About Cognitive Behavioural Therapy

Background

Cognitive Behavioural Therapy (CBT) is an evidence-supported treatment that focuses on changing patterns of thinking (called cognitions) and changing the actions (called behaviours) that contribute to emotional distress.

Culturally-adapted CBT, on the other hand, is psychotherapy that has had aspects added or changed in order to be more relevant to a specific ethnic group. The types of changes that could be made include changes in language, examples used for talking about problems, or the activities of therapy so that they are similar to culturally familiar activities. The adaptation of CBT is done in consultation with experts who ensure that the adaptations do not make the psychotherapy less effective. It is also done by consulting people in the community who know the culture and can help decide which elements should be included in the psychotherapy.

Therapists do not require psychiatric training to administer CBT as they have a clear set of procedures to follow during the treatment period. Over a series of sessions, these procedures have been shown to help reduce the symptoms of depression, anxiety and other mental disorders.

The Process

CBT begins with a therapist challenging an individual’s beliefs and behaviours. Positive thoughts then translate to positive behaviours, ultimately resulting in positive feelings (see below). This is referred to as “therapy” as opposed to “counselling” because therapists have a clear set of procedures to follow during the treatment period. These procedures have been shown to help people reduce the symptoms of depression, anxiety and other mental disorders.

For example, an individual who is depressed may have negative thoughts and may avoid their friends and family, thereby making them feel sad and lonely. It becomes a vicious cycle in which the individual will continue to dwell on negative thoughts about themselves and their environment. A therapist would to treat this individual by challenging their negative thoughts and instructing them to change their behaviour in response to their beliefs. An increase in positive thoughts and a change in behaviour will ultimately lead to the individual feeling better about themselves and their environment.

CBT infographic

The Basis of CBT Interventions

CBT interventions target problematic thoughts and behaviours by challenging them and providing functional alternatives. CBT interventions build on Beck’s (2005) cognitive model, which identifies early learning experiences as the origin of maladaptive thoughts and beliefs and points to these dysfunctional thought patterns as the cause of negative moods and behaviours.

According to the cognitive model, core and intermediate beliefs are at the root of dysfunctional thinking. Core beliefs are the deepest level of cognition and are often shaped by childhood learning experiences. Beginning in childhood, people try to make sense of their environment. Their understanding, whether accurate or not, influences how they think about themselves, other people and the world. Intermediate beliefs are the attitudes, rules and assumptions that directly influence people’s thoughts about a situation. When verbalized, intermediate beliefs often take the form of “should” or “must” statements or conditional (i.e., “if … then”) statements.

Techniques Used in CBT

Role play—Rehearsing situations can heighten clients’ awareness of automatic thoughts, help them develop a more balanced response and modify intermediate thoughts and beliefs (Beck, 2005). The effectiveness of role play is augmented by cognitive techniques such as coping statements.
Behavioural experiments—Encourage clients to behave in a way that is inconsistent with their negative thought patterns. This can test the validity of unhelpful automatic thoughts, rules for living and core beliefs. Help clients design an experiment to test a balanced thought of which they are not convinced. Have them predict the outcome and anticipate problems and coping strategies. Then, have them rate the experiment’s success and summarize what they learned. If the results do not support the balanced thought, clients should either design a different experiment or adjust their balanced thoughts.
Coping cards—Reminder notes help clients reference balanced thoughts when required. Write balanced thoughts on sticky notes or cue cards that can be carried or stuck on a surface for easy access. Encourage clients to read their coping cards daily and as needed (Beck, 2005).
Referral—For many clients, learning to modify automatic thoughts and maladaptive responses is enough to help them cope. Other clients may need deeper changes. Getting to the root of the problem may require restructuring intermediate and core beliefs. Although the same interventions can be used, it can be trickier to identify and verbalize more fundamental thoughts. The process can be challenging and may require more sessions than resources in a primary care setting allow. At this point, referral should be considered.