In this episode, Sarah revisits her most popular episode to date - Episode 24 What is CBT and how does it work?
In this episode, Sarah explains exactly what Cognitive Behavioural Therapy is all about so that you can gain an understanding of how it works, what it’s helpful for and how you can prepare for your first session should you decide that it’s the right option for you.
A full transcript of this episode is available at https://ask-the-therapist.simplecast.com/episodes/revisiting-what-is-cbt-and-how-does-it-work
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This episode was written and presented by Sarah Rees. It was edited by Big Tent Media and Produced by Emily Crosby Media.
Sarah Rees 00:09
Welcome to Ask the Therapist, a monthly podcast for everyone who's interested in how our minds work building resilience through journaling, and all things therapy. I'm your host, Sarah Rees, a mental health nurse and CBT therapist with over 20 years of experience in the field of mental health.
Sarah Rees 00:27
I hope you're having a lovely summer. as I record this, we've just hit some record temperatures here in the UK, it's been very, very toasty. But it's come back down to a bit of a normal temperature, we still have some of the summer to go and I hope you're enjoying it and getting to take some time out for yourself. Over the last month, I dipped into the archive of the acid therapist podcast, and looked at what episodes have been downloaded the most. What's the most listened to? And there was one episode that stood out heads and tails above all the others. And that is the episode that I did quite a while ago now called what is cognitive behavioural therapy. I am a cognitive behavioural therapist fully accredited. And I wanted to provide a really good overview of the principles and the foundation of CBT to help people who might have been referred for CBT just about to start their sessions and wanting to know more wanting to be better prepared. Or if you're considering which type of therapy might be right for you, this would be a good episode. And if you're considering being a CBT therapist, you might want to know some of the fundamentals. So I hope this gives some really good insights. This episode has had already over 2000 downloads. So it's hugely popular. But if you feel that I have more to answer on this, do drop me a line, ask me any questions. And I'll try and get those answered for you. Also, in September, I have a little miniseries coming along. I've rewritten my free guide that's on the website about building resilience. And I'm going to do a miniseries that goes along with that. So it's gonna be six shorter episodes on a fortnightly basis. And you can download the free guide, or just listen to the episodes and it's gonna be all about building resilience. So that's coming in September. To make sure that you get notified of those episodes. Don't forget to subscribe, and hope you enjoy the episode.
Sarah Rees 02:36
Today I'm going to talk to you about what is CBT cognitive behavioural therapy. So hopefully, you'll get a good understanding of what the therapy is about how it works, how it helps people, and if it's right for you, Cognitive Behavioural Therapy or CBT, as it's most commonly known, as was developed by Dr. Aaron Beck in the 60s for the initially for the treatment of depression. CBT is a structured short term and goal focused psychotherapy, it looks at solving current problems in the here and now and modifying dysfunctional or unhelpful thinking styles and unhelpful behaviours. That's how Dr. Beck has defined it. It has developed and expanded in many ways over the years. And it's used to treat a wide range of mental health problems, people who are in vicious cycles or patterns of behaviour, or for people who just want to get the best out of their life. There's a common misconception that cognitive behavioural therapy is just about positive thinking. And it's so much more than that. The key concept is that thoughts, feelings and behaviours are all interconnected. And you can get trapped in unhelpful patterns of thinking, doing and feeling. So our thoughts impact how we feel what we do, and ultimately create the lives that we live. So becoming more aware of our thoughts, feelings and behaviours, we can look at changing different aspects. Cognitive Behavioural Therapy has so many features and benefits. It's a very collaborative therapy. So you bring to the therapy room, your experience, your past experience, your current struggles, what you want help with, and the therapist brings their knowledge their many years of training and, and practical experience. And together you bring those two knowledges together to practically work towards solutions. It's very practical, in that we're constantly looking at what thinking styles are in place and what you need to move to or what behaviours and helpful or maintaining situations and what you need to move to. So it's almost as important what goes on outside the sessions as what goes on inside the sessions. The CBT therapist has been trained in a therapeutic approach the application of CBT we've been trained in all the Anxiety and mood disorders and all the relevant evidence base for each mood and anxiety disorder. So CBT is grounded in research and evidence, which means it's tried and tested. So the practical strategies and the tools that you will learn have been tested out in research, we know it works. Initially in therapy, we do something called an assessment where we get a really good overview of your past experiences, the key problems areas, and then we look at the goals that you have for therapy, the therapy is mainly based in the here and now but myself and no other therapists sometimes do look at people's past, if it's relevant. For some people, it's not, we