Cognitive-Behavioural Therapy (CBT) is especially useful in
assisting people with specific phobias and depression, as well as
anger management. The basic idea of CBT is that a person’s feelings
are a result of the way they think about events, rather than the
events themselves. This means that two people can have very
different responses to the same event. The goal of CBT, therefore,
is to identify thoughts that are making life difficult for people,
and then help people to challenge or change these thoughts to make
them more realistic. This reduces the negative feelings that a
person might be experiencing.
CBT can best be described using an example. A common situation
which makes people anxious is the prospect of speaking in public.
When a person has to speak in public, they typically think about
what will happen if things ‘go wrong.’ That is, what will happen if
they forget what to say, or say the wrong thing, or in some other
way ‘mess up’ the presentation. Usually, they will be very worried
about what people will think of them if they make a mistake.
Typically, they will assume that people will laugh at them, or
think bad things about them. CBT might invite the person to imagine
themselves in the audience when a speaker makes a mistake. “How
would you react? Would you laugh at the speaker, or think bad
things about them? You probably would not, so perhaps you should
not assume that other people will treat you that way…”
The aim is to assist people to develop more realistic thoughts
about events. Accordingly, CBT should only be used when people’s
difficulties are being caused by their thinking. CBT can at times
be misapplied. It can leave people with the impression that their
thoughts are causing a problem when in fact they are not. I
remember one teenage girl who was being bullied by schoolmates and
was therefore becoming anxious about catching a train with them in
the morning. She had seen a therapist who specialised in CBT
(meaning that the therapist used CBT in all situations), and the
therapist had tried to show the girl that she was being
unnecessarily anxious about being teased. The therapist tried to
encourage the girl to think differently about being bullied.
However, it was clear that what the girl thought – ‘if I go on the
train, the other girls will tease me’ – was actually quite correct.
What she actually needed was someone to say ‘your anxiety is doing
a good job of protecting you. Is there another way you could get to
school?’ As it turned out, she decided to get up a little earlier
and catch an earlier train. This was a very simple solution and the
anxiety greatly reduced.
Of course, this was still a form of CBT. We still changed the
way the girl thought. But the thought that we changed was that the
girl had to catch the same train as the other kids, not that the
teasing was unpleasant.