CBT Therapist Near Me: Cognitive Behavioural Essentials

Cognitive Behavioural Therapy (CBT) is a popular and effective talking therapy for many psychological problems. We use CBT in our clinical and coaching work. This article will help you understand key elements of this approach to psychological difficulties.

What Is CBT?

CBT emerged from earlier forms of psychological treatments developed through the 20th century (e.g., Behavioural therapy, Rational Emotive Behavior Therapy). CBT emphasises the role of thinking in emotional responses to events. In other words, thoughts are the link between situations and our responses. Losing a job and thinking ‘Great, I hated that job’ is going to produce a very different response to ‘This is the worst thing that could ever happen to me’.

We also consider the relationships between thoughts, behaviours, emotions, and the physical body (physiological reactions) in CBT. We assume that altering one of these elements can have an impact on others. The connections between these four aspects of our lives can be represented in this simple diagram:

There are other important features of CBT. Examples include:

A focus on addressing psychological distress in the present, rather than attempting to address difficulties in a person's past.
Psychological problems are viewed as normal processes that have been intensified for some reason. For example, anxiety is a very normal experience that we all encounter on occasion. The brain sometimes starts to over-estimate the number of dangers in our life. This error triggers false alarms in the body (i.e., excessive anxiety).

CBT Effectiveness

CBT is a consistently beneficial treatment for various psychological and physical health conditions (1). However, we lack information on treatment outcomes for certain groups (e.g., children, older adults, ethnic minorities; 2).

CBT is used to successfully treat many physical health and mental health problems, particularly depression and anxiety disorders. However, this approach is also used in trauma and anger management therapy to name a couple of additional examples.

CBT can also be used as part of a holistic therapy or combined with other forms of psychotherapy as ‘intergrative therapy’.

What To Expect In Sessions

The process of CBT first involves understand why and how a person's difficulties have occurred. This stage is known as assessment and formulation.

CBT sessions then involve an intervention that targets underlying problem causes. Strategies used in CBT relate to the four aspects represented in the above diagram. For example, unhelpful thinking patterns are identified through the use of thought diaries, then addressed through various ‘thought challenging’ techniques. Clients are often asked to change behaviours in some way to address issues such as avoidance and counterproductive ‘safety behaviours’.

CBT is generally a short-term intervention. But the number of sessions completed for a given issue can vary greatly (6-12 appointments is typical).

When using CBT in my practice, we often agree on an initial block of sessions with a client (usually 4-6). This is followed by a review of progress and discussion about whether further work should take place. However, treatment should be flexible and accommodate your needs and circumstances.

It isn't straightforward to make predictions about how effective CBT will be or how long it will take to work. Overall, CBT is an effective treatment on average (2). But not everyone will respond in the same way (or at the same speed).

In my practice, we commonly see people experiencing positive effects after about 4-6 sessions, but this varies. Commitment to appointments is crucial to maximising the chance of a quick response.

Learn about CBT costs in this article.

An Example

We use many questions to help identify and respond to unhelpful thinking patterns. We have listed several questions below that can be asked whenever a difficult or negative thought appears. Remember, unpleasant thoughts are sometimes accurate. There’s no point trying to twist these in the hope of changing reality.

These questions are best used for highly subjective thoughts and thinking errors (e.g., mind-reading, catastrophising).

Here is an example:

‘John thinks I’m not talented enough to do this job’

What’s the evidence that this thought is accurate?

I don’t have any clear evidence. I am trying to guess what’s in his head.

What would I say to a friend who had this thought?

Test out this thought. Ask for some direct feedback on how you’re performing.

What are the pros and cons of having this thought?

Keeps me alert to potential threats, but it leaves me feeling on edge and suspicious of colleagues.

CBT For Depression

Low mood and anxiety are difficulties often addressed through CBT. Applying CBT to low mood, we often use the following techniques:

Keeping a mood diary to understand the problem better
Introduce an 'activity schedule' where depression-causing behaviours are eliminated while mood-improving activities are introduced
Develop a person's problem-solving skills
Identify depression-causing thoughts, then responding to them with more accurate alternative statements.

CBT For Anxiety

For social anxiety, we might undertake these tasks:

Teach physical relaxation techniques
Identify anxiety-causing thoughts, then generate more helpful, realistic counter statements
Identify anxiety-provoking situations, then enter these repeatedly in a controlled, gradual way
Conduct 'experiments' to test the accuracy of anxious thoughts.
Here are some more tips for social anxiety

Online CBT Therapy

CBT is a therapy that is now widely available online. There is evidence that online delivery is an effective format (3).

We recommend having live sessions with a therapist (virtual or in-person). Then reinforce this work with good quality self-help resources. Here are a couple of options:

Moodgym
The book ‘Mind Over Mood’ by Greenberger & Padesky (published by Guilford)

If you live in the UK, there is the possibility of receiving NHS CBT via your GP. Alternatively, many practitioners like myself now provide online consultation. Always look for registration or accreditation with a reputable organisation (e.g., HCPC, British Association for Behavioural Therapy).