Cognitive Behavioural Therapy is not about correcting faulty thinking as is often simplistically suggested in the press; rather it is about helping people to understand how they have become trapped by their attention, reasoning and current coping strategies and how to find ways about of these traps. The focus is on helping people to find and distinguish helpful ways of thinking and behaving-not just accuracy. Thinking one will die if one falls whilst trying to escape from the top floor of a burning house might be 'true', but it is not a helpful focus.
Cognitive Behavioural Therapy does this by describing how we respond to the world in a way that gives us a strategy to modify our experiences when these are causing us distress. It does this by dividing our experience in to three components; THOUGHTS, FEELINGS AND BEHAVIOURS and then exploring the interactions between them. Initially these distinctions may seem obvious. However, they are not ones that we use on a day-to-day basis as generally we respond to the world in a reasonably automatic way. So breaking our experience down in this way takes some practice.
The Components
Thoughts
Thoughts are the things that go on in our minds, the words and statements. They are what someone would hear if they were sitting in our head, or what would appear in the thought bubble of a cartoon. They are heard in the first person, present tense e.g. “I really don’t want to go to work today”.
Feelings
Feelings are described by the single words that we use to identify our emotions e.g. angry, sad, happy, and anxious.
The distinction between thoughts and feelings is not always easy to grasp and can take some practice. This is probably because the intensity of feelings is sometimes overwhelming, making it difficult to separate these different aspects of our experience. However the distinction between thoughts and feeling is an important one to make, one that is fundamental to CBT, as it is not possible to modify the components of our experience or influence the way they interact, if we can’t tell the difference between them.
Sometimes when feelings are either very negative or very strong we develop ways of blocking them out (e.g. keeping very busy, drinking alcohol, bingeing on food), this can make the task of identification harder still.
Behaviours
Behaviours are our observable actions, the things that we do, and so more often than not, the easiest of the three components to identify.
The Interactions
CBT suggests that when something happens, an event, we make an interpretation of that event, a thought occurs. That event can be either internal or external e.g. a memory or the actions of another person.
Depending on the nature of that thought, we will then experience a congruent feeling. A positive thought will led to a feeling of happiness, an anxious thought to panic. This feeling will then trigger further congruent thoughts. So for example when we are feeling low, we will find it much easier to access similarly negative thoughts, when we are feeling happy, similarly positive thoughts are more accessible to us. A feedback loop is created leading to the perpetuation of mood states. We typically see this in those stuck in depressive episodes or experiencing chronically high levels of anxiety.
The nature of the feeling will then influence what we do, it will trigger a behaviour. Anxiety will motivate us to take action, before an exam it may motivate us to revise. The behaviour will then trigger additional feelings, so feeling depressed may lead a person to withdraw (behaviour), resulting in their mood dropping further. A second feedback loop is created. Our behaviour also influences our thinking, creating a third feedback loop. For example trying something new will reinforce beliefs about our capacity to takes risks and cope well with them.
Here are some examples:
Example1
Chris wakes up in the morning (event) and thinks “What a beautiful day, I can’t wait to get outside and enjoy it”. This makes him happy (feeling) and possibly excited about the day ahead. This in turn motivates him to get up, dressed and out of the house (behaviour).
However, Mark wakes up in the morning (event) and thinks “I can’t face another day; I have nothing to look forward to”. As a result he feels low. This leads him to pull the covers over his head and avoid leaving the house all together (behaviour).
Example 2
Anna eats a donut (event) and thinks “This is delicious”. This makes her feel satisfied and she continues with her day (behaviour) .
However, Julie eats a donut (event) and thinks “This is going to makes me really fat”. This makes her panic (feeling) which results in her self-inducing vomiting (behaviour).
These are very simple examples but illustrate the point that the way we think can substantially influence the way we feel and then how we behave. However, this is often not how it feels. Sometimes it can feel as if a direct link exists between the event and the feeling or the event and the behaviour, so that when something happens and we just feel something, or an event occurs and we just do something. A good example of this is the experience of driving to a place that you have been too many times and realizing when you arrive that you cannot really recall getting there.
We know that these direct links cannot exist because if they did no one would leave the house and everyone would vomit after eating donuts. But it can’t be denied that it does feels like this. Why?
Our minds are full of thoughts; there is a constant stream of them. If we paid attention to all of them we would not get anything done. So what it seems happens, is that those thoughts that occur most often slip just below the level of our conscious awareness. The circuit of thoughts, feelings and behaviours becomes like a well run track whereby a groove is created and these regularly occurring thoughts drop down into it just out of sight. This has the advantage of allowing us to attend to new thoughts, the old ones continuing to operate automatically, being triggered and themselves trigger congruent feelings and behaviours without the need for our conscious interference. This system works well as long as these ‘automatic’ thoughts are not triggering distressing feelings and unhelpful behaviour.
CBT in Action
CBT can be useful when our ‘automatic’ thoughts become negative and begin to trigger similarly negative feelings and behaviours. This is not to suggest that CBT simply encourages positive thinking as a way of resolving real and distressing problems. However it does take advantage of the fact that our thoughts heavily influence our feelings and behaviours. Usually when we are overwhelmed by our problems our thought patterns become distorted or skewed in some way, so that important information that would help us feel and behave in a more adaptive way is filtered out. CBT aims to identify these thoughts, evaluate their accuracy and then if necessary restructure them so that they offer a more balanced reflection of reality. Such a change in our thoughts will lead to changes our feelings and behaviours.
CBT also takes advantages of the other interactions that exist between the components of our experience. It will teach you strategies to regulate and improve your mood whilst also helping you to tolerate negative feelings more easily. This will impact both on your behaviour and your thoughts. In addition CBT will enable you to make specific changes in your behaviour which will again have a knock on effect on both your thoughts and feelings.
CBT was originally developed as a treatment for depression but has subsequently been adapted for a range of problems and to date provides one of the most effective solutions for emotional distress.
