Happy Mental Health Monday! When we talk about mental health, we often look for solutions to problems. It is quite easy to want to ‘fix’ mental health difficulties and ‘cure’ our symptoms. The truth is, mental health difficulties are often really natural responses to some of life’s more adverse situations. Clinicians and practitioners like to focus on providing something called evidence-based interventions. These are interventions that have been through robust research processes and several trials to support any argument that they are successful treatments. One of the more well known evidence-based psychological interventions throughout different levels of mental health is Cognitive Behavioural Therapy, or CBT.
So, what is CBT?
Cognitive Behavioural Therapy focuses on two elements – our thinking and our behaviour. The theory behind this therapeutic intervention is that our thinking styles and behavioural responses are going to drive our emotions and possibly any physical sensations. Simply put: how we think affects how we feel which affects what we do.
We describe this relationship as a vicious cycle. To illustrate this, we split the situation into five key areas. An example can be as follows:
Invited to a friend’s party
“what am I going to wear?” “what if I don’t know anybody”
“who will I talk to?” “can I get out of it?”
Physical Sensations Emotions
Hot Sweaty Heart racing Anxious Worried
Nausea Shaking Breathlessness Nervous
Make an excuse and not go
Go but make sure to drink alcohol to make socialising easier
Go and make an effort to talk to people I don’t know very well
This illustration shows how a person might respond to an invite if they are experiencing anxiety. The thoughts they experienced are a natural and valid response, they might be the result of anxiety and they may also trigger it. Similarly the behaviours are natural responses to the uncomfortable physical sensations as well as the thoughts and emotions. What CBT might address is how the subsequent thoughts and behaviours made a person feel. The kinds of questions a CBT intervention might provoke could be: Did avoiding the party make them feel better? How long for? If another invite came in a week’s time, would they feel any more or less able to go to that one? Did avoiding the party confirm or dispute any of their predictions?
The answers to these questions might inform potential strategies to disrupt this vicious cycle. These strategies might include behaving differently and pushing ourselves into anxiety-provoking situations. They might also promote thought challenging or diffusing to allow us to gain a different perspective or simply allow our thoughts to occur without infiltrating our functioning.
CBT is offered in various different modalities and can be beneficial for a variety of different mental health difficulties. Most commonly, it is offered in a 1:1 face-to-face setting with a qualified CBT therapist. In England, the NHS provides CBT predominantly within Improving Access to Psychological Therapies or IAPT services. It is offered at two levels; Low Intensity and High Intensity. It can also be offered online, over the telephone, or in groups or psychoeducational courses as well as 1:1.
So, how can it help me?
CBT can be really beneficial to a whole range of individuals. It can help you if you have a lack of motivation or difficulty managing worry, just as much as it can if you have an Anxiety Disorder or a diagnosis of Depression. It will help by working on your ‘here and now’ problems and offering practical strategies for you to implement in your day-to-day life.
CBT is also adapted to treat Eating Disorders, Psychosis, and PTSD. This is known as CBT-E (Enhanced), CBT-P, and Trauma-focused CBT. These types of CBT are commonly offered in specialist services by specialist therapists, although it is common for those trained at a High Intensity level to receive training in CBT for trauma.
If you think that you could benefit from CBT, it can be really helpful to look into self-help materials online. These are provided by charities such as Mind as well as NHS services. Accessing CBT can be done in England through your IAPT service; most take self-referral but your GP can always refer you as well. Clinical Psychologists are also trained in CBT as a fundamental aspect of their doctorate training. You can find accredited CBT therapists by looking up your country’s psychological board. In the UK it is the British Association for Behavioural and Cognitive Psychotherapies, in America it would be the American Psychological Association.
I hope this was a helpful look at one of the biggest and most successful types of therapies! If you are struggling with your mental health, don’t be afraid to ask for help. Call Samaritans on 116 123 to speak to a confidential listening service who can help guide and support you.