With CBT For Anxiety being released recently, I wanted to investigate the brilliant topic of cognitive behavioural therapy because this is a highly effective psychological therapy that can be used for a wide range of mental health conditions. Therefore, in this clinical psychology podcast episode, you’ll be reading or listening to an extract from the book introduction you to cognitive behavioural therapy. Including its theoretical approach, how it treats mental health conditions and how it came to be in the first place. If you enjoy learning about mental health, psychotherapies and clinical psychology then you’ll love today’s episode.
This episode has been sponsored by CBT For Anxiety: A Clinical Psychology Introduction To Cognitive Behavioural Therapy For Anxiety Disorders. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it.
Introduction To CBT (Extract From CBT For Anxiety. COPYRIGHT 2024 CONNOR WHITELEY)
Now that we’re getting onto the part of the book we’ve all been waiting for, let’s start learning about the amazing topic of Cognitive Behavioural Therapy.
As a result, we first need to know both the cognitive and behavioural theories that Cognitive Behavioural Therapy is built on before we can ever hope to understand how CBT works for anxiety disorders.
Therefore, as you can probably imagine Cognitive Behavioural Therapy is based (at least in part) on the cognitive approach to behaviour. As well as Westbrook, Kennerley & Kirk (2007) noted that there is evidence that a lot of mental health conditions are associated with a wide range of cognitive factors. For example, many conditions cause people to have information processing biases, faulty belief schemas as well as dysfunctional ways of thinking.
Then if we apply this logic to anxiety disorders then we’ve already discussed in the book how anxiety causes a person to have faulty belief systems about how dangerous the stimuli is, the dysfunctional ways they develop to “cope” with the anxiety and their bias information processing because how they perceive the stimuli.
Also, the cognitive approaches to treatment were first pioneered by Albert Ellis (1962) and Aaron Beck (1967) with their aim being to incorporate cognitive processes into psychology, all whilst still maintaining an empirical approach to this because they wanted to avoid ungrounded speculation.
In other words, they wanted to make sure their findings withstood empirical scrutiny and it is a brilliant thing that they set out with this in mind.
In addition, when it comes to cognitive approaches, this view focuses on the idea that a mental health condition is caused by a person developing irrational beliefs, dysfunctional ways of thinking and biased information processing like we saw earlier. And this leads to the person’s mental processes being impacted heavily.
For instance, the way a person behaves and emotionally reacts to a stimuli is strongly influenced by their cognition. Like their beliefs, thoughts and interpretation. As well as this impacts how a person reacts to an event too.
For example, because I personally don’t find spiders anxiety-provoking, if I see a spider then I don’t interpret this as dangerous, life-threatening and I’m not overwhelmed by the emotion of fear. Yet if an anxious person saw a spider then their cognitive processes would tell them this is a life-threatening situation and they will react completely differently to me because the anxious person has biased cognitive processes.
Furthermore, the cognitive approach believes mental health conditions develop and the mental health difficulties onset because of cognitive factors (obviously) but both functional and dysfunctional beliefs develop earlier on, and these beliefs may not cause difficulties for a long period of time.
And this is something that I personally find very interesting about mental health. A person could have depression, ADHD, autism or another condition and function absolutely perfectly. They can hold down a job, have tons of friends (if they want) and live a perfectly happy life, but it is only when they start to struggle and need help is when clinical psychology is really needed.
And something that I personally love to remind people is that a mental health condition isn’t a death sentence like some people sadly believe it is. Sure a person with a mental health condition might need a little more support, guidance and treatment but given all of those things there is a good chance they could live a very happy and relatively clinically “normal” life.
Nonetheless, if the person does experience a critical incident event, also known as encounters the anxiety-provoking stimuli, then this would be a disturbing event to them, this could activate their negative beliefs and then lead to a distressing emotional response.
What’s The Cognitive-Behavioural Approach?
Building on both the cognitive approaches, to form Cognitive Behavioural Therapy, this approach has to be combined with behavioural approaches. Therefore, whilst the cognitive approach focuses on a person’s cognitions and beliefs and how these might lead to particular behaviours. It is these behaviours that are actually a core factor in maintaining or changing beliefs and emotions. Meaning this can become a very vicious cycle.
In other words, a person’s negative cognition and beliefs cause negative behaviours. Then these behaviours reinforce the cognitions and beliefs and so on. Since it’s the behaviour in a person’s response to a negative experience or cognition that could have a significant effect on whether the emotion persists.
For example, if a person reacts badly to a spider then of course the person will want to avoid spiders to avoid this feeling again. Hence, they develop avoidance behaviours. Like, avoiding the situation and event completely, escaping it or engaging in safety behaviours.
Now personally, I love safety behaviours and I think they are truly fascinating because to be honest they have to be some of the biggest cons in psychology. Due to safety behaviours are fully intended to protect us from threat or prevent harm coming to us. As a result, these safety behaviours might reduce our anxiety in the short term, but they always have the unintended consequence of maintaining anxiety in the longer term.
That’s why I think safety behaviours are very interesting cons that we pull on ourselves because we convince ourselves that we’re helping ourselves to be less anxious, and if we don’t do these behaviours we’re going to basically die. But in reality, they’re making us “worse”, not “better.
