What is CBT?

And how does it work


What is CBT and how does it work

Cognitive Behaviour Therapy is in some sense a modern re-interpretation of a very old way of looking at ourselves and the world, namely Stoicism. One of the central tenet’s of this philosophy is the notion it’s not what happens to you that matters, it how you think about what happens to you. There are a number of different definitions of CBT, and indeed there is a range of variations within this one model, however what underpins all these models is the hypothesis that our thoughts, the ration mind, can shape our behaviour, our thoughts and ultimately our emotions. 

CBT arose in the mid 1950’s partly as reaction against what it felt was the meandering, purposeless exploration of the unconscious advocated by the psychodynamic approach, and replaced this with a more goal-orientated, practical approach. It recognised that for some people talking about their problems didn’t ultimately make them feel any better and that what was required was a more directive, critical examination of both the client’s thoughts and behaviours.

It pioneered what was referred to as the ‘hot cross bun’ model which was important in demonstrating how thoughts, feelings and behaviours can influence and distort each other. 

CBT Hot Cross Bun Model

How does it work ?

Ironically how it works is similar to the psychodynamic approach, by first focusing and identifying unconscious thoughts, particularly negative and critical dialogue that many people, but particularly individuals suffering from depression and anxiety, experience. Then secondly challenging these thoughts. It identified a number of distorted thinking patterns, for example black & white thinking, catastrophising, that lock individuals into an unhealthy way of living, and together with the therapist these are explored and ultimately revised.

Criticisms of CBT

Can you think your way better ? Can you think your way out of depression ? Are you your thoughts ? These are some pretty straight-forward sounding questions, the fact that they however have no easy answers does present serious challenges to the CBT movement.

The main thrust of the criticism towards CBT counters the belief that our ration mind is charge. That whatever we experience we can think are way out of it. Critics believe such an approach downplays both the emotional and the unconscious patterns of behaviours that have been with us since childhood. And this is a legitimate criticism. If you’ve ever experienced grief or heart-ache the notion that these powerful sometimes over-whelming emotions can be ‘reasoned away’ is obviously a nonsense. The emotional aspect to our lives, critics of CBT would argue, actually shapes our thinking and not the other way around.

Another criticism, from the psychodynamic camp, is that CBT under-estimates the unconscious, the history of learned behaviours and patterns of relating from childhood and without understanding and exploring these processes any change in our thinking will be either temporary or superficial. 

It's worth noting however often when people criticise CBT what they are actually criticising is the NHS implementation of this approach. This tends to be shorter term, target-orientated, heavy on the paperwork and with a pronounced doctor / patient hierarchical dynamic many therapists (though not all) have tried to escape. Non-NHS CBT will be far more open to both exploring the historical and emotional components of your thinking patterns. 

Although some of these criticisms are valid, equally if you suffer from prolonged depression or acute anxiety, the last thing you may want is an extended exploration of your feelings or your unconscious motivations for your behaviour and what you may need, and what CBT provides, is some concrete and practical plan of action to shift things forward.

Further Reading

sean delaney therapy blog


The following articles are written to help you understand what is this process of therapy, what actually happens in the room, from finding a therapist to leaving one, from understanding what a counsellor can help you with and what they can't.
It includes topics on the different types of therapy, to couples therapy, and about the role of diagnosis in mental health.

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