Written by Dr David Lee, Lead Consultant Clinical Psychologist at Camali Clinic
Cognitive-Behaviour Therapy (CBT) is a form of talking therapy which is shown to be effective for the treatment of a wide range of problems in children, adolescents and adults.
It was developed initially in the USA with strong input from UK clinicians. Today, CBT is used throughout the world and it continues to advance in many ways. Generally, CBT is the most effective approach for helping individuals with anxiety disorders and mood disorder. It is shown to have very strong evidence for the effective treatment of fears and phobias, worry (or generalized anxiety), panic attacks, social anxiety health anxiety, separation anxiety, obsessions and compulsions, the experience of trauma and a whole range of other anxiety-based problems. In addition, CBT is effective for treating depression and low mood, and for helping with related issues including low self-esteem. Other problems have also been shown to be effectively treated with CBT, including eating disorders, addictions, relationship problems and psychotic experiences.
CBT works as a collaborative process between the therapist and the patient (or client).
Problems are identified as targets early in therapy and these are then framed in terms of therapy goals. The emphasis is on working in “the here and now” with a focus on where the individual would like to be in the future. The notion of ‘working together” is essential to good outcome. The therapist guides the individual to take steps toward change by helping him or her to become more aware of how our thoughts and behaviours can influence the way we feel emotionally and physically (in our bodies). The goal is to change unhelpful thinking patterns and behaviours and replace them with more functional ones. A major part of CBT involves learning and practising new skills for managing thoughts and feelings. This is a process of discovery, new learning and emotional experience.
The following diagram is helpful for understanding how our thoughts, mood, biology and behaviour are all related:
CBT sessions usually last for one hour and have a structure to them. There is always an endpoint in mind as the therapist and individual work towards the goals systematically, attempting to overcome obstables and ‘roadblocks’ along the way. Generally, CBT lasts between 6 and 20 sessions depending on the nature of the problems.
CBT can work extremely well as part of a collaborative process between the therapist and adolescents, as with adults.
With younger children, the process is adapted and there is greater emphasis on working with the parents or family as well as with the child. Education surrounding thoughts, mood, biology and behaviour plays a core part in CBT (i.e. this is known as ‘psychoeducation’). With younger children, creative and engaging means are used such as pictures, videos or toys.
CBT places emphasis on the individual gradually learning to play an active role in helping themselves. In younger children, the parents or family may take a more “hands on” role in this regard. There is emphasis on self-help ‘out-of-session’ tasks including going over material that was covered in the session, keeping diaries or “testing out” a new way of approaching situations, as well as attempting to drop more familiar but unhelpful behaviours.
CBT can be a fun, unique and engaging experience.
The relationship between the therapist and the individual is always of major importance. Success generally occurs when the individual (or parents/family) can trust the therapist and work with him or her to learn new ways of thinking and approaching situations
Essentially, CBT is a time-limited, goal oriented, evidence-based psychological treatment. Clinical guidelines based on research trials (such as those published by the UK National Institute for Health and Care Excellence or ‘NICE’) recommend the use of CBT for anxiety disorders and mood disorders in children and adults, as well as other related problems. CBT is focused on goals and on meaningful change rather than dwelling unnecessarily on past experiences.