Knowing where (or how) to start to support our mental and emotional wellbeing can be difficult. There are substantial resources available online, extensive self-help books, practices to learn and therapists to try, to name only a few initial steps. In fact, there is such a vast array of ways to help improve and promote our mental wellbeing, it is not surprising that these options can seem confusing and overwhelming. Moreover, it is crucial to remember that mental health naturally fluctuates and to consider that every individual is unique; our different emotional experiences vary, relative and subjective to us alone. Finding what support or treatment works for you may be a process of trial and error but the important thing, is to try to acknowledge your emotions and associated behaviours, in order to take your first steps to change. 

This article aims to outline and discuss one therapeutic treatment type: Cognitive Behavioural Therapy. I hope it sheds some clarity on whether this type of therapy might be able to help you or a loved one.

 Cognitive Behavioural Therapy – What is it and does it work?

Due to recent awareness of psychological well-being, and a rise in diagnoses for mental health disorders, modern research continually aims to assess the best treatment methods for sufferers today. Cognitive Behavioural Therapy (CBT) is a form of person-centred psychotherapy used to help treat mental health disorders that meet the criteria of the DSM-V (the diagnostic manual for disorders). It focuses on a problem in the present and is orientated to finding solutions by exploring both a patient’s past and current experiences. In practice, CBT “explores the links between thoughts, emotions and behaviour,” working to actively change negative thought and behaviour patterns to improve one’s emotional health. It aims to deliver 12-16 sessions on average which is not only time-limiting but cost effective for organisations such as the NHS. Whilst CBT alone has been found to be effective for treating less severe forms of cognitive disorders, it is often recommended in combination with medication for treating other conditions such as psychosis.

History

Beck developed CBT; recognising that human emotion and behaviour is influenced by psychological perception. In 1964, he outlined “three levels of cognition.” These levels being: ‘core beliefs’ often founded in early childhood relating to self, the world and others; ‘dysfunctional assumptions’ being maladaptive rules for living, and ‘negative automatic thoughts’ or NATS. These three cognitive levels are explored during CBT in relation to the ‘here and now’, whilst considering a patient’s previous and early experiences, in order to change negative psychological patterns and improve emotions.

The Collaborative Relationship

Indeed, this active change is nurtured by a collaborative partnership between both therapist and client, in an effort to break a negative cognitive cycle. This collaborative process is effective in helping patients through psychological problems as it allows assisted testing of maladaptive cognitions or assumptions, revision of behaviours, whilst evaluating rationale and utilising agreed SMART goals. These goals are “specific, measurable, achievable, realistic and time-limited”. Thus, it is these collaborative techniques used by both therapist and client that allow a structured and directive approach to changing the client’s poor cognition. Whilst CBT can be delivered via many means, face-to-face is most common in primary care settings. Mostly, patients engage more with the face-to-face therapy due to stronger communication, with therapists recognising higher compliance and understanding of CBT from this delivery. Equally, this practice allows both parties to be receptors of physical body language and facial expression, both enhancing the relationship and increasing effective practice. Fortunately however, online self-help is also effective in treatment, and is potentially both more accessible and more affordable. 

For Panic Disorder

Using some of these methods, panic disorder for example, may be treated using CBT. Panic disorder constitutes anxiety with panic attacks (DSM-V, 2013). Panic attacks occur within a cycle: a trigger, increased bodily sensations, poor perception of those sensations (threat or catastrophizing), followed by a respondent panic attack.  Recent research has revised the most effective methods of CBT treatment for panic disorder and anxiety across all ages. A 2002 study concluded that there are five components to CBT for ‘anxiety disorders’ when treating children and adolescents specifically. These are, “psychoeducation, somatic skills training, cognitive restructuring, exposure methods and relapse prevention plans”. 

Tools and Techniques

In a collaborative sense, psychoeducation, exposure and planning are of great value in CBT treatment. It is important for a therapist to educate a patient about their psychological thought patterns, resultant feelings, and behaviours. Upon understanding the cyclical process of negative cognition, the patient may then be able to assess, neutralise and overcome their symptoms, using learnt CBT techniques. Similarly, exposure techniques have been largely regarded as a proactive method to conquering fear symptoms related to panic attacks. However, this is not common practice for CBT therapists working with children and adolescents due to concerns that it may be too taxing on patient resilience. This is less evidential in adult exposure CBT treatment, and systematic desensitisation may be a gentler exposure technique, shown to reduce fear and anxiety.

Usually, CBT methods and session quantity are predicted by symptom severity and outcome, after therapist case formulation in primary care settings. Still, case formulation by a therapist must be validated, with prevention planning and thought diaries to check case accuracy with the self-reporting patient. This “homework” setting method allows for the unlearning of unwanted cognitive responses. A form of reflection, revision and improvement of emotion, all by the patient’s own tools with therapist support.

For Eating Disorders

Similarly, eating disorders are another maladaptive cognition that may be treated using CBT. “Bulimia nervosa, anorexia nervosa and eating disorders NOS (not otherwise specified) share a core psychopathology: the over-evaluation of the importance of shape, weight, and control”. These factors determine patients’ self-worth and maladaptive, unhealthy behaviours may follow in excess; extreme exercise, excessive use of diuretics/laxatives, and predominantly, food restriction. With this, comorbid cognitive disorders may develop; mood disorders, depression or anxiety, prominently comorbid in bulimia. The National Institute for Health and Care Excellence (NICE) provided recent evidence-based guidelines for treatment of eating disorders, CBT-enhanced version (CBT-E) appearing to be the most effective treatment for bulimia nervosa specifically. It is equally supportive of anorexia nervosa and NOS eating disorders, with 49-60% of outpatients obtaining good outcomes, and relapse rates appearing to be low. Interpersonal psychotherapy (IPT) is a leading alternative treatment for adults with eating disorders. A 2015 study showed that at post-treatment stage, 65.5% of CBT-E participants met criteria for remission, compared with 33.3% of IPT participants. Whilst IPT may be effective treatment, it is less pronounced, with CBT-E currently the most prevalent and successful evidence-based treatment for eating disorders. Therefore, a transdiagnostic CBT-E approach towards all eating disorders has been developed to improve all related psychopathological symptoms between the above three types.

Conclusively, evidence-based CBT treatment for cognitive disorders is effective in reducing negative symptoms. Currently, it is the most prevalent psychotherapeutic treatment. It may also provide psycho-education for individuals to correct their thoughts and behaviours that may cause negative emotions, poorer cognitive health, and reduced overall quality of life. CBT has the ability to equip people with tools for improved mental wellbeing and it is therefore important in early intervention strategies in primary care settings. Improved cognitive well-being results in improved human functioning and greater quality of life. It is for this reason that CBT continues to be the most prevalent, evidence-based therapy, today.

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