What's involved in doing CBT?
Cognitive behavioural therapy (CBT) differs from what some people might classically think of when they picture therapy. Whereas counselling, for example, involves the patient talking and the therapist listening and processing what they say, CBT is more of a ‘doing’ therapy.
Treatment involves a very active process that aims to help the patient feel better through problem-solving, and equipping them with practical techniques they can use to combat their difficulties. It’s also very collaborative, with the therapist and patient working together and taking equal responsibility for resolving the difficulties.
CBT treatment is available in different formats – with face-to-face and online options, offered through the NHS and also privately. However, the process tends to follow the same structure.
Assessment: The therapist will want to get to know you, find out about your problems and their impact on your life, and discover what you hope to get from therapy. For example, someone with depression might be asked to describe how they spend their days, and how things affect their mood. You’ll be asked to complete a questionnaire about your symptoms – this will help you both to see where you are, and also to track your progress.
Formulation: Most people experience mental health problems as a ‘vicious cycle’. To gain a deeper understanding of yours, you and the therapist will figure this out together. Formulation, as it’s known, involves mapping out the thoughts, emotions, behaviours and physical symptoms in an individual’s vicious cycle, and how they all link to each other. This will highlight what needs to change to help you feel better, and where treatment should be targeted.
Setting goals: You and your therapist will agree some things you’d like to improve, and turn them into concrete goals you can work towards. These goals will bring to life what you’d like to achieve by the end of your therapy sessions, and help the therapist to tailor sessions to your needs. They’ll also be used to measure your progress, so should be as specific, practical and realistic as possible.
To help you think of some goals if you’re unsure, your therapist might ask something like: “If you were to wake up in the morning and things were different, what would be different? And how would you know that things were different?”
Learning: Right from your early sessions, you will learn something new that you can put into practice straight away in your day-to-day life. This could be a deeper understanding of your problem, or a new technique for challenging your beliefs around it. For example, if you’re struggling with negative thoughts you’ll learn to recognise and challenge them, acknowledging that they often don’t represent reality, to reduce their impact on your life.
‘Homework’: CBT involves more than just the hour a week you spend with your therapist. One of the most valuable parts of therapy is putting into practice what you’ve learned at home, in the time between sessions. You and your therapist will agree the tasks you’ll find most useful, to reinforce new techniques, tools and strategies by working on them out ‘in the wild’!
For instance, if your goal is to become more assertive, you might practice this with a colleague who’s trying to get you to do some of their work, or a customer service operative who doesn’t want to answer a question. Someone with depression might have an action plan that helps them to slowly increase their activity levels.
With online CBT, you’ll be able to message your therapist during the week to get help if you need it, to keep the learning and practice going between sessions.
Regular reviews: You’ll revisit your goals on a frequent basis, and talk about what’s going well, and what isn’t. This will give the therapist a chance to refocus your action plan if necessary, to make sure you’re getting what you need.
Measurement: CBT is outcome-based, so measuring your progress is tremendously important. Your therapist will regularly check how well the treatment is doing, normally through repeating the symptom questionnaire you answered during the assessment weekly, to see whether things are improving.
Relapse prevention planning: The aim of CBT is to give you a ‘toolkit’ you can benefit from in the long-term, as well as helping you to feel better in the short-term. Your therapist will teach you ways you can protect yourself against your problem coming back and, if it does, how to recognise it and address it.
To get the most from the CBT process it’s important that you’re completely ready for it; that you feel it’s the right time to begin treatment, and can commit to making the session each week and also to put in the work in between. If you’re ready to get started, you can find out more about online CBT and begin your journey here.