ABC of CBT
Despite the ongoing publicity and debate around CBT as a treatment of choice for depression, anxiety and other mental health issues, it is not a new fad, or latest trend in counselling and therapy. It is an established and evidence based set of therapeutic practises, that has integrated ideas and theories from Behaviourism, whose focus is primarily how behaviour is influenced by external surroundings and stimulus, more Behaviour & Activity charts these days than the controversial experiments of the early days (ie Millgram and the electric shock experiments on participants who got quiz answers wrong ). And Cognitive Therapy, which focuses on internal thought processes as having the major influence on our moods and behaviour.
Cognitive Therapy, was introduced by Dr Aaron Beck in the 70’s who challenged the prevailing idea that your emotional response was a direct result of something that happened to you. He believed that it is possible for you to have control over your responses to events in your life, and that if you changed the thoughts, then your feelings and behaviour could also change.
Situation —————————————————Emotion (common sense model)
Situation————-Cognition—————————Emotion (cognitive model)
And this isn’t a new thought. The ancient Greek Stoic philosopher Epictetus said “Men are disturbed not by things, but by the principles and notions which they form concerning things.”
Apart from the fact that I know that it works, on a professional and personal level, I am interested in CBTs focus on the here and now, looking at what is going on today and what you can do to could control it, rather than focusing on past events and their influence. That doesn’t mean that you don’t look at the past, of course you do, but only when it is helpful and relevant to seeing things differently today. CBT also has a positive view of mental health, viewing it as a continuum that we can all go up and down, with psychological problems such as depression and anxiety at one end of the scale and feeling okay on the other end, they are not viewed as if they are on a different dimension, so that you are not odd or strange when you are anxious, stressed or depressed. Just human.
So how does CBT work? One of the first tools I tend to introduce people to is The ABC model. This helps you examine when you get upset and help you look at as a learning experience, so that you can lessen the upset in the future. You are encouraged to write the problem, situation or activating event that has upset you, and to look at your beliefs and thoughts around this. What is it you are telling yourself about this situation? And to help you to look at the impact the thoughts are having? What feelings and behaviours are around ? By being more aware of the thought patterns that habitually arise, and recognising the impact that they are having on you means that you can start to challenge the thoughts and therefore change behaviour.
Activating event = This could be any situation, no matter how small or how major, from not getting the job that you applied for, being involved in an accident, having your bag/suitcase/wallet stolen, receiving an email which annoys you, being stuck in traffic and are going to be late for an interview or other important meeting….to your partner telling you that they have had enough of your bad moods/ untidiness….your manager telling you that you need to work the weekend….the list is endless.
Your Beliefs = What are your immediate thoughts surrounding this? How dare they not employ me, I’m no good. I’ll never get a job. What’s the point in applying? Why me? This should not have happened to me. That’s not fair. There are too many idiots on the road. I never want to drive again. How dare he? He always does that to me, He is an idiot. Am I just always wasting my time here? How could he/she do that to me? How dare he say that to me. Who does he think he is. He is always saying these kind of things. After all these years…I will never meet anyone again, I am useless, I will be alone and lonely … and so on….
Consequences = What is it you do as a result of these thoughts? You can look at this in two ways, how you feel about this, and what kind of emotional responses there are – and how you behave as a result. It might be that you feel that your confidence has been reduced, you feel angry and irritable. So, your behavioural response might be to get annoyed, more irritable, grumpy and get annoyed with people around you more. You might get into more arguments, leading you to avoid people more. Or your mood may become lower, more depressed, and your behaviour might be that you don’t want to go out, you ignore calls, you stay at home watching tv. And noticing the impact on you physically? what is this doing to your body? Are you having more headaches than normal, an acid stomach, tension in your neck or back, tired aching muscles, more colds than normal?.
Once you have stopped and had a think about what the chain of events is in response to a situation, the next step is to recognise the links between these thoughts, feelings and behaviour. For many of us, it can be a bit of a light bulb moment when you are able to see the connection. And that you are responsible for these thoughts and the ensuing mood/ behaviours that follow. No matter how annoying your boss, your partner, your mother is its you that has to own the responses. You can’t blame anyone else, No matter how hard you want to. You can also start to see patterns in your thoughts and behaviours. And this is where the important work of therapy begins, to help support you in recognising and changing these patterns.
One method of challenging your thoughts is based on the ideas of Socrates, another ancient Greek philosopher. He encouraged his students to think for themselves. He insisted that the students question everything. That they make use of their own minds, form their own opinions, and make connections for themselves. His approach was by using questions to help students reach a conclusion without directly instructing them. In much the same way as a CBT therapist would work with you to help you reach your own conclusions.
Examples of Socratic questions might be.
- ‘What evidence supports this idea? And what evidence is against its being true?’
- ‘What might be another explanation or viewpoint of the situation? Why else did it happen?’
- ‘What are worst, best, bearable and most realistic outcomes?’
- ‘What’s the effect of thinking or believing this? What could be the effect of thinking differently and no longer holding onto this belief
- ‘Imagine a specific friend/family member in the same situation or if they viewed the situation this way, what would I tell them?
What this exercise encourages you to do is to start ‘Thinking about your thinking’
Socrates also said ‘A life unexamined is a worth not living’ which is still relevant to CBT today. In the next session, I will focus on the B – beliefs ; and look at typical negative thoughts, that people may have and how you can recognise them in your own thinking.