Core Treatment Components
When it comes to what CBT actually involves, there are a few flat out critical elements that make up this amazingly effective and fascinating therapy.
Firstly, there is a lot of cognitive restructuring involved. This component involves challenging and modifying a person’s negative thoughts as well as their dysfunctional beliefs. This is typically done by examining the evidence for a person’s beliefs.
For example, we’ll talk a lot more about cognitive intervention in two chapters’ time but an anxious person will believe their safety behaviours save them and without their safety behaviours they will basically die. That is how powerful these behaviours are, so as you’ll see in two chapters a therapist can challenge these beliefs by using experiments and testing whether or not there is evidence to support these beliefs.
Another core feature of CBT is it involves a therapist helping to modify a person’s tendency to indulge in unhelpful thinking processes, this relates to the cognitive biases we spoke about earlier, so the therapist works with the client to modify and reduce these unhelpful mental processes. Like, how a person pays excessive attention to the threat, how they ruminate on the anxiety provoking stimuli and they engage in mental checking.
As well as when it comes to helping a person reduce their unhelpful behaviours, this includes things like reducing their avoidance, safety and checking behaviours. Also CBT involves behavioural experiments (definitely more on that later) and exposure and response prevention (again more on that in a later chapter).
Levels Of Cognition
Of course, we could never ever hope to learn about cognitive approaches and CBT without looking at levels of cognition, and this is absolutely critical when it comes to Cognitive Behavioural Therapy. Since a person’s levels of cognition are as follows:
· Their automatic thoughts
· Their intermediate beliefs, attitudes and rules which are assumptions about the world and the self.
· Their core beliefs. Their basic beliefs about their self, others and the world.
And this idea about levels of cognition is flat out critical in CBT because a therapist has to be very careful when they do cognitive restructuring because you cannot hope to change someone’s core beliefs automatically. That just isn’t how things work but you can start off with challenging and modifying a person’s automatic thoughts then their intermediate beliefs and then their core beliefs.
You need to work “slowly” and gradually for the therapy to work.
An anxiety example of how a therapist might go about finding out what a person’s core belief is, is as follows:
· I’m terrified of spiders (automatic thought)
· I know if a spider gets near me it could attack me (potential intermediate belief)
· If a spider touches me then I know for a fact I’m going to get bitten and I’ll be rushed to hospital (potential core belief)
Now I have to admit that it is far, far easier to come up with potential levels of cognitions with depression for teaching purposes but you get the general idea. A CBT therapist would have to effectively peel back the layers of a person’s cognition to truly understand why they have these biased mental processes.
Thinking Errors/Biases
If you’ve studied depression then you might be familiar with this section of the chapter because there are a lot of commonalities between all types of CBT (at least “first-wave” therapies) and the types of cognitive biases and errors a CBT therapist would encounter.
Therefore, here are the following cognitive errors a therapist is likely to encounter and I have broken them up so you can clearly see the error and an example of what it is like:
· All or nothing- if I can’t love all dogs then I’m scared of all of them.
· Exaggerated standards/expectations- if I can’t pet a dog then I’m a failure (a potential example at least)
· Catastrophising- my life is over because if I go outside I might see a dog and it might kill me.
· Selective attention to the negative/threat- a person is basically always drawn to anxiety provoking stimuli.
· Over-generalising- “I’m scared of my brother’s pet dog so I’m scared of all dogs”
· Dismissing the positive- I might be able to stroke my sister’s dog but I feel worthless and scary around all other dogs. I’m so lame.
· Magnifying/minimising- minimising the positive and magnifying the bad
· Jumping to conclusions
· Emotional reasoning- being irrational and basing your reason on emotion, not fact.
· Personalising
· Internalising/externalising
Again, some of those examples might sound similar to depression and that is to be expected considering there is a comorbidity between depression and anxiety in some people.
Role Of Avoidance And Safety Behaviours
Returning to my topic and building upon what we learnt earlier, a very good definition of a safety behaviour can be found in Salkovskis (1988, 1991):
“A behaviour which is performed in order to prevent or minimise a feared catastrophe”
As well as we know that safety behaviours have several effects on a person’s beliefs. Like they prevent a person from getting disconfirming evidence about their beliefs (this is flat out critical for the information in two chapters’ time), this can increase the sensation a person experiences like their anxiety and fear, and safety behaviours increase their rumination and preoccupation with the anxiety provoking stimuli.
Overall, all these effects on behaviour that safety behaviours cause are linked together to make the person focus on the stimuli they find threatening and this of course isn’t helpful.
Hence, the need for CBT for anxiety disorders which is what we’ll look at in a moment after we understand more about the behavioural approach.
I really hope you enjoyed today’s clinical psychology podcast episode.
If you want to learn more, please check out:
CBT For Anxiety: A Clinical Psychology Introduction To Cognitive Behavioural Therapy For Anxiety Disorders. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it.
Have a great day.
Clinical Psychology Reference
Whiteley, C. (2024) CBT For Anxiety: A Clinical Psychology Introduction To Cognitive Behavioural Therapy For Anxiety Disorders. CGD Publishing. United Kingdom.
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