What is Cognitive Behavioural Therapy?

Cognitive Behavioural Therapy (CBT) is an evidence-based form of therapy that aims to deal with emotional, behavioural and cognitive problems with a goal-oriented and systematic approach. CBT is based on the idea that the behavioural and cognitive patterns that cause psychological problems are learnt. The therapy aims to use practical interventions and techniques, such as thought challenging or behavioural activation, in order to change these problematic patterns. In doing so, it encourages clients to play an active role in their own treatment, which is often a very empowering part of the process.

What is the so-called “Third Wave” of CBT?

Cognitive Behavioural Therapy started as Behavioural Therapy at the beginning of the 20th century. Dr Beck and Dr Ellis’s groundbreaking contributions to the field of psychotherapy from the 1950s onwards placed an increasing importance on the role of cognitions or thoughts when it comes to treating mental health issues. Since the 1990s the most modern and innovative developments in Cognitive Behavioural Therapy are grouped together as the “third wave” of CBT. The “Third Wave” approaches are characterised by including new concepts and themes such as mindfulness, cognitive defusion, acceptance of uncomfortable feelings and thoughts, unmet emotional needs, emotional regulation and the importance of the therapeutic relationship that allows the client to experience a satisfying new emotional experience. The treatment effectiveness of the “Third Wave” approaches has been empirically supported in numerous studies since the 1990s.

Out of the heterogeneous group of “Third Wave” treatments, I use techniques and elements of the following therapeutic approaches in particular:

Acceptance and Commitment Therapy (ACT)

ACT includes educating the client about the key mechanisms of their psychological make-up, mindfulness exercises and teaching clients to change their relationship with their thoughts, rather than the content of their thoughts. The client is encouraged to consider what has value to them in their lives and to behave in accordance with these values, rather than avoiding emotions and experiences.

Dialectical Behavioural Therapy (DBT)

DBT was originally developed for the treatment of Borderline Personality Disorder (BPD). It teaches a broad spectrum of skills in the areas of mindfulness, distress tolerance, regulation of emotions and interpersonal effectiveness and places a high importance on the relationship between therapist and client.

Mindfulness-based Cognitive Therapy (MBCT)

MBCT was specifically developed to reduce the number of relapses in clients with severe depression. It educates clients about their psychological make-up and encourages the clients to practice mindfulness meditation. A core goal is to develop metacognitive awareness, which is the ability to experience cognitions and emotions as mental events that pass through the mind and may or may not be related to external reality. The focus is not to change “dysfunctional” thoughts, as is done traditionally in CBT, but to learn to experience them as internal events separated from the self. In other words, the aim is to change the relationship with our thoughts rather than the content of our thoughts.

Schema Therapy

Schema Therapy is an integrative and innovative form of therapy that addresses long-lasting problems such as relationships issues, chronic depression, anxiety and personality issues. It is an empirically supported treatment pioneered by Dr Jeffrey Young.

Schema Therapy integrates Cognitive Behavioural Therapy (CBT), object relations, attachment theory and experiential techniques into a unified whole. It focuses on the identification and treatment of schemas, seen as the “root” of presenting issues, such as anxiety or depression, and which are experienced as stable and enduring patterns in one’s life, comprising of memories, bodily sensations, emotions and thoughts.

Schemas typically develop in childhood or adolescence when core emotional needs are not being met in our upbringing. Once developed, schemas are perpetuated behaviourally through the coping styles of avoidance, surrender or overcompensation.

The treatment focuses on helping the patient to break these negative patterns of thinking, feeling and behaving and to develop healthier alternatives to replace them with.

Is Schema Therapy right for you?

Dr Jeffrey Young, who worked as a CBT therapist closely with Dr Aaron Beck, developed Schema Therapy as a therapy approach for those patients who did not respond to more “standard” CBT techniques. These patients usually had long-standing patterns or recurring themes in their thinking, feeling and behaviour that required different therapeutic interventions. In comparison to more traditional CBT techniques, Schema Therapy has a stronger focus on the patient’s emotions and their unmet emotional needs. It also places a significantly higher importance on the relationship between therapist and patient than in a traditional CBT setting.