don't need to go into what happened in your childhood. For some people, it is relevant, I think it can be helpful in kind of developing helping people develop a compassionate narrative of where they find themselves today. So I think in many respects, it can be really helpful. But it doesn't need to be an in depth kind of 10 sessions of going over the past. And lots of people like that, because they don't want to go back to the past, they're struggling with something in the here. And now, they want practical tools and strategies to change things now. And that's where CBT comes into its own. It's a very active therapy, where the therapist is always looking for patterns of thinking and behaviour. There's lots of psychoeducation. And what that means is kind of education around all the anxiety and mood, experiences and difficulties that people can have. And lots of therapists are trained in how your mind works, which is hugely beneficial, because our minds are really tricky, and often do not help us. And we can be really self critical of ourselves in our minds. And that almost becomes a problem in itself, that I think I'm broken, or I'm wrong, or I'm doing something wrong, or I'm stupid, or I'm just an anxious person, or I'm a depressed person, we're actually understanding how our minds work and how our minds react to our environments. And what goes on around us can help us kind of shift from being self critical to self understanding, and to kind of giving ourselves and our minds what they need, as within every therapy, a very key ingredient is your relationship with your therapists. So your connection with how well you get on with your therapist, how much you think that they can help, you will have a direct impact on on the quality of your therapy. And we know from the research that the more you trust your therapist, the more you kind of trust in their experience and knowledge, the better your outcomes, there's a lot to be said for that if you don't connect with your therapist, you just don't click, it's really worth moving on quite quickly. Because we know that your therapist relationship directly correlates with the outcome of therapy, sitting with somebody in the therapy room, having somebody else's mind in front of you that's not judgmental, that's compassionate. And that is not emotionally involved as well is hugely important. Just sharing our stories helps them lose their power at times, it helps you get clarity, see the links around the patterns that you're in, and with clarity and awareness, then you have more choice over what you do going forward. One of the key aims of cognitive behavioural therapists is that at the end, you will learn to be come your own therapist, so you'll have more knowledge about your mind what's going on for you. And you'll have practical tools and strategies to help you going forward. So hopefully the same problem doesn't arise again. But if it does, you know what you need to do to move you forward, for example, often in depression, we feel low, we do a lot less in our lives. And that doing less keeps us depressed, because the natural things that lift our mood just aren't present day to day. So in just knowing that lots of people that if they get depressed again, will know that they need to be a lot more active. So they will keep the things in place that are antidepressant for them. And that will keep their mood lifted. And that can be applied to lots of different problems that if it comes up again, you will know the things to practically do to keep you at the top of your game. So I'm just going to run through some of the really common questions that I get asked when somebody phones me up or sends me an email thinking about having some CBT sessions really commonly if somebody's never been to therapy before they'll be quite nervous. And the last what's my first session going to be like? Do I need to prepare? What do I need to do for it? And it is good to sit down and spend just half an hour thinking about what brought you to therapy? How would you know if therapy had been helpful for you? What are the key things that you want help with? When did it all start? What's the retrigger is as a specific incident, how a thing What's changed for you? And how would you like them to get better? And how would you know if you've achieved your therapy goal, and then the first session, you can bring that list with you, or just have an outline in your mind. But the first session, you're not going to have to do all the talking. And that is specifically kind of, I suppose I definitely designed my first sessions to kind of take the pressure off somebody. So as they come in and sit down, I'll ask them a little bit about kind of date of birth, where you from your address, GP, some really basic information and tell you a little bit about me my background, which is mental health, nursing, and you know how long I've been here and stuff, just break the ice. And then I'll ask you kind of what's brought you to therapy and where you'd like to start. Sometimes that can really fluster people. So I might kind of say, okay, just tell me what's going on in the here. And now how are you feeling coming today, you're never going to be stuck, you're never not going to know what to say. Because therapists are used to being in front of people that a nervous, worried, not sure about how to get it across. And it's our job to make you feel comfortable, and to help you kind of get the information out. So almost allow yourself to be led by a therapist. So the first sessions usually take an hour, some therapists do 15 minutes, generally, it's an hour, how many sessions will I need is the next really common question. And it's really difficult to say, because everybody's so individual, but some people come to me and they say, I want four