Cognitive Behavioural Therapy

CBT sessions begin with building a therapeutic alliance between the therapist and the client, essential to improving the overall treatment outcomes. Building rapport promotes connection between them and establishes trust and healthy collaboration in working towards the desired goals. These can be achieved by creating a safe environment, accepting or welcoming, showing respect for their differences, allowing clients to say whatever they feel and validating them, and being honest and transparent. 

CBT involves a rigorous assessment process crucial in identifying the client’s problems, setting treatment goals or desired outcomes, and tracking progress. A CBT therapist might ask about some details, such as what complaint brings the client into therapy, its severity, how and when it started, how it affects daily functioning, exploring what factors may have triggered or contributed to the distress, any medications taken, and past histories of CBT and other therapies. Furthermore, the assessment also allows the client to recognise how certain interpretations of a situation affect their feelings and actions.

One of the most essential parts of CBT is setting specific goals to be achieved throughout the therapeutic journey. This begins with developing a concrete understanding of what the client wants to change, for example, ‘to feel less anxious and improve mood.’ Thereafter, the therapist might ask what this goal means. And how will you know if you have met this goal? What actions are to be taken to achieve the goal? Once these questions are answered, the therapist and client work collaboratively to identify general and specific goals and ways to accomplish them.

Psychoeducation is a CBT strategy that aims to educate clients about the nature of their condition, its symptoms, how it disrupts their lives, and the treatment options available. It also discusses the rationale of the treatment, the principles of CBT, and how it works in treating a mental health condition. Understanding how the therapeutic process works is associated with high success and recovery rates. 

The cognitive therapy element in CBT focuses on cognitive restructuring. This involves identifying and challenging faulty thought patterns so the client can modify, replace, and change them with healthier thoughts. Some of the most commonly identified distortions are:

Personalisation: When you feel personally responsible for things you cannot control

Catastrophising: Thinking about the worst-case scenario

All-or-Nothing Thinking: Seeing things in absolute terms, such as good or bad, success or failure

Overgeneralisation: Making a broad assumption based on limited or no evidence at all

Should Thinking: Having rules or expectations about how things or people should be

Similar to the cognitive aspect of CBT, its behaviour therapy element works on identifying problematic behaviours and modifying them to promote healthy coping methods.

One of the most commonly used techniques is behavioural activation, which encourages clients to engage in activities that they feel are rewarding or pleasurable. This includes activity scheduling, monitoring, and graded task assignments that help clients break the cycle of negative thinking and promote motivation. 

In addition, CBT therapists employ exposure therapy, which involves the gradual confrontation of a fearful object or situation, to treat fear and anxiety-related disorders. Relaxation strategies such as deep breathing, progressive muscle relaxation, grounding techniques, and visualisation are also taught. 

One of the characteristics that sets CBT apart from other psychotherapies is its ability to objectively evaluate the client’s treatment progress and improvement. The specific goals to be achieved throughout the therapeutic process are regularly assessed to identify what works and what does not. Based on this evaluation, the therapist and client can work together to adjust some strategies to align with the target goals. 

Aside from activities and tasks done during therapy sessions, some homework may be assigned to help the therapist review progress and provide more insight into the client. Homework can be used to educate, identify faulty thoughts, and determine usual coping mechanisms. Some of the most commonly assigned homework includes journalling or thought recording, behavioural experiments, behavioural activation activities, and bibliotherapy.