Cognitive Behavioral Therapy - 7 questions to ask yourself to decide if CBT will benefit you
Cognitive behavioural therapy (CBT for short) is a widely available form of talking therapy that research has shown to be effective for many psychological disorders, including: depression; panic; agoraphobia; excessive worry; obsessive-compulsive disorder; post-traumatic stress; health anxiety; excessive anger; and the distress associated with psychotic symptoms such as voice-hearing and delusions. As the name of the therapy suggests, CBT focuses on trying to change unhelpful beliefs and behaviours so as to enable a person to achieve desired goals.
There are many kinds of talking therapy, other than CBT, and anyone experiencing mental health problems may benefit from some form of psychological intervention; the overarching message is to find a therapist you feel comfortable with and give it a go. Nonetheless, there are some indicators that differentiate between those people who are likely to achieve significant gains from psychological therapy within a relatively short time-frame (typically between 6 to 20 weekly sessions) from those who may require longer periods of intervention or who may even be deemed unsuitable.
If you are currently considering whether CBT may help you with a mental health problem, ask yourself each of the following questions. The more “yes” answers you can give to these questions the more likely you are to achieve quick benefits from a course of CBT. If you answer yes to all of the questions, rest assured there are a multitude of clinical psychologists and cognitive-behavioural therapists eagerly anticipating your arrival!
Introduction to CBT by Dr. Robert L. Leahy
Are you psychologically minded?
In a general sense, someone who is “psychologically minded” is able to reflect upon, and talk about, their inner world. With regards to CBT, psychological mindedness is about being able to reliably distinguish between the following components of human experience:
Thoughts: These are our private inner self-talk, beliefs and opinions. All of us have a constant stream of thoughts as we strive to make sense of what is going on around us, past and present. Thoughts are not facts; they are our best guesses about the meaning of things we witness. Sometimes our thoughts are accurate and valid, often they are distorted. Examples of thoughts are, “Nobody likes me,” “I made a fool of myself in front of all my work colleagues” and “I’m worthless.”
Emotions: These are our feelings. As a rule of thumb, feelings can always be described using just one word, for example: angry; sad; happy; anxious; guilty; ashamed; excited; depressed; apprehensive; panicky and jealous.
Situations: These are the factual events that we experience in our lives. Within this dimension there is no opinion, interpretation or feeling, just an objective description of what exactly happened; for example, “When I got home from the pub last night, my wife said I was a ‘useless drunk’.”
Behaviours: These are the things we do from one moment to the next. Every minute of each day we are displaying behaviour, such as, “Lying on my bed, Watching television” or “Weeding the garden.”
Physical Reactions: These refer to our bodily reactions and anything to do with our biology. Examples of physical reactions include: heart pounding; sweating; breathlessness and headache.
A central skill of CBT is to understand how each of these five elements of our experience can have a knock-on effect on each other. Therefore, being able to differentiate between them should aid the therapy process.
Are you able to identify specific goals for therapy?
If you are able to specifically describe what you are hoping to achieve from therapy you will be more likely to find CBT helpful. A specific goal is one that highlights a desired change in a particular aspect of behaviour or emotion. The following are examples of specific goals:
“To reduce the number of panic attacks I suffer”
“To overcome my fear of flying so I can visit my daughter in Australia”
“To feel less anxious when delivering a sales presentation at work”
“To reduce the time I spend checking the doors and electrical appliances before leaving my house”
Such goals are realistic and measurable and will enable you and your therapist to focus on the particular area of your life that you most want to change.
In contrast, the following goals are over-general and vague:
“I just want to feel normal”
“To become a more confident person”
“To feel better”
These non-specific goals are less useful in short-term CBT and a therapist would encourage you to break them down into more precise components.
Are you prepared to work as an active partner in the therapy?
To benefit from CBT the service-user is required to actively collaborate with the therapist. If you expect to turn up for the sessions and passively absorb the therapist’s words of wisdom you will not gain much from the process.
The approach assumes that the recipient is more of an expert than the therapist. Only the service-users know the life experiences they have endured, the thoughts they are having and exactly what it feels like to suffer the paralysis of their overwhelming emotions. The therapist will have some expertise in helping people with similar problems to your own. It is only by giving weight to both these types of expertise, by working genuinely as a partnership, will CBT achieve its aims.
