In the current therapeutic climate, CBT has become a very popular approach. This is mainly due to the emphasis the NHS placed on ‘results’, whatever that means. The IAPT system (which is the NHS based therapy), is entirely based on CBT. This is not just unfair to other approaches, but reduces the offer available to the public. IAPT, in my opinion, is also guilty of creating an over-simplified version of CBT.
The approach created by Aron Beck, the father of behaviourism, is sophisticated and philosophically grounded. I think the IAPT is giving a very poor representation of what CBT could be.
CBT is a model that helps us make sense of the reality around us. To begin with, we divide reality in:
Thoughts: this is what I think about, in terms of content, as if it was a title, or a sentence. I know we don’t always think sentences, but for the purpose of this model we’re going to pretend we do. So an example would be, when I’m distressed my thoughts are: ‘I’m not good enough’, or ‘I can’t make it’
Physical sensations: This is what happens in my body. For instance when I’m anxious I might feel tight in my chest, my breathing might be shallow, I might feel my heart racing and so on. As well as physical sensations, we want to think about the lack of them. For example when we feel depressed, we tend to feel numb and disconnected to our body.
Emotions: this is about our feelings. I think it’s important to understand that anxiety and stress are not necessarily to be considered feelings; when I’m anxious I might be feeling scared, angry, frustrated, annoyed and so on. Again, we can also consider a lack of emotions, for example in the case of depression: lack of motivation, lack of enjoyment and so on.
Behaviour: this is what I do or I avoid doing because of my mood. For example, if I’m particularly anxious I might avoid crowds, I might bite my nails, I might ask for reassurance to people and so on. All of these examples are things that we do with our body, but other than physical behaviour, we need to consider cognitive-behaviour, this means things that I do with my thoughts. For example there are a lot of unhelpful thinking patterns we can fall into when we’re anxious: catastrophizing, jumping to conclusion, self-critique, worrying, repeating the same thought and so on. Classifying those as a behaviour, I think, it’s very important because it implies it’s something I have a degree of control over. And I do! I think my thoughts, whether I am conscious of it or not. Thoughts don’t just magically appear in my head, although sometimes it can feel like it. I think that, for example, thinking about worrying as an activity, enables me to think that I could potentially do something else with my thoughts. So categorising those unhelpful patterns as behaviours, it’s empowering.
I think this is a bit the point of CBT and the only way to deliver it in a relational way is to think about it as an empowering tool. I want my clients to feel empowered and enabled, so the CBT is a tool I can offer to support them.