How CBT works

CBT works on the principle that our emotional upsets arise from the way we interpret the things that happen to us. It is the type of thoughts that we have in any given situation that leads to us feeling the way we do.

Certain ways of thinking can trigger or help perpetuate certain mental health problems such as anxiety, depression, obsessive compulsive behaviours, etc. During therapy, you and your therapist work together to investigate the particular types of thoughts you have which trigger your emotional and behavioural problems.

The therapist makes no judgements about your thoughts, but helps you to examine whether or not they are realistic and appropriate. Thoughts that lead to distress tend to be inappropriate to the situation. If this is the case for you, you are helped to learn techniques that enable you to think in more realistic, rational and helpful ways. As you practice your new thinking style, you will gain control over your unhealthy negative emotions.

Although CBT was developed during the latter part of the 20th century, and has come to prominence mainly in the last twenty years, the principles that lie behind CBT go back a long way - as far back as the first century AD, when the philosopher Epictetus stated that

"Men are disturbed, not by things, but by the views which they take of them."

This philosophy, that it is not events that lead to emotional problems but the way we interpret the events (our thoughts or 'cognitions') is central to CBT.

Will CBT work for me?

As a rule, the more specific the problem, the more likely it is that CBT may help. This is because it is a practical therapy that focuses on particular problems and identifies ways to overcome the problem.

CBT may be flavour of the month in the NHS, but it is not a panacea for all mental health problems. It does not suit everyone and it is not helpful for all conditions. With this caveat in mind, by breaking down more complicated life situations into smaller parts it is possible to address a wide range of issues.

If you are in a state of distress through anxiety or depression, medication may be helpful to allow you to gain fully from therapy (this goes for most therapies not just CBT). You should discuss this with your GP.

You need to be committed and persistent in tackling your mental health problem with the help of the therapist. Confronting your unhelpful habitual ways of thinking can be difficult and challenging. You may be taken out of your comfort zone when tackling situations about which you feel anxious or distressed. However, many people have benefited greatly from CBT and the skills you acquire can have long term benefit, helping to prevent your difficulties recurring.


What about my past?

Although CBT is concerned with how you feel now, often it is important to find out where and how your distorted thinking originated, whether it was something to do with your childhood or something traumatic that happened recently. However, insight into the origin of your problems is usually not enough to effect long term relief. In CBT the idea is not to rake through your past just for the sake of it, in the hope that you will magically reach your own state of wisdom. The CBT therapist realises that it is necessary to do something practical with this insight into the past (something lacking in many other forms of psychotherapy). By identifying more rational thoughts (such as the realisation that we were not to blame for our parents' anger or abuse) and by practising this rational thinking we can overwrite the habitual pattern of thinking that has been causing us problems.

One thing we cannot do is go back and change the past. What we can change is how we think and feel about the past.


Do-it-yourself CBT

A lot of clients who come to see me say to me, "I've read all the self-help books there are, and they haven't done any good." This sort of comment demonstrates the difficulties in trying to implement therapeutic methods on your own. It can be hard to let go of your familiar ways of thinking, even if they are self-destructive. The more tangled up you are in your web of self-defeating thinking, the harder it can be to see a way to break free. It is for these reasons that CBT generally works best with the help of a trained therapist. It can also be difficult to try out challenging activities without the support of a compassionate, but neutral person.

If you want to try using CBT principles by yourself, there are a number of excellent books available, particularly those written by Paul Hauck or Windy Dryden. The following books are ones that I often recommend to my clients as part of the work we do together, since they explain the principles of CBT clearly and succinctly (the particular form of CBT discussed in these books is REBT - Rational Emotive Behaviour Therapy).

10 Steps to Positive Living
Dr Windy Dryden, Sheldon Press
An excellent self-help book, written by one of the world's leading CBT/REBT practitioners. This book explains in concise no-nonsense language the theory behind CBT/REBT and how to apply healthy thinking to improve your life.
Order from Amazon (Opens in a new window)

Overcoming Depression
Dr Windy Dryden, Sheldon Press
Case studies, exercises and practical suggestions, giving clear explanations of how to tackle depression using CBT/REBT principles.
Order from Amazon (Opens in a new window)

Cognitive Behavioural Therapy for Dummies
Rob Willson and Rhena Branch, John Wiley & Sons Ltd
Written in an accessible and readable style, this book gives an excellent overview of the principles of CBT/REBT with a particularly good chapter (amongst others) on Self-Esteem/Self-Acceptance.
Order from Amazon (Opens in a new window)

Other practical self-help books written from a general CBT perspective include those in the "Overcoming ..." series published by Constable & Robinson;
Overcoming Weight Problems,
Overcoming Obsessive Compulsive Disorder,
Overcoming Chronic Fatigue