What is Self-Compassion?

Self-compassion means applying compassion to one’s self when we feel insecure, inadequate or suffer from any other uncomfortable emotion, instead of judging ourselves harshly for feeling them in the first place.

Professor Paul Gilbert from the University of Derby has researched and pioneered the use of self-compassion as a therapeutic tool in Great Britain. He developed Compassion Focused Therapy (CFT) specifically for helping individuals with high levels of shame and internal self-criticism. One of its core interventions is to help people move away from social ranking that focuses attention and thoughts on the (potentially harmful) power of others, and instead teaches us how to use cooperative caring processes in relation to ourselves and others.

Dr Kristin Neff and Dr Christopher Germer are the leading researchers and experts on self-compassion in North America. Their research points out that there are costs associated with the pursuit of high self-esteem, such as narcissism, isolation and contingent self-worth. Dr Neff has defined self-compassion as being composed of three main components – self-kindness, common humanity (“All human beings suffer from time to time. You are not alone in this”) and mindfulness.

What problems can be addressed in psychotherapy?

Therapy can help you deal with any emotional problem that you feel is hard to deal with alone. This could be a phobia that stops you enjoying life to the full, such as a fear of flying, eating in public or insects, or a chronic, long-term recurrent depression, personality disorder or eating disorder. It could even be an emotional response to a normal life trauma, such as the breakdown of a relationship or bereavement that is stopping you from leading the life you want to lead. There is no definitive list, but if your problem is affecting your quality of life, it might be helpful to seek some professional help.

It is important to stress that emotional problems and mental health disorders are far more common than most people think. Studies suggest that 1 in 3 people will suffer from a mental health problem in any given year. If you are thinking about beginning therapy, you are in very good company.

In the United Kingdom, the National Institute for Health and Clinical Excellence (NICE) recommends CBT as the treatment of choice for a number of mental health difficulties, including post-traumatic stress disorder, obsessive compulsive disorder (OCD), bulimia nervosa and clinical depression.

I feel ashamed about starting psychotherapy – is that common?

Many people find it difficult to ask for help in any area of their lives. They often feel that they are admitting that they cannot deal with a problem that they feel they “should” be able to deal with on their own. Some people find this embarrassing or feel that they are “weak”. I have noticed over the years that although this affects a lot of women, it is especially notable in male clients. By starting therapy you are making an active decision to improve a currently problematic aspect of your life and that is always a positive step.

How many sessions do I need?

The amount of sessions you may need varies greatly and depends on your particular issue, on you as a client and on what you want to get out of therapy. Treatment for a phobia of spiders, for instance, is likely to be much shorter than treatment for long-standing issues like clinical depression or suffering from a personality issues. It is important to note that every case is different and that there is no instant cure, but also that you will be actively involved in deciding how long your treatment should last. I think it is also important to mention that doing psychotherapy is not like going to your GP and getting some medication prescribed that offers you instant relief. The way to change and progress is often slow and not linear.

How often do I need to come?

Your psychological treatment will be tailored to your individual needs. However, I normally recommend that clients attend one 50-minute session a week. Towards the end of your treatment, after your condition has significantly improved, I would expect to move these sessions to once every fortnight or once a month. After the treatment we might also decide to have one or more follow up sessions, after six-months or so, to check on your progress and make sure that you have maintained your progress.

Are the sessions confidential?

Sessions are completely confidential. In line with all professional and ethical guidelines, your name and the content of your sessions will not be shared with anyone without your explicit agreement. If you had given your consent, I would discuss your treatment with your GP or your consultant psychiatrist from time to time to ensure that your psychological and medical treatment are well coordinated.

Will I be given medication?

As a Cognitive Behavioural Psychotherapist I do not prescribe medication, though often psychological therapy will be part of a complete treatment that may include medication prescribed by your consultant psychiatrist or your GP. If you feel that medication should play a role in your treatment, you will need to discuss this with your GP.