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Patrick McGee & Associates
Psychologists, Counselling Sydney

COGNITIVE BEHAVIOURAL THERAPY

CBT is a treatment approach that is based on the concept that the way we think effects how we respond. People can interpret the same life event very differently, leading to many and varied emotional and behavioural consequences. Some of these consequences can be helpful, and some not so helpful in our day-to-day lives.

The theories of cognitive therapy suggest that negative or unhelpful thoughts and beliefs are a significant factor in the development or exacerbation of depression, anxiety, anger, low self esteem, self defeating behaviours and difficulty with coping. Therefore, being able to identify and challenge these beliefs can assist a person to reduce distress and enhance their ability to cope in everyday life situations.

CBT for specific mental health conditions.

CBT has been shown to be an extremely effective treatment approach for conditions such as depression and anxiety. It has also been found to be a beneficial adjunct treatment for many other mental health conditions, including –

• Psychotic disorders
• Addictions
• Anger, guilt & shame issues
• Marital or family problems
• Personality disorders

• Eating disorders
• Pain disorders
• Adjustment disorders
• Sexual dysfunction

How does CBT work?

CBT is not about ‘looking on the brighter side’; it is about learning specific strategies to think more realistically about life. These strategies are collectively referred to as ‘cognitive restructuring’.

CBT works on the principle that negative, unhelpful beliefs need to be ‘tested’, to determine whether they are accurate, realistic & truthful. In most cases, the thoughts are actually irrational misconceptions, commonly known as ‘cognitive distortions’. Cognitive distortions serve to maintain a negatively skewed and unhelpful belief system, leading to distress and increased difficulty coping in situations. Common cognitive distortions include:

1. Black & White Thinking – Seeing something in terms of ‘all good’ or ‘all bad’ with no middle ground. For example, telling yourself that being in a relationship must be all good, otherwise it is a terrible, unfulfilling relationship.

2. Catastrophising – Exaggerating mistakes or problems by blowing them out of proportion. For example, if your boss asks you to do something again, telling yourself that it is ‘the worst thing that could have happened’ and that you must be ‘the worst employee ever’.

 3. Mindreading – Reading more into the behaviour & expressions of others than is really there. For example, if your boss calls you into his/her office to speak to you, you think ‘He/ she looked at me strangely, I bet they’re angry with me and I’ll get into big trouble’.

4. Fortune Telling – Imagining the worst case scenario will occur and assuming all life events will turn out badly. For example, not wanting to attend a party because you ‘know you’ll have a bad time’ and ‘no one will speak to you’. Using this cognitive distortion can lead you to actually making a negative scenario a reality (i.e. at the party you feel uncomfortable and avoid contact with people). This is often referred to as ‘self fulfilling prophecy’.

5. Labelling – You attach a negative label to yourself or others instead of describing the actual behaviour or action. For example, calling yourself a hopeless loser rather than just acknowledging that you made a mistake.

6. Overgeneralising – Drawing a general conclusion on the basis of only one incident. You tell yourself that, if something is true in one case, it must apply in all cases. For example, telling yourself that you are stupid and unreliable when you forget one appointment.

Therefore, CBT can help an individual to identify & restructure these negative, irrational thoughts by replacing them with alternative interpretations that are more realistic and factually based. In doing so, people are able to think about life situations in a more helpful and constructive manner, thereby coping better with the day to day challenges they face, and learning to better control how they react in and respond to given circumstances.

Learning CBT

The skills & strategies of CBT are taught by an experienced mental health worker, usually with a background in psychology. Depending on the clinical circumstance, CBT may be taught in an individual or group environment. There are however obvious benefits in learning CBT within a group framework. Group dynamics have shown to be extremely effective in helping an individual to develop a new and clearer perspective on their own issues, thus further facilitating the process of cognitive restructuring. The types of activities undertaken and skills taught in a CBT program are likely to include:

• The identification of negative thinking and subsequent emotional/ behavioural response.
• Challenging unhelpful thinking through the use of problem solving and testing of negative thoughts.
• Coming up with alternative, constructive, more realistic and helpful thoughts to utilise instead.
• Testing alternative thoughts and measuring the emotional/ behavioural response.

What do I do between sessions?

CBT is an active skills-based approach, so you will have to put work into learning new strategies and ways of dealing with difficult life issues. To get the most out of the sessions you will need to commit some time outside the sessions to working on tasks that you and your Psychologist agree upon. About 1 hour per day is usually enough, depending on the issues that you are working on, although it is often the case that the more time you put in between sessions, the more you will get out of the program and the faster you will achieve its benefits. Tasks you may be asked to complete between sessions may include: keeping a thoughts diary, practising relaxation techniques, completing an activity that you were working on in a session, or reading some relevant chapters from a book.

How often will I attend sessions?

Ideally you will attend on either a weekly or fortnightly basis initially. At the     start of treatment sessions tend to be more frequent so that you can quickly make some positive changes and start to feel better. As you progress through the session plan, you might discuss meeting less frequently so that you have more time to put in place longer term changes and work towards your goals. Please note that if you are feeling very anxious or depressed you would usually benefit from more frequent sessions initially.

Using CBT in everyday life.

Just like learning any skill, the CBT strategies work much more effectively when practiced regularly and used on a daily basis. Therefore, CBT must be utilised in an ongoing manner, practiced and refined by the individual as often as possible. People who use the strategies of CBT in their everyday life often refer to the process as ‘becoming your own therapist’. The skills are extremely practical, can be applied in almost any situation and if employed regularly, are with the person for life.

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