are most useful for different types of people and which therapeutic interventions work best with different types of problems.
Research shows that people who have CBT for various types of problems – in particular, for anxiety and depression – stay well for longer. This means that people who have CBT relapse less often than those who have other forms of psychotherapy or take medication only. This positive result is likely due in part to the educational aspects of CBT – people who have CBT receive a lot of information that they can use to become their own therapists.
More and more physicians and psychiatrists refer their patients for CBT to help them overcome a wide range of problems with good results. These problems include the following:
Addiction
Anger problems
Anxiety
Body dysmorphic disorder
Body image problems
Chronic fatigue syndrome
Chronic pain
Depression
Eating disorders
Gender identity and sexuality issues
Obsessive-compulsive disorder
Panic disorder
Personality disorders
Phobias
Post-traumatic stress disorder
Psychotic disorders
Relationship problems
Social anxiety
We discuss many of the disorders in the preceding list in more depth throughout this book, but it is very difficult to cover them all. Fortunately, the CBT skills and techniques in this book can be applied to most types of psychological difficulties, so give them a try whether or not your particular problem is specifically discussed.
Understanding CBT
Cognitive behavioural therapy is a school of psychotherapy that aims to help people overcome their emotional problems.
Cognitive means mental processes like thinking. The word cognitive refers to everything that goes on in your mind including dreams, memories, images, thoughts and attention.
Behaviour refers to everything that you do. This includes what you say, how you try to solve problems, how you act and avoidance. Behaviour refers to both action and inaction, for example biting your tongue instead of speaking your mind is still a behaviour even though you are trying not to do something.
Therapy is a word used to describe a systematic approach to combating a problem, illness or irregular condition.
A central concept in CBT is that you feel the way you think. Therefore, CBT works on the principle that you can live more happily and productively if you’re thinking in healthy ways. This principle is a very simple way of summing up CBT, and we have many more details to share with you later in the book.
Combining science, philosophy and behaviour
CBT is a powerful treatment because it combines scientific, philosophical and behavioural aspects into one comprehensive approach to understanding and overcoming common psychological problems.
Getting scientific. CBT is scientific not only in the sense that it has been tested and developed through numerous scientific studies but also in the sense that it encourages clients to become more like scientists. For example, during CBT, you may develop the ability to treat your thoughts as theories and hunches about reality to be tested (what scientists call hypotheses) rather than as facts.
Getting philosophical. CBT recognises that people hold values and beliefs about themselves, the world and other people. One of the aims of CBT is to help people develop flexible, non-extreme and self-helping beliefs that help them adapt to reality and pursue their goals. Your problems are not all just in your mind. Although CBT places great emphasis on thoughts and behaviour as powerful areas to target for change and development, it also places your thoughts and behaviours within a context. CBT recognises that you’re influenced by what’s going on around you and that your environment makes a contribution towards the way you think, feel and act. However, CBT maintains that you can make a difference to the way you feel by changing unhelpful ways of thinking and behaving – even if you can’t change your environment. Incidentally, your environment in the context of CBT includes other people and the way they behave towards you. Your living situation, your culture, workplace dynamics or financial concerns are also features of your larger environment.
Getting active. As the name suggests, CBT also strongly emphasises behaviour. Many CBT techniques involve changing the way you think and feel by modifying the way you behave. Examples include gradually becoming more active if you’re depressed and lethargic, or facing your fears step by step if you’re anxious. CBT also places emphasis on where you focus your attention. Mental behaviours, such as worrying and chewing over negative events, can be helped by learning to focus your attention in a more helpful direction.
Progressing from problems to goals
A defining characteristic of CBT is that it gives you the tools to develop a focused approach. CBT aims to help you move from defined emotional and behavioural problems towards your goals of how you’d like to feel and behave. Thus, CBT is a goal-directed, systematic, problem-solving approach to emotional problems.
Making the Thought–Feeling Link
Like many people, you may assume that if something happens to you, the event makes you feel a certain way. For example, if your partner treats you inconsiderately, you may conclude that she makes you angry. You may further deduce that her inconsiderate behaviour makes you behave in a particular manner, such as sulking or refusing to speak to her for hours (possibly even days; people can sulk for a very long time!). We illustrate this common (but incorrect) causal relationship with the following formula. In this equation, the A stands for a real or actual event – such as being rejected or losing your job. It also stands for an activating event that may or may not have happened. It could be a prediction about the future, such as ‘I’m going to get the sack’, or a memory of a past rejection, such as ‘Hilary will dump me just like Judith did ten years ago’. C stands for consequence, which means the way you feel and behave in response to an actual or activating event.
A (actual or activating event) = C (emotional and behavioural consequence)
CBT encourages you to understand that your thinking or beliefs lie between the event and your ultimate feelings and actions. Your thoughts, your beliefs and the meanings that you give to an event produce your emotional and behavioural responses.
So in CBT terms, your partner does not make you angry and sulky. Rather, your partner behaves inconsiderately, and you assign a meaning to her behaviour such as ‘She’s doing this deliberately to upset
