s ok to tell them if something feels too much - while some things may feel challenging, a good therapist will make sure you only take on what you’re ready for.

What does CBT treat?

CBT treats mild mental health challenges as well as more serious conditions. CBT can be effective for the treatment of:

Whether you have a diagnosable mental health condition or not, CBT can help you cope better with life’s challenges.

What are the benefits and limitations of CBT?

It’s important to choose a therapeutic approach that fits you. Understanding the benefits and limitations of CBT can help you decide whether you’d like to give it a try.

Here are some benefits that CBT can offer you:

  • CBT can be as effective as taking medication. This makes it a great drug-free alternative for treating mental health issues
  • CBT will give you practical and helpful strategies that you can use in everyday life to help you cope better with future stresses and difficulties
  • The strategies you learn through CBT can stay with you forever. You can tap into these skills any time you face difficulties again in the future
  • CBT will give you practical and helpful strategies that you can use in everyday life to help you cope better with future stresses and difficulties
  • CBT is a short-term, goal-focused treatment that is usually completed within 12-20 weeks.

Now, let’s look at some of CBT’s limitations:

  • For some people, CBT’s ‘present focus’ may mean it is not effective in addressing possible underlying causes of mental health conditions, such as past experiences.
  • CBT relies on your commitment to homework or activities outside of sessions. While it’s common to be asked to apply what you learn to your everyday life in most types of therapy, it is usually central to the process in CBT. You may be asked to do things like keep thought diaries, challenge your thoughts, and practice new behaviours.
  • If you generally dislike structure, then CBT may not be the ideal choice for you.
  • Some of the things you may be asked to do for homework in CBT can involve stepping out of your comfort zone. This may cause mild to moderate discomfort.

If you don’t like the sound of CBT, that’s okay. You don’t need to feel disheartened as there are many other approaches to choose from. A good therapist can use other strategies, or point you in the right direction if CBT isn’t working for you.

Can I try CBT on my own?

CBT works well as a self-help strategy but for best results, you should consider working with a therapist. A therapist can give you extra guidance and support to break stubborn patterns or habits that may be hard to break on your own, or that you may not be aware of.

That being said, if you’d like to test CBT out, you can download a CBT app. Our favourite is MindDoc, but there are many other options available to suit what you’re looking for.

Another option is to try a CBT book such as CBT Made Simple, which gives a detailed explanation of CBT, along with strategies you can apply for yourself. There’s also CBT in 7 weeks, which is a step-by-step workbook with prompting questions and activities. Both books are written by licensed psychologist Seth Gillihan.

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