At the end of each CBT session, some home-tasks will be agreed (for example, writing one’s thoughts down when experiencing a dip in mood) to be tried by the service-user before the next therapy appointment. It is vital that this between-session work is consistently attempted in order to achieve optimal benefit from this form of therapy.
Are you willing to experience an increase in emotional pain?
Like other forms of psychological therapy, in CBT it is often the case that service-users will feel worse before they feel better. Discussing painful life experiences (past and present) together with the identification of negative beliefs about oneself, other people and the future – for example, “I’m a failure,” “My friends always let me down” and “No one will ever love me” – will commonly evoke strong negative emotions. Although the wish to not think or talk about painful thoughts and memories is completely understandable, it is not possible to meaningfully engage in CBT if you remain actively avoidant of these aspects of your experience.
The good news is that, after the initial increase in discomfort, directly addressing these painful thoughts and experiences is typically less traumatic than expected. Furthermore, doing so provides the opportunities to helpfully challenge the negative beliefs that past experiences have burdened you with, thereby promoting better mental health.
Are you able to view your mental health problem as being the result of something other than a biochemical imbalance?
Given the glut of mendacious assertions from psychiatrists and the pharmaceutical industry that mental health problems (such as depression) are directly caused by a biochemical imbalance in the brain, service-users can be forgiven for often assuming that only medication can alleviate their psychological pain. As such, engaging in psychological therapy might seem an irrelevance, like a diabetes-sufferer trying to talk away his body’s lack of insulin.
Within a CBT perspective, our thoughts, biology, feelings and behaviour can all potentially have a knock-on effect on each other. Thus, if a depressed person’s negative thinking style is changed through a course of CBT, this thinking change will likely have an effect on the person’s feelings, behaviour and biology. Similarly, if someone’s depression is successfully treated with anti-depressant medication, there will be a corresponding and positive impact on thoughts, feelings and behaviour.
A significant barrier to benefiting from CBT is when a person presents with the view that the mental health problem can only be alleviated by directly rectifying the assumed biochemical imbalance.
Are you sufficiently alert to learn new skills?
Like any other talking therapy, CBT is about learning about yourself and applying these new skills in your day-to-day life. Human beings only learn if they are sufficiently alert to concentrate, reflect and respond to the issues discussed in the session. A person who is over-sedated, either as a result of prescribed medication or illicit drug use, will not be able to take advantage of the therapy sessions.
While drowsiness is a handicap to gaining benefits from CBT, over-arousal can be equally detrimental to the therapeutic process. Although there are always likely to be episodes of high arousal during a therapy session (given that difficult issues are being addressed) persistent agitation and distractibility will impede learning.
Is your current living situation stable?
It is not uncommon for a person to present for therapy seeking help with depression and/or anxiety only for it to become apparent that the service-user is currently in an abusive relationship and is being assaulted on a regular basis. In aversive circumstances such as this, the resultant depression and anxiety is not a psychological problem it is a situational one; the emotional reaction is consistent with current circumstances and no amount of therapy will relieve the distress. The victim needs to free herself from the abusive situation.
Similarly, if day-to-day life is extremely stressful (for example, involvement in a Court case or embroilment in a messy divorce battle) it may not be the optimal time to enter therapy.
To be able to answer “yes” to each of the above questions would render you an ideal candidate for CBT. Of course, the large majority of people entering therapy will not present in such perfect circumstances and therefore should not be put off from seeking this form of intervention as they may still benefit. Nevertheless, the more “yes” responses you are able to give the more likely you are to make quick gains from the process of CBT, as indicated by the following quiz.
Quiz - will CBT help you?
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6-7 "Yes" answers: You are ideal for CBT and should work extremely well with this form of talking therapy.
3 - 5 "Yes" answers: Although not ideally suited for CBT, it is still worth considering this form of therapy, particularly if you are prepared to work at it. Any benefits might take longer to achieve.
2 or less "Yes" answers: CBT is unlikely to suit you so it may be worth considering other forms of therapy.