What is CBT?

This article is part of our current series explaining what to expect from different forms of therapy that we deliver at JSA Psychotherapy.

Aaron T Beck, an American psychiatrist, first developed CBT as a treatment for depression. After overwhelming evidence to support its success, it has become a recommended treatment for many other difficulties.

What are the main concepts of CBT?

1: We act on our beliefs

If we believe something strongly enough, we will act as if this belief is a fact. For example, in ancient times, people used to believe that the Earth was flat. As a result of this, they didn’t sail too far away from land in case they fell off the edge. We all experience events throughout our lives that shape and mould our beliefs about ourselves, the world and others. When these beliefs are based on reality, they can be beneficial, either protecting us from harm or helping us get what we need. However, others, like the one described above, can limit our thinking and actions and have a negative effect on our lives. The only way to tell which beliefs are factual is to test them.

Some of these beliefs are unconditional or ‘set in stone’, so to speak. These can be about our-self, the world or others. When these unconditional beliefs are activated, they spark off conditional beliefs which tell you how to act in line with your unconditional beliefs. This usually happens in the form of since…then…

For example: Since the world is flat, then I’d better not sail too far or I’ll fall off the edge.

2: We either think with logic or our emotions

When life is going well and is reasonably calm we’re able to think logically about most situations. Imagine you’re down to your last quid and were debating whether or not to spend it on a lottery ticket. Logically you might think about the chances of winning, if you know anyone who’s won, how much profit they make etc. What might you do after these thoughts? However, if you wake up in the morning and feel in your gut like a winner and your emotions are running high then you may make a very different decision.

It’s not unusual that when we experience psychological distress and difficulty, we process everything emotionally instead of logically. We can often live by the rule of ‘It feels this way so it must be true’. A big part of CBT is testing this rule.

3: We can’t separate our thoughts from the rest of our experience

We’ve already described how our thoughts and beliefs influence our actions. However, our thoughts also drive our emotions and bodily responses. For example, imagine you walk into a room full of people and they stop talking when you enter. Your first thought may well be ‘they were talking about me’. If this is a negative thought (‘they were talking about me because I’m annoying’), it’s likely to kick off a negative series of reactions. For example, you may feel upset or angry, your body may start shaking or sweating and you may take action by walking out. However, if it’s a positive thought (‘they were talking about me because it’s my birthday soon and they’re planning a surprise party’), you’re likely to feel happy or, at the very least, relieved. CBT is not about ‘thinking more positively’, however, it’s about thinking in line with the evidence. More on this later.

4: Our reactions to events have a greater impact than the events themselves

In the above scenario about walking into a room, the exact same situation occurred in both examples, but two very different responses were experienced. This is good news because it means that, if we can learn helpful and therapeutic reactions, we have control over how events impact our lives.

5: We all have NATS

Everyone experiences those situations and moments that just seem to guarantee the production of negative and hurtful thoughts. For some of us, they see to come more frequently than for other people, but they exist for all of us. These thoughts pop into our mind without us wanting them to be there or without us prompting them. Unsurprisingly, Beck referred to these as Negative Automatic Thoughts (or NATS). And just like real life (g)nats, they constantly buzz around us, causing bother and making life miserable. As described in point 3, these NATS can create, maintain or increase negative emotions and bodily feelings in us.

6: CBT tests rules like an experiment

If you look back at points 1 and 2, you may remember that we act according to our beliefs and their associated rules. When deciding whether to follow our rules, we can either think logically or emotionally. CBT is all about gathering and using evidence to test our beliefs and rules to see whether they’re helpful or not. We do these like a lab experiment, with a theory that we’re trying to investigate and an attitude of curiosity. For example, one of the first rules we test is:

Rule 1: A thought is a fact

Rule 2: A thought is an idea. It isn’t necessarily a fact

7: We work on finding the most helpful way to act

If our thoughts aren’t facts, then we have a choice whether to follow them or not. This is especially the case with our NATS since they make us feel negative and don’t help us do what we want to. In CBT we first of all test whether our NATS line up with reality. If they don’t then we come up with alternative, more realistic thoughts and act on them instead. This is different to ‘the power of positive thinking’ because a thought could be negative and helpful (protecting us from harm) or positive and harmful (thinking we’re invincible). Instead, we want to have the most factual and accurate thoughts, not the most positive ones.

CBT is all about making choices based on evidence which we gather through assessing the basic facts of a situation.

If you would like to download an info sheet version of this article as a pdf for your own use, you can do so by clicking this link.