sessions, or I want six sessions, they'll we'll go over what they want help with. And we'll kind of narrow it down, get our goals really clear. And it might be that I say, right, well, in our sessions, we'll work on this. But outside of sessions, it'd be really helpful if you could read this or watch this video. So it might mean that you do more in between sessions, I think you've been problems have been going on for many, many years, then the course of therapy is likely to be longer is something that's just happened recently, for example, if somebody has recently started having panic attacks in the last six months, they might need just four to six sessions. If somebody has post traumatic stress from an incident that happened 10 years ago, that could take a lot longer. It depends. And sometimes it depends on the person's motivation, where they are, and where they want to get to. Some people use cognitive behavioural therapy, or therapy in general, a little bit like physiotherapy, and that they like to kind of review and reflect on things on a regular basis. So I've been seeing some people for a number of years, because they just find it helpful in their lives to just constantly be reflecting and making sure that the best versions of themselves, I know if I'm doing something new, or I've had a personal trainer for many years, and it just keeps me on track. And that's how some people use it. Another question I get asked a lot is what the structure of sessions is like. So each session lasts about an hour, the first bout four or five sessions are often what we call the assessment phase, where you're kind of getting an overview of the problems, the goals, and structuring out how sessions will look and how treatment will look. And then in the more active stage of treatment, we will initially start by kind of having a quick review of your week how things have gone, what we want to cover in sessions. And then at the end of sessions, thinking about kind of what is going to be helpful for you to do in between each session to keep the momentum going, as you're looking at maybe changing behaviours, or changing thoughts, it really varies. And at the end of treatment, the last number of sessions might just be looking at kind of how you maintain progress, what you've learned and what you've got out to sessions, and what you need to do going forward to kind of keep yourself in check rarely, and that might be coming back to have a few booster sessions. Or it might be just putting alerts in your phone at three month mark or six month mark, just to kind of make sure that you're maintaining progress. Another question I am often asked is How frequently should I have CBT sessions. And again, that depends on each individual because everybody's experience is very different. I generally like to see people, at least for the first four sessions weekly, and then often as we get further into CBT, because you're doing a lot in between sessions, it's useful to spread out sessions, so to go to fortnightly, and then month like at the end and then maybe have a final session in three months time. But some people just really want to get through things quickly and they find weekly keeps them on track. Some people find that we cover so much in the session and there's bits to do afterwards that they like the two weeks so you can play around with that with your therapist. I thought it might be useful to kind of go through through what I'm doing as a CBT therapist in the CBT session. So there's lots of different areas, I suppose initially, I'm always looking for patterns in how you're thinking, how you're feeling, and what you're doing to manage. I'm always thinking about what do you need to learn about your mind or your psychology, that's going to be really helpful for you. So thinking about the education that I can offer, that's going to be helpful and give you a sense of this is normal, it makes sense, I know what to do and how to move it forward, I'm always looking at your coping strategies. So with any any experience we find ourselves in, we put in place what's called safety behaviours, or coping strategies. So if I'm anxious, when I go into a shop, I might lower my gaze, I might rush around really quickly, I might do a lot of avoidance of the sharps. If I'm worried about public speaking, that might be something I avoid, or I might speak very quickly to get through it. If I'm very depressed, I might want to hide away and keep myself very small and not do social engagements or keep in contact with friends. So I'm always looking at what you're doing to cope, how you are managing, and then we're looking at is that helpful or not? What's the intended consequence of that behaviour? Like, for example, anxiety in social situations. So we know that people might be kind of really planning what they're saying in their mind, because they're anxious to get messing up the social situation to that coping strategy is over planning. So then we look, what's the intended consequence of that is to do well in a social situation. But what's the unintended consequence, and the unintended consequence of being in your mind a lot in social situations is that you're not in the conversation. And that can come across maybe as rude. Or you might miss bits of a conversation. And that kind of scuppers a social situation, the coping strategies that we put in place, we put them in place for very good reason, but quite often, they can become unhelpful, and we don't see the way they're unhelpful. When you sit with a therapist, they will help you to kind of evaluate what's helpful and what's unhelpful? Or what are the things we could try. I'm always thinking about what's overdeveloped for a person and what's underdeveloped. An example of that is that I'm an over thinker, I'm an analytical