Cognitive Behaviour Therapy (CBT) is a relatively short term, focused approach to the treatment of many types of emotional, behavioural and psychiatric problems. The application of CBT varies according to the problem being addressed, but is essentially a collaborative and individualised program that helps individuals to identify unhelpful thoughts and behaviours and learn or relearn healthier skills and habits. CBT has been practised widely for more than 30 years. It has been researched extensively, and has demonstrated effectiveness with a variety of emotional psychological and psychiatric difficulties. It is also continually evolving, and third wave CBT therapies such as Mindfulness Based Cognitive Therapy (MBCT), Acceptance and Commitment Therapy (ACT), Dialectical Behaviour Therapy (DBT), Schema Therapy and others are increasingly being used for a variety of emotional, behavioural and psychiatric problems.
- CBT has been extensively investigated in rigorous clinical trials and has empirical support.
- CBT is structured, goal oriented, and focuses on immediate difficulties as well as long term strategies and requires active involvement by the client.
- CBT is flexible, individualised, and can be adapted to a wide range of individuals and a variety of settings.
CBT is one of the most established and researched psychological therapies for emotional, psychological and psychiatric dysfunction. For some problems, such as anxiety and depression, CBT is as effective as medication and can also enhance the effects of medication. The results of CBT are long-term, and you can keep using what you have learned in therapy to approach other problems in your life.
In particular, CBT has demonstrated effectiveness with individuals experiencing the following problems:
- Generalised Anxiety
- Obsessive Compulsive Disorder
- Post-traumatic Stress Disorder
- Eating Disorders
- Brain Injury
- Somatic Disorders
- Sexual Dysfunction
- Couples/Marital problems
- Social Anxiety
- Anger & Stress Management
- Child Anxiety Disorders and Child Depression
- Child Behaviour Problems
CBT is particularly useful in treating the problems listed above where you request a practical method of treatment for a specific problem rather than “wanting to understand yourself better”; are able to consider psychological causes of problems; and are able to be actively involved in the therapy process and will practice skills between sessions.
CBT has been extensively investigated in rigorous clinical trials and has empirical support. Broadly, CBT has evidenced the following outcomes:
- CBT is compatible with a range other treatments that you might receive such as medication or supportive counselling.
- Because the individual is actively involved in their treatment they are more likely to stick with it.
- Because CBT is flexible and individualised, it can be adapted to a wide range of individuals and a variety of settings.
- The client can keep using what they have learned in therapy to approach other problems in life.
In a broad sense, as its name suggests, CBT involves both ‘cognitive therapy’ and ‘behaviour therapy’. Cognitive therapy focuses on an individual’s pattern of thinking while behaviour therapy looks at associated actions. When combined skilfully, these two approaches provide a very powerful method to help overcome a wide range of emotional and behavioural problems in children, adolescents and adults. Depending on the problem, CBT may involve a mix of both therapeutic modalities, so some issues are better treated with more behavioural methods and some with more cognitive methods. One of the strengths of CBT is that it aims not just to help people overcome the symptoms that they are currently experiencing, but it also aims to teach the person new skills and strategies that they can apply to future problems. It focuses on the ‘here and now’ whilst developing an understanding of past styles of thinking and behaviour that have developed over time.
CBT examines all elements that maintain a problem, including our thoughts (cognitions), feelings, behaviour and the environment. It is a structured therapy, which involves a partnership between you and your therapist. You are fully involved in planning your treatment and the therapist will always let you know what is happening. Usually you will have a thorough assessment in the first session or two. Each session will involve discussion, explanation and practice of skills and techniques. Often you will be required to practice those techniques in between sessions.
In the first session, your cognitive behaviour therapist should:
- Undertake a thorough assessment – you will be asked about past experiences and treatment to better understand the nature of the difficulties for which treatment is being sought.
- Give you an opportunity to tell them anything you think is relevant to your issue.
- Explain the basis of cognitive behaviour therapy and how it works
- Explain what you can expect from therapy
- Give you an idea of how long you will need to see them – the number of sessions varies with the type of difficulties being treated.
- Discuss the treatment plan with you including goals and ways to monitor progress.
CBT is a well-planned therapy focused on outcomes. There are a range of techniques and styles in CBT, but regardless of their approach, each session your therapist should:
- Give you an opportunity to tell them what has happened since you last saw them
- Explain what will happen during that session
- Measure and keep you informed about your progress
- Give you time to practise any new skills and ask any questions during the session
CBT is an active therapy – sometimes described as a ‘doing therapy’ rather than a ‘talking therapy’. So, individuals will be expected to be active participants in their own therapy. This means that you can expect to be fully involved in your sessions and to develop with your therapist some tasks to practice in between sessions. Sometimes these tasks are called ‘homework’.
CBT sounds like quite a simple therapy, but it takes a skilful therapist to be effective. A competent cognitive behaviour therapist will have had substantial training and experience in the area. Most professionals using CBT (i.e. Psychologists, Psychiatrists, Mental Health Nurses etc) should be registered with their relevant professional registration board, which oversees professional training and competence.
Your cognitive behaviour therapist should never
- Enter into a sexual relationship with you – whether you initiate it or they initiate it
- Enter into any other improper dual relationship
- Divulge information about you unless:
- you specifically authorise in writing the release of information; or
- the release of information is to protect you or others from harm; or
- the release of information is required by law.
- Exploit you, for example by asking favours of you
- Force or try to coerce you to engage in a particular type of treatment, such as group therapy.
A qualified therapist would be expected to practice the code of ethics applicable to their profession. Be sure to contact relevant regulatory bodies if you are concerned about the practice of a therapist.
Ask your therapist if they are a member of the Australian Association for Cognitive and Behaviour Therapy.
If you are looking for a new therapist, speak with your GP about a referral to a suitable qualified CBT practitioner in your area.