Self-help Articles

by David Pollak

This article is about Cognitive Behaviour Therapy (CBT). We’ll delve straight into the rationale behind CBT and what it involves. We then take a look at specific examples of depression and reasons Psychologists love using CBT.

Rationale behind CBT: the cycle

Cognitive Behaviour Therapy (CBT) is one of the most thoroughly researched and widely used interventions, consistently proving effective in treating depression^1-4,9, anxiety^3,8,9, general problems and a host of other issues^7,12,13,15. Here’s an example.

A common belief with depression for example is, ‘nothing will improve my situation.’ With this belief comes the thought, ‘Why try as hard if my situation won’t improve’, so I don’t try as hard; and the thought, ‘Why give it a real go if the situation won’t change’, so I give up more quickly, etc. This leads to unsuccessful attempts to improve my situation, a worsening of my symptoms of depression, and I use this as evidence to confirm my underlying belief, ‘nothing will improve my situation.’

When depressed, we usually don’t see this unconstructive cycle. Negative thoughts lead to self-sabotaging actions that depress our mood further, followed by more negative thoughts, all stemming from our beliefs. The cycle is self-perpetuating, meaning we keep this unhelpful pattern going.

The rationale behind CBT is to discover unhelpful beliefs associated with this cycle and then challenge them using three main steps. Let’s look at these steps.

• CBT involves three main steps

  We’ve just seen the rationale behind CBT. It involves breaking our cycle of negative thoughts, more symptoms, more negative thoughts, etc. To do this, our Psychologist focuses in on thoughts (e.g., cognitive), activities (e.g., behaviour) and the cognitive behaviour relationship.

• Thoughts

  Automatic negative thoughts typically occur when we are depressed. Thoughts such as, ‘no one likes me’, ‘nothing will improve my situation’, etc. fill the mind reducing appetite, making it harder to sleep, reducing motivation and concentration. This initial step of reducing these negative thoughts is commonly achieved using diversion and distraction techniques. The aim here is to begin reducing symptom severity by taking some focus away from such thoughts.

• Activities (sub-heading, bulleted)

  Symptom reduction then leads the way to monitoring and then planning activities. We record our activities and how much we enjoy and successfully complete them. More enjoyable and achievable activities are then planned. Symptoms such as anhedonia (e.g., reduced pleasure from things previously enjoyed) and helplessness are directly targeted through planning such activities. Planning activities is especially helpful in depression because when we are depressed we don’t feel like doing as much. Engaging in enjoyable and achievable activities further reduces symptoms.

• Cognitive behaviour relationship

  Psychologists spend the majority of therapy time with us in this last CBT step. It involves identifying negative thoughts, collecting evidence about negative thoughts during planned activities, and then using this evidence to challenge both negative thoughts and unhelpful beliefs.

For example, I identify the negative thought, ‘No one likes me’. My Psychologist and I plan an activity to collect unbiased information, finding out friends and family keep arranging get-togethers. With my Psychologists help, I begin believing this negative thought less and less, learning my loved ones wouldn’t keep arranging get-togethers if they didn’t like me. While this is just one example, evidence collected from planned activities is used to challenge the validity of my negative thoughts and question unhelpful beliefs.

Each piece of evidence gradually builds our new, more realistic picture as we gradually let go of our negative perspective. This step carefully dismantles negative thinking patterns through behavioural activities, substantially alleviating symptoms.

Why Psychologists love using CBT

CBT works well when it comes to overcoming depression1-4,9. The CBT rationale and intervention is readily adaptable to a wide range of issues and this is consistently supported by research7,12,13,15. It can also help improve our life in general. Not only that, we gain learnable skills during therapy. We learn how to distract our self from thoughts, how to find and engage in pleasurable activities, and how to identify and challenge unhelpful thoughts and beliefs. These are useful skills.