person, I'm always thinking, but what if that and what is that and overthinking everything over and over thinking every situation and, you know, over preparing and over planning, so what's that's overdeveloped for me. So what's under develop is just being and this is what I work on. So you work on what's underdeveloped, kind of what's the muscle that's not developed. And the muscle for me is about just being in the moment just being present, not thinking just allowing. So that's what I work on through meditation, and yoga and lots of dog walks. So as a therapist, I'm thinking, what's over developed for this person? What do they do really well? And what are the things that are underdeveloped that might benefit from being enhanced? I'm always thinking about what does this person need, given their experience, given what they're struggling with? What do they need? And I actually think that's a really nice question to ask ourselves at times, given where I am, what I'm going through, what do I need? And when we ask ourselves this, and we slow things down, after we we know more than what we realise, in sessions, I'm always thinking about what can we do and it's done very collaboratively, generally with with somebody, but I'm thinking what needs to happen in between sessions. So what can we be working on in between sessions? That's going to really enhance the sessions, I'm always thinking about how does this person support themselves? And what do they need? I'm always thinking about what the key fears are or their blocks, what's stopping this person moving forward? Or what are the fears and blocks that have meant that they are where they are, I'm always working on helping people identify the beliefs about themselves that they hold about the others and the world. So for example, that I see lots of people that have a belief about other people as being judgmental and critical. And yes, some people are judgmental, and some people are critical, but is that everybody? Generally it's not. And just toning down that belief can mean that you live in a less dangerous, hostile world. So you're just karma. So I'm always trying to listen out for beliefs people have about themselves, the world and others and helping them become more aware of it because with awareness, we have choice and we can start to alter and shift it I'm always thinking about what behaviours and thinking stuff Miles will be most helpful for the person, how can you waise be learn? How can we help somebody learn new thinking styles or new ways of doing things differently. And often that is through trial and error. So we do lots of things called behavioural experiments. So if and going back to maybe a social situation, often people who are socially anxious won't give much eye contact. So we, they might spend a week really trying to give eye contact, and they might have a negative belief about that. But if I give more eye contact, people think I'm kind of coming on to them or a bit weird. And actually, often what we find is when we give really good eye contact, people are quite flattered, and it kind of connects you up more with people. And that is an amazing way to learn. Because once you've got that evidence, you can't dispute it. You know, we don't always get it, right. But it's trying things out having a real experience of putting in place a different behaviour, or a different thinking style or working, looking at a different belief system, and playing around with it and seeing how it feels. So that's kind of what I'm doing in therapy. And I guess, every CBT therapist comes from a different background. We've all had different training on top of our CBT training. So I've done work in compassion focused therapy, and EMDR, which is eye movement, desensitisation reprocessing. So all those things will influence how I practice as a therapist. So going forward, what would be the next step is really thinking about the type of therapist, that's going to be most helpful for you. I have done a blog post, which are attached to the show notes. In this episode about choosing the right therapist, you can go to your general practitioner in the UK and have a chat with your GP about different types of therapy that are available on the NHS and what might be most suitable for you. And you can do Google searches and look around at people's websites. And often just looking at somebody's website, you can get a general feel for who they are and what they do. And then I think it's important to have a conversation with the therapist and just make sure you you're a good fit. And we're in the UK, the professional organisation that accredits CBT therapists is called the BA BCP. And that's the British Association of cognitive and behavioural psychotherapies, to be a BCP and they have a find a therapist finder on there, it's a directory. So hope that's been helpful. I'll be hopefully doing other podcasts in the future, I look more specifically at CBT for phobias, CBT for different types of anxieties or mood or OCD, but today's been quite broad and quite general. So I hope it's been helpful, and I look forward to speaking to you all again soon.
Sarah Rees 22:57
Thank you for listening to Ask the Therapist. For more information about the CBT journal, visit my website at sarahdrees.co.uk. You can also sign up to download your free guide to building emotional resilience delivered straight to your inbox. You will then also receive regular newsletters where I share my blog posts, podcasts and tips and strategies for better mental health and psychological resilience. Don't forget to review and subscribe to the podcast and you can also share episodes on social media using the #AskTheTherapist. This episode was written and presented by me Sarah Rees and edited by Big Tent Media and produced by Emily Crosby Media