Cognitive Behavioural Therapy (CBT) is a relatively brief, evidenced based psychological therapy that is the gold standard for the treatment of most mental health conditions in Australia and across the world. There’s a fair bit to it when you work on complex cases, or with individuals with complex needs, but I’ve attempted a basic description of the process below. I’ve also included a link at the bottom of the article with further information.

 

People tend to think certain situations or events directly lead to particular feelings and behaviours. For example, I might make a mistake at work and then feel self-conscious and upset, worrying about the possible fall-out for the rest of the day. To me, the situation directly feeds the outcome, yes? I made a mistake, and it upset me, a lot. Well, not really. The basic premise of CBT is that there’s a piece in the middle that is really important. It’s crucial really. Most often it’s a negative belief about the self, or a fear. Usually it’s both at the same time.

 

Using the example above, perhaps the missing piece is that I fear failure because I have a deep-down feeling that I’m not very competent.  It’s not logical, I know I am reasonably competent, but still that feeling of incompetence is there, festering away underneath all of my usual compensations (we’ll get to that). If this is the case, then the emotions relating to that little mistake, and my pre-occupation with it, starts to make a lot of sense. It also explains why another person might have had the same experience but a completely different reaction. The diagram above illustrates this process.

 

That’s where CBT starts, but not where it finishes. The goals of CBT can be extensive, but they almost always include exploration of what the underlying beliefs and thoughts are, evaluations of their validity, and investigations as to where they might have come from. Then the work begins to identify the many ways those negative beliefs are fed through our thoughts and behaviour on a daily basis.

 

The ‘behavioural’ part is especially crucial, as what we do tends to provide us with the experiential feedback that either feeds our negative beliefs, or helps to build a new healthier belief. For example, perhaps because of the distress associated with making mistakes, I might start to become controlling and perfectionistic. I might over-focus on detail, or seek constant reassurance, or be so personally invested that I cannot possibly delegate to a colleague.

 

Where does that leave me? Firstly, by doing this I’m reinforcing that crappy belief about being incompetent, because no-one else seems to need to do all of that extra work to be competent, do they? And secondly, by behaving in this way, I’m depriving myself of the opportunity to learn that, you know what, I can do perfectly well without all the extra compensation. I am actually pretty competent after all.

 

Because behaviour is a big part of how we came to form and reinforce our unhelpful beliefs, behavioural change is often the best way to wade back out again. It is my opinion that the best CBT-informed treatment includes several behavioural goals. Just sitting in a therapy room and talking about things, even if we’re working to challenge some unhealthy cognitions while doing so, is rarely enough.

 

As I’ve noted above, CBT techniques tend to fall into two categories. I've added a third, as per the way I usually deliver CBT:

1. Cognitive (thought logging, thought challenging, and cognitive restructuring are a few typical techniques)

2. Behavioural (exposure, behavioural experiments, and behavioural activation are the most common).

3. Emotional (feelings identification and mindfulness of emotion to build tolerance of emotional experiences).

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To sum up, Cognitive Behavioural Therapy is a great way to address self-criticism and several other anxieties that wreak havoc on our days and impact our wellbeing. A good CBT therapist can walk you through this process, helping you to not only improve your day-to-day wellbeing, but to flip the script on those unhelpful beliefs that underlie your self-concept and undermine your progress at every turn.

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Article author:

Elizabeth Talbot

Psychologist

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Image and article reference: https://beckinstitute.org/get-informed/what-is-cognitive-therapy/