Distinctive features of CBT

Cognitive Behavioural Therapy (CBT) is one of the most popular psychotherapies in the world and is regarded as the gold standard for evidence-based treatments. But what makes it different from other types of therapy?

Listen online

Transcript

(00:06):
Welcome to the mental health professional's podcast. I'm your host, Chris. And today we are talking about what makes cognitive behavioural therapy different. What are the distinctive features of CBT?

(00:45):
You've probably heard of CBT if you work in mental health or even if you don't, because it's one of the most popular therapies in the world, and it is technically a technical integration. So long ago we had cognitive therapy, we had behavioural therapy and then we smushed them together and we got cognitive behavioural therapy, which today is it's an incredibly effective therapy in terms of the evidence. It is the thing that seems to work for a wide range of treatments and has the biggest evidence-based of any psychotherapy in the world. So what makes it unique? What makes it different from other modalities? Well, many therapies have a lot of crossovers, but let's talk about some of the things that CBT has really championed. So first of all, that the cognitive model, the idea that our thoughts, our feelings, our emotions, and our behaviours are all linked together in a little triangle.

(01:50):
So each point of the triangle, we can modify those and those will have an effect on the other. So we can change our thinking and not might change how we're feeling. We could also go change our behaviour. Maybe that will change how we're thinking and thinking of it as that triangle, where we can move one of the corners and that will move the other corners is really the basis of a lot of the things we do in CBT. We then have the more cognitive side of it. So looking really examining our force and thinking of our thoughts as these processes and these processes are sometimes going wrong, going a skew so things like spotting thinking errors. So identifying a recurring fault we're having and looking at us and like, okay, well, what can we learn from this is this black and white thinking, is this catastrophising, is this jumping to conclusions?

(02:46):
Is this a recurring for that? We need to challenge and coming up with the idea of thought challenges. So if we were thinking maybe we have social anxiety and we're worried about going to a party, we can sit down and identify the thoughts there. And the thought is I will do something really embarrassing, and we can notice that this thought comes up a lot and then develop a challenge for it. Like I've been to a ton of parties and I haven't embarrassed myself before, or if I do embarrass myself yet, it will be a bit unpleasant, but I will get over it and really getting down to those kinds of individual cognitive strands of what's the thought. And how can I challenge it? So if we compare that to a different approach to say, mindfulness, mindfulness wouldn't challenge a thought, it would just say, okay, just let it sit there.

(03:36):
Don't give it any attention. Whereas in CBT, we're all about those four challenges. Then the other side of CBT is behaviourism. So a real emphasis on what we do and changing our behaviour. This often comes in the form of behaviour like experiments. We might do some exposure. So if we have a dog phobia, we might start looking at pictures of dogs, looking at videos of dogs, going near a dog, eventually working up to patting a dog, but not all behavioural experiments necessarily have to be exposure. We can just use it to challenge the way we're thinking. So if we think a certain thing is going to happen, we can use a behavioural experiment to challenge that. And this idea that we should go kind of behaviour first and retrain our emotions to show us what really happens, retrain our thoughts to show us that they're just a thought.

(04:33):
And actually what happens when we do it in reality is X is, is a key part of behaviourism. And a key part of CBT also tends to look at contingency management. So this is the things that may be keeping our anxiety or depression or whatever we're trying to tackle going. So for example, if we're, yeah, again, thinking about awkward social situation, is there something we do to kind of mitigate that? For example, whenever we go to the pub, we have to sit right by the exit so we can get out quickly. Well, that might be maintaining our anxiety because every time we go in there, even though we're doing some good behavioural work, we're thinking yes, but I only feel okay because I'm next to the exit. And therefore, we never learned that the pub is a safe environment because we think it's that safety behaviour we're doing that is keeping us safe or something like using drugs, using alcohol to make feelings of low mood, go away.

(05:40):
If we can manage these contingencies and look at doing something else, then we can not only solve the emotional problems, but also behavioural problems like drug and alcohol abuse as well. So contingency management is sometimes overlooked because it's not in the name, but is a key part of CBT. Now, a question that comes up a lot, when we talk about all of this is doors, cognitive, behavioural therapy ignored that relationship that chatting about in the room. It seems to be all about doing kind of homework, thinking about force, keeping thought diaries, doing behavioural experiments, having homework, and has it forgotten that there's a therapeutic relationship there that the therapist and the client need to have a relationship I would emphatically argue? No. I think that anyone that does CBT well then uses things like the core condition from person-centred and make sure there's a really strong relationship there between therapist and client.

(06:41):
Because if I'm going to ask a client to go out and do a behavioural experiment, do something that's scary. I want to make sure that I've built up plenty of trust with them before I ask them to go do that. That said, if we can pair it to something like person centered, so that the relationship between therapist and client, that therapeutic Alliance is everything. That's where the magic is. Whereas in CBT, we want that relationship, but there's also this other technology. There's the behavioural experiments, the four challenges that we can bring into the room as well. Hopefully, then that's given you a short overview of what makes CBT different. What are the key features where you think, okay, well, what, what, where would I go? When would I use CBT? What kind of clients would like CBT? Well, those are the standard features that CBT Lilly driven over the past few decades.