How CBT Can Change How You Think, Act and Feel.

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Using CBT to Think, Act and Feel Differently.

Cognitive Behavioural Therapies are the most researched of all the talking therapies. The term has come to encompass various approaches which work primarily with thoughts (cognitions), behaviours or both. These approaches have a good evidence base to support their use in the treatment of anxiety and depression and are approved by NICE. (The National Institute for Clinical Evidence)
This sort of approach has a number of advantages. Firstly it tends to be bring about change quickly thus courses of treatment tend to be shorter than is the case with many other approaches. Secondly, because this sort of approach is very structured, the techniques are capable of being standardised. This is helpful in a service where care is provided by a number of different providers. Another advantage is that you the client can learn to utilise the techniques on your own. This means that once you address one problem using these techniques it is likely that you will be able to go on to use the same approach in addressing other issues. In other words it teaches you how to be more psychologically resilient, to be, if you like your own therapist.
The cognitive element of CBT is about looking at thought processes and identifying and challenging thought patterns which are illogical, irrational or unhelpful. Once these have been identified and challenged they are replaced with with versions which are perhaps more balanced, true and most importantly helpful to you. Recognising this faulty thinking is called cognitive insight but it is only the beginning of change. The real challenge is to start to feel differently. This is sometimes described as knowing with our heart rather than our head. The behavioural part of CBT is about this shift. It is often only as we start to behave inline with our healthier thoughts and beliefs that we start to feel differently.
CBT is not a panacea though and it has also been criticised. A client has recently told me that CBT to her seemed only to be about changing behaviour and not emotion. Certainly there is a emphasis in this approach to looking at behaviour and thoughts. This can leave some clients feeling that this approach allows them little opportunity to explore their emotions.
Whilst changes in emotional state often follow from changes in behaviour and thinking sometimes clients find that ‘acting differently’ doesn’t translate into ‘feeling differently’. It is as if a part of them isn’t fooled and hasn’t changed. Though we might know in our head what would we should think or do our emotion be it anxiety, panic or depression is just too overwhelming for us to think or act differently. This is when other approaches such as hypnosis can be very helpful when used with CBT and I will explore this in future blog.

The Road to Hell is Paved with Good Intentions – Positive Intentions Behind Negative Behaviours

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When working with unhelpful or unwanted behaviours it can be helpful to consider the original purpose or intention that the behaviour evolved to serve. One of the presuppositions of neuro linguistic programming (NLP) is that every behaviour has some positive intention behind it, or in other words it has at least at sometime served a positive purpose. NLP is of course a theory and this is a supposition not a proven fact. It does seem sensible, however, to assume that as human beings we seek to behave in ways that meet our needs, that is we do not deliberately self sabotage ourselves.

Accepting that we originally derived our behaviour in order to meet a need does not mean that we have to like or accept the behaviour. Indeed it may now be unhelpful or destructive to ourselves or others. Nevertheless, if we can identify and accept the positive intention that was behind it, this can help us to find more compassionate approach to change and one that results in changes that are more likely to be maintainable.

For example a person may overeat in order to meet the need for self-soothing, the need to ally boredom, or the need to be distracted from difficult thoughts or feelings. Recognising these needs allows us to consider whether they are any longer being served by the behaviour. It is much more likely that change can be sustained if alternative ways of meeting these needs can be found. When a behaviour, though unhelpful is continuing to meet a need this is also termed a ‘secondary gain’. For example secondary gains from anger might be feeling energised, feeling in control, or being able to maintain an emotional distance from others.

Secondary gains are often about getting more of something (e.g. power or attention) or about avoiding something we don’t like facing (e.g. difficult emotions, doing something that we are not confident about.)

Whilst we can sometimes recognise the positive intention of our behaviour at other times we may not be consciously aware of this. This is often the case when behaviours began in childhood. Children generally have less choice than adults when it comes to making meaning of their experience and meeting their emotional needs. For example the child who growing up in an unpredictable environment might meet their need to feel safe by striving to always behave perfectly or avoiding attention. This may result in the persistence of unwanted perfectionist or avoidant behaviour in later life.

As we grow our awareness of the world develops allowing for new meanings and choices to be made. Sometimes a part of us get stuck unable to move on this way. The therapeutic space is one in which we can start to recognise this and create for ourselves new meanings choices and behaviour.