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How Does Therapy Work? CBT Edition

You might be considering therapy and you might be feeling a bit nervous about it. In movies and on TV, therapy is usually only shown as a weird and uncomfortable experience.

I’ve been on both sides of the spectrum. I’ve been someone who went to therapy, didn’t know what to expect and felt a bit hesitant before my first session. Now I’m on the other side, I’m a social worker and I’ve learned what techniques we might use and how they work.

Most therapists use one or two theories to help them help you. Theories help them understand common patterns of human behaviour and what helps people heal, these theories help therapists create therapeutic techniques and activities. I wanted to write a series of blogs that discuss the most common theories that are used in therapy today. I wanted to do this because sometimes people go to therapy and find it doesn’t work for them. Often they never go back. Sometimes this is due to the therapist, sometimes people just aren’t compatible. Other times this could be due to the type of theories the therapist is using. If you understand the theories you can ask them to switch it up or find someone who uses a different theory. Therapy is hard work but if something isn’t working you have the right to change it up.

I wanted to talk about Cognitive Behavioural Therapy (CBT) because it is one of the most common types of therapy. You will probably run into this at some point in your healing journey, if you haven’t already.

What is Cognitive Behavioral Therapy ?

CBT is commonly used to treat anxiety, depression, addictions, disordered eating, trauma, grief, anger, chronic pain, obsessive compulsive disorder, phobias and low self- esteem. The main belief of CBT is that your thoughts, actions and feelings are cyclical, meaning they all impact each other in a cycle. Depending on the nature of your thoughts this cycle can be helpful or harmful to you.

Let’s take a failed test as an example - there are two common ways people might react to this.

Your first reaction might be to believe you failed the test because you’re dumb. Because you tell yourself you are dumb, you might give up on studying since you aren’t “smart enough” to understand the material anyway. As a result, you do poorly on future tests and you continue to believe that you aren’t intelligent. As you can see, your first thought (“I failed because I am dumb”) fuels a downward spiral.

Instead you could think something like “I failed because I don’t understand the topic and I didn’t ask for help”. In the future if you could get help before the test, you would do better on the next test and you would feel more confident going forward.

As you can see, the unhelpful thought spurred negative feelings and unhelpful actions which led to a poor outcome. The second thought was more helpful because it was more objective, you looked at the facts rather than blaming yourself or the situation. It was clear what you could do next time and as a result you could recover more easily. Basically this is the goal of CBT, to help you shift your unhelpful thoughts to more helpful thoughts, as helpful thoughts can lead to positive feelings and behaviours.

How does it work?

CBT focuses on specific problems and attainable goals. You will probably be meeting with your counselor every week or every other week for 30 minutes to an hour.

The process usually goes like this:

  • Identifying the problems in your life
    • Are you depressed, anxious, have low self-esteem, have problems with people in your life?
  • Becoming aware of your thoughts, feelings and beliefs about the challenges you face
    • How do you think about yourself and your problems? What do you feel and believe about these challenges? Do you think you can overcome them or not?
  • Identifying unhelpful thinking patterns
    • Do you think about yourself and your problems in a negative or inaccurate way? Do your thinking patterns stop you from solving your problems or get you into deeper trouble?
  • Reshaping unhelpful thinking patterns
    • Take your negative/inaccurate thoughts and try to change them up to be a bit more realistic or helpful.

To accomplish all of those steps you will likely have homework in between sessions; it might be reading, doing an activity or practicing a new skill. The homework is meant to help you identify your underlying thoughts, feelings and behaviours, and to practice new ways of thinking, feeling and acting. Generally there is time at the beginning of each session to talk about the homework. Your therapist will ask you how it went, how you felt and if there were any challenges. If you had any challenges they will help you troubleshoot.

Your therapist won’t push you to do things you don’t want to do, but you will be encouraged to get outside your comfort zone. You might have to think about things that make you scared, sad or angry and you might feel drained. You might also be encouraged to face situations or places that scare you, this is known as exposure therapy. The therapist will check in with you throughout the process.

Once you have gained these new skills, therapy will end and you can put what you’ve learned into practice. You will make an effort everyday to monitor your thoughts, feelings and behaviours to avoid a downward spiral, some days will be easier than others. Some therapists allow you to come periodically for a refresher session if needed.  

Pros of CBT

  • It’s collaborative, your therapist isn’t going to tell you what to do. They are going to work with you to find a solution that suits you.
  • It can be helpful for people who are on medication but need some additional support.  
  • CBT is very focused and structured, as a result this type of therapy is shorter than other therapies.
  • It’s available in many formats such as groups, one on one counselling, self help books, and apps/computer programs. There are many options and you can find the one that works best for you.
  • You learn concrete skills that often turn into habits such as; relaxation, coping, resilience, stress management and assertiveness. Once you leave therapy you can continue to use these skills.

Cons?

  • You are a part of the process, you have to work with the therapist, and you will have homework.
  • Your problems don’t magically disappear. You learn skills but you still have to practice them to make them sustainable.
  • CBT is very structured and there can be a lot of written exercises. This type of therapy might not be good for people who struggle with writing, reading and/or focusing.
  • Since the focus is on your thoughts, feelings and behaviours it doesn’t help you solve larger outside issues, but it could help you respond to them better.

Possible Pro and Con

  • This therapy focuses on the present, it does not explore your past in depth. Some people might like this, while other people might want to spend more time understanding how their past impacted the present.

If CBT seems like a good fit for you, try it out. Remember that therapy can be uncomfortable sometimes as you are reflecting on upsetting situations in your past and present. Also, you might be encouraged to try things outside of your comfort zone. Do your best. If something doesn’t feel right let your therapist know, they can work with you.  

References

  1. https://www.anxietybc.com/cbt-home
  2. https://www.nhs.uk/conditions/cognitive-behavioural-therapy-cbt/how-it-works/
  3. https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610
  4. http://www.thecbtclinic.com/pros-cons-of-cbt-therapy