On the 29th January 2014, I was asked to appear on BBC Radio Nottingham to talk about CBT. I work with the newest form of CBT – Mindfulness – in my practice, but here is a brief précis of what CBT is and how it can help; along with some details of books and websites you may find useful.
What is CBT?
CBT is a form of therapy that can help with a range of ways of thinking that might cause us problems with how we get on in the world, including anxiety and phobias. The C stands for Cognitive, which refers to anything that goes on in our mind; for example our thoughts, dreams and memories, whilst the B refers to our Behaviour – essentially anything we do and the way we act. T stands for the Therapy.
CBT teaches us that how we think influences how we feel and that, in turn, influences how we behave. To illustrate this, imagine someone who thinks that the world is a really scary, bad place, full of nasty people who want to hurt others. They are likely to feel scared and anxious when they go out into the world and therefore may want to stay close to home; may not make friends easily and are unlikely to want to explore the world. On the other hand, imagine someone who thinks that the world is neither good nor bad and although there are some bad people in the world; the majority of people are OK and don’t set out to hurt others. This person is likely to feel more confident and safe in the world and therefore they may have lots of friends and explore the world around them.
Essentially, CBT asks us to re-examine our thoughts and look at them in a different light so that we can think, feel and act healthier.
When is CBT not suitable?
Not everything that happens to us in in our mind! If we are in an abusive relationship, then we need to act accordingly with the help of a trusted friend or therapist; if we lose someone we love then we need to go through the very normal and necessary grieving process. CBT works best with destructive and repetitive thoughts that prevent us from living our lives to the full.
How does it work?
- Firstly, it helps us look at the way we interpret the thoughts we have. Just because we have a thought, it doesn’t mean it’s true. Consider Tom, who wakes up one morning hungover. The last thing he wants to do is get out of bed. As he stumbles into work, he thinks “This is a terrible day.” He stumbles into work and at lunchtime, his boss calls him into this office and tells him he’s being given a raise. Now Tom thinks “This is a great day!” Which of these two thoughts of Tom’s is true? It’s important to remember that thoughts are not facts.
- Secondly, I practice a modern form of CBT called Mindfulness which teaches us that it’s our emotional response to our mental state that cause the problem, not our thoughts itself. For example, imagine that Lucy was having a fantastic weekend with a friend she likes immensely but doesn’t get to see very often. When the weekend came to the end and her friend left, Lucy felt sad. This is a particularly natural and normal response to something that you’ve enjoyed ending. If Lucy were to respond in a healthy way, she would acknowledge that she felt sad at her friend leaving and just accept that she’s going to feel like that for a short time because she’s had such a wonderful time with her friend and she didn’t want it to end. If she did so, very shortly, she would feel better. However, if Lucy felt sad and then started to think, “What’s wrong with me? Why do I feel so bad? I’ve had a great weekend – I shouldn’t feel like this – there must be something wrong with me. I bet my friend isn’t feeling like this – she’s normal – not like me. I bet if she knew how I felt now, she wouldn’t want to be my friend. In fact, that’s probably why I don’t have as many friends as I’d like. They know that’s something wrong with me…” And on and on and on down into a spiral of anxiety and thoughts that aren’t going to help Lucy at all. More importantly, even though it was her natural and understandable sadness at her friend leaving that started her off on this train of thought, it isn’t long before that sadness is overtaken by Lucy’s distress at the fact that she is sad. When this happens, the original sadness is forgotten and it is Lucy’s preoccupation with the fact that there must be something wrong with her that causes the problem. CBT and, in particular, Mindfulness CBT teaches us to let our thoughts go and not judge or condemn ourselves for what is going on in our head.
- Thirdly, many people who have anxious and repetitive thoughts are very self-focused. They think a lot about what other people might be thinking about them; how their actions might be interpreted and whether things are OK. An effective way to combat this is for them to become aware of their environment and how they are reacting to it. Consider the following scenario: Katie is walking down the beach in her swimsuit. She thinks that she looks fat and unattractive and as she continues walking, she notices that there are other women who look much more glamorous and attractive in their swimsuits and some of them seem to be looking at her. She thinks that they probably think that she looks dreadful and starts wishing that she hadn’t had that last slice of pie last night – if only she could stick to a diet; she just wasn’t strong willed or motivated enough to really lose weight. What must people be thinking? It isn’t long before she ends her walk on the beach and vows never to return.
But consider another scenario – as soon as Katie steps onto the beach, she starts to focus on what the sand feels like underneath her bare feet; between her toes. Is it hot, cold, wet? What’s it like to walk on? As she walks along, she notices what the sun feels like on her skin. Is it too hot? Does she feel like she’s burning? Or is it just right? And where does she feel it most? What can she hear? Can she hear the waves lapping? Or the seagulls up above? Or the sound of children playing? What else? Maybe there are other sounds in the distance. And what can she smell and taste? What does it feel like right here and now to be experiencing these things? As she’s doing this, Katie will almost certainly forget about what others think; about her weight and her discomfort with that.
And that is the beauty of Mindfulness CBT. It works (with practice) because the mind can only focus on a certain number of things at once. When we’re focusing on what’s happening to us now, we can’t focus on what happened in the past or what disasters may happen in the future. Allow your mind to focus on something which will ultimately help you to feel good about yourself!
If you’re interested in further reading about this, you could try:
The Mindful Way Through Depression: Freeing Yourself From Chronic Unhappiness. Mark Williams et al.
Cognitive Behavioural Therapy for Dummies. Rhena Branch and Rob Willson.
www.moodjuice.scot.nhs.uk/ A useful site full of self help guides for dealing with anxiety, phobias and depression.