Another reason Psychologists love using CBT is that research consistently shows it is great for reducing relapse6,10,14. A relapse is a reoccurrence of an illness. Researchers keep finding the same result: those who receive talking-type therapies, such as CBT, have lower relapse rates compared to those who receive medication only5,9,14. Skills gained during therapy with Psychologists tend to reduce the chance of relapse.

Conclusion

We’ve learnt the rationale behind Cognitive Behaviour Therapy (CBT) involves an unhelpful cycle of thoughts and behaviours. We then looked at a general guide of what CBT involves to better understand how Psychologists help us stop that damaging cycle. We finished by discovering Psychologists love using CBT because it works to help us with a range of issues we wish to overcome.

References
(1) Beck, A.T. (2005). The current state of cognitive therapy: a 40-year retrospective. Archives of General Psychiatry, 62, 953–9.

(2) Butler, A.C., Chapman, J.E., Forman, E.M. & Beck, A.T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26, 17–31.

(3) Cape, J., Whittington, C., Buszewicz, M., Wallace, P. & Underwood, L. (2010). Brief psychological therapies for anxiety and depression in primary care: meta-analysis and meta-regression. BMC Medicine, 25, 8-38.

(4) DeRubeis, R.J., Hollon, S.D., Amsterdam, J.D., Shelton, R.C., Young, P.R., Salomon, R.M., O'Reardon, J.P., Lovett, M.L., Gladis, M.M., Brown, L.L. & Gallop, R. (2005). Cognitive therapy versus medications in the treatment of moderate to severe depression. Archives of General Psychiatry, 62, 409–16.

(5) DeRubeis, R.J., Siegle, G.J. & Hollon, S.D. (2008). Cognitive therapy vs. medications for depression: Treatment outcomes and neural mechanisms. Nature Reviews Neuroscience, 9(10), 788-796.

(6) Fava, G.A., Rafanelli, C., Cazzaro, M., Conti, S. & Grandi, S. (1998). Well-being therapy. A novel psychotherapeutic approach for residual symptoms of affective disorders. Psychological Medicine, 28(2), 475-480.

(7) Grime, P.R. (2004). Computerized cognitive behavioural therapy at work: A randomized controlled trial in employees with recent stress-related absenteeism. Occupational Medicine, 54(5), 353-9.

(8) Hoffman, S.G & Smits, J.A. (2008). Cognitive-behavioral therapy for adult anxiety disorders: A meta-analysis of randomized placebo-controlled trials. Journal of Clinical Psychiatry, 69(4), 621-32.

(9) Hollon, S.D., Stewart, M.O. & Strunk, D. (2006). Enduring effects for cognitive behavior therapy in the treatment of anxiety and depression. Annual Review of Psychology, 57, 285–315.

(10) Kennard, B.D., Stewart, S.M., Hughes, J.L., Jarrett, R.B. & Emslie, G.J. (2008). Developing cognitive behavioral therapy to prevent depressive relapse in youth. Cognitive and Behavioural Practice, 15(4), 387–399.

(12) Knapp, P. & Beck, A.T. (2008). Cognitive therapy: Foundations, conceptual models, applications and research. Revista Brasileira de Psiquiatria, 30 Suppl 2, s54-64.

(13) Toner, B.B. (2005). Cognitive-behavioral treatment of irritable bowel syndrome. CNS Spectrums, 10(11), 883-90.

(14) Vittengl, J.R., Clark, L.A., Dunn, T.W. & Jarrett, R.B. (2007). Reducing relapse and recurrence in unipolar depression: A comparative meta-analysis of cognitive–behavioral therapy's effects. Journal of Consulting and Clinical Psychology, 75(3), 475-488.

(15) Young, K.S. (2007). Cognitive behavior therapy with internet addicts: Treatment outcomes and implications. Cyberpsychology and Behaviour, 10(5), 671-9.

Author’s bio

David Pollak is a Senior Psychologist at Australian Psychology Solutions. David practices in the Eastern Suburbs of Sydney, Australia and has worked as a Psychologist since 1999. http://www.wix.com/psychologysolutions/psych
0407 676 192