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What to Expect From Cognitive Behavioural Therapy (CBT)

by Sara C
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With mental health becoming more openly discussed over the past few decades, more and more people are looking into ways to improve their lives and life outlooks through therapy and counselling. Through this, many people have found themselves being recommended CBT, or Cognitive Behavioural Therapy, as a viable means of supporting those struggling with depression and anxiety disorders, among others.


If you have been considering CBT, or are preparing for your first sessions, it can be good to have a solid understanding of what you’ll be doing, and what you have to look forward to when working with a therapist.


What is Cognitive Behavioural Therapy (CBT)?

What if self-defeating thought patterns make you feel like your own worst enemy? In cases like these, Cognitive Behavioral Therapy (CBT) might help you see things more constructively and realistically. A skilled CBT therapist will call your attention to cognitive distortions that can fuel your anxiety and make you feel bad about yourself. Some examples of cognitive distortions are all-or-nothing thinking, catastrophising, and downplaying one’s accomplishments.


Your first session with a therapist trained in CBT will assess whether CBT is the right fit. While there aren’t outright contraindications for CBT, it might not be the most suitable choice for some patients. For instance, there could be better ways to help a patient who is violent, severely depressed, or suffering from extreme delusions – or there could be an option to use CBT together with medication. If you and your therapist decide to go ahead with CBT, there are some differences from other forms of talk therapy. Let’s discuss how CBT might surprise you compared to other therapies.


CBT is goal-oriented

All forms of psychotherapy have goals – for instance, psychoanalysis aims to explore past trauma and unconscious desires, then recondition the brain to help the patient relate to themselves and the world more healthily. While goals in other therapies can seem general and fuzzy, CBT encourages the patient to commit to specific things they would like to achieve as a result of adjusting their patterns of thought and mindset. For example, if the motivation for CBT is to deal with social anxiety, the patient might set a goal of feeling comfortable attending five social events. 


CBT focuses on the present

You might go into therapy with the expectation of spending a long time focussing on childhood traumas and how they shaped you, but this isn’t the primary concern of CBT. Discussion of childhood experiences and how they affect the patient’s behavior and thought patterns in the present is legitimate, and CBT can be used to address trauma. But even then, the focus is on how to manage difficult emotions and triggers in the present. There is a subcategory of CBT called trauma-focused cognitive behavioral therapy, but this still focusses on the present. The discussion centres around the patient’s approach to managing and thinking about trauma. Usually the therapist will not encourage spending a lot of time discussing the past, although “informed CBT” is more flexible on this point. 


CBT is highly structured

The structure of a CBT session varies between therapist and variant of CBT. But rather than a free-form conversation about your life and thoughts, the clearly defined strucutre of a CBT session might almost resemble a meeting you could have at work, except with the task of improving your wellbeing instead of addressing the needs of a business. 


It is typical for each session to have a clearly defined agenda to cover. For example, the agenda for a CBT session might follow the structure of initial mood check, review of any homework tasks from the previous session, a discussion of any anxiety-provoking moments that occurred since the last session and how cognitive distortions may have contributed to that anxiety, the introduction of new suggested strategies for the patient, and a checkout with positive affirmations and acknowledgement of the progress the patient is making.


In a specific session, during the initial mood check the patient might mention that they have been feeling depressed. The therapist might enquire what happened to make the patient feel that. The patient says they have been feeling lonely when they notice other people at the university they attend seem to have more friends. The therapist asks whether the patient completed last week’s homework task to try to strike up a conversation with a classmate. The patient says yes and describes how that went. It becomes apparent the most anxiety-provoking moments occurred when the patient felt their classmate was thinking something negative. The therapist explains that this congitive distortion is called “mind reading.” She sets homework for the following week to note down after conversations instances in which the patient felt they knew someone else was thinking something negative. 


The therapist explains the intention to go over the notes next week and identify instances of mind reading. This will help the patient to find the flaws in the logic with more distance and objectivity. Finally, the therapist commends the patient’s courage for being able to talk to classmates, and mentions the positive outcomes that may arise as they start to pinpoint sources of anxiety when meeting new people.


CBT concentrates on the short-term

Traditional CBT treatment usually requires weekly 30- to 60-minute sessions over 12 to 20 weeks. Sometimes a therapist may decide to work with a patient for a longer term, but the goals that are defined would have estimated due dates, and after that new targets and milestones would be identified. For example, the patient may struggle with depression, anxiety, and making new friends. If the issues are complex, a series of sessions might focus on each of these issues with goals for each week, and overall goals for measuring improvement before moving on to the next issue. 


The focus on the short term is a reason why CBT might not suit every patient or problem, but can also be an important selling point of therapy, for people who are reluctant patients, cannot afford therapy on a longterm basis, or do not like the idea of sitting in a chair for years discussing their feelings and past. The short-term nature of CBT is one of the reasons it is the first choice of treatment for depressive symptoms and disorders in adolescents and children, who may have limited patience and attention span for therapy. When doing therapy for younger patients, there is a trade-off between the child spending time in therapy and missing out on other beneficial extracurricular activities or having to miss time from school, so CBT is often considered a good fit for young people.


Deciding if CBT is for you

If you are still on the fence about whether CBT would help with your specific issue, the nice thing is that it isn’t a longterm commitment. By its nature, the short-term goal-oriented approach should allow you to tell quickly whether improvements are happening. Therefore, you can try CBT and feel comfortable that it won’t be a long arduous process, although like any therapy, the maximum benefits will come to patients who are willing to commit to self-improvement, work hard, and think carefully about advice from the therapist. 

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