Cognitive Behaviour Therapy: How Does it Work?

The techniques described in this book are based on a treatment approach known as Cognitive Behaviour Therapy (or simply Cognitive Therapy) developed by American psychiatrists Aaron Beck and Albert Ellis. The premise is that the way people think about themselves and the world around them contributes to the development and maintenance of intense unpleasant feelings.

Behaviour therapy aims to change your behaviour so your attitudes and moods improve. Cognitive Therapy teaches you how to change your thinking habits using the following process:

Feeling low

How to Get the Best from this Book

This book offers practical suggestions and a step by step guide to a very successful programme for change. A series of exercises and techniques are outlined which are useful tools in the process of gaining understanding and control over your moods. These exercises are an integral part of the Cognitive Therapy approach. To get maximum benefit from the book, you need to do the suggested exercises regularly. It's also important to:

What Causes Our Feelings?

Why would the sight of a baby in a pram cause one woman to become very distressed, another woman to feel completely disinterested and yet another to experience feelings of happiness? The answer lies in the personal meaning that each woman associates with the sight of a baby.

Contrary to what you may assume, it is not simply what happens to you that causes your reactions. It is the meaning you place on your experiences that leads you to feel and react in certain ways. This is demonstrated by two important observations.

Firstly, everyone has unique interpretations of particular events based on their personal experiences. These interpretations will determine their emotional reactions. One woman may look at a baby and think, 'It's impossible for me to have children'; to another woman the sight of a child may hold no special significance, while a third woman may be reminded of happy moments with her own child.

Secondly, the same person may react differently to similar events on different occasions. You may have noticed this yourself. Sometimes you may feel irritable when someone teases you, yet at other times you may laugh with them. Your stream of thoughts or images at the time of the event is what determines how you will react. If the interpretation you make when someone teases you is something like, 'She's putting me down', you are most likely to become annoyed. At another time you may think, 'She's in a playful mood, I'll play along.'

Belief Systems

Your belief system is the collection of beliefs that defines the way you have learnt to view your world, your experiences and yourself. The meaning you place on an event, the significance the event has for you and the imagery it evokes, is determined by that underlying system of beliefs.

Your beliefs and personal values are formed by early childhood experiences. They are your response to your environment at the time. Those beliefs are either confirmed or modified by further experiences you have throughout your life. Together, they form the basis of your personal philosophy towards life and will influence how you react in various situations. A few examples of belief systems are:

'Do unto others as you would have them do unto you.'

'Everyone gets what they deserve.'

'Everything has a purpose.'

Belief systems can be negative, 'Nothing good ever happens to me', or positive, 'The world is basically a good place.' Without you necessarily being aware of it, these beliefs cause you to tune in to certain information or experiences and to screen out others. The person who believes he has little control over what happens is most likely to focus on and recall instances that confirm this belief. On the other hand, the person with the more positive attitude will tune in to positive experiences and tend to dismiss the unpleasant ones. This is how biases in thinking occur.

This process of tuning in to or screening out certain information is called 'filtering' and is demonstrated by the following example.

An empty bus leaves the depot for the day's run. On the first stop, it picks up 10 people . . . next stop it picks up 20 people . . . then it lets off 15 people at the next stop . . . after this 30 people are picked up . . . then it lets off 20 people . . . next it picks up 40. The question is, how many stops did the bus make?

This example shows how a bias may have occurred in your thinking. You probably assumed that one set of information, namely the number of passengers, is more important than the other information received, namely the number of stops. You were also probably unaware of this bias in the way you gave attention or priority to certain facts and disregarded others.

As well as influencing how you select information, your biases also affect the way in which you understand or explain your experiences. Consider the following example:

A little boy was wheeled into the emergency room of a hospital. The surgeon came in to examine the child and exclaimed in surprise, 'Son!' But the surgeon was not the boy's father.

If you assume that all surgeons are male, you would have difficulty solving this puzzle. The surgeon is of course the boy's mother.

Belief systems can cause biases and assumptions to be made as you try to understand your life experiences. You are not necessarily aware when such biases or assumptions are operating. Nor do you need to challenge them, unless they spoil the quality of your life. For example, if a person believes that he is inferior to others, this bias will cause him to dwell only on negative things about himself and filter out any positives, thus confirming his belief. As a result, he thinks his belief is reasonable.

Your everyday thoughts and images give important clues about which of your beliefs cause biases and so affect your behaviour and moods in unhelpful ways. These everyday thoughts and images, known as automatic thoughts, are described later in this chapter.

Helpful beliefs allow for flexibility and changes in your judgements of your experiences and allow for the possibility that both you and/or others might be wrong on occasions. They help you to respect yourself and maintain your self-esteem. Unhelpful beliefs are usually too rigid, not allowing you to adapt to life's circumstances. As Edward de Bono said, 'If you never change your mind, why have one?'

The ABC of Thinking, Feeling and Behaving

Cognitive Therapy is based on two significant principles:

Thus it is not the event itself, but rather how you interpret it at that particular moment, that determines how you feel and respond. Cognitive Therapy is also based on the principle that all our thoughts are habits and as such are acquired ideas about things. Our thoughts do not necessarily represent reality. Nor do they necessarily represent who you are.

This process is illustrated by the following diagram:

A EVENTS (imagined or real)

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C REACTIONS (feelings and behaviour)

Imagine that you are standing up on a bus and someone bumps into you from behind resulting in you plunging into the lap of an unsuspecting passenger. Your immediate reaction may be one of anger provoked by thoughts such as: 'What a fool. He should be more careful. How inconsiderate.' The reality of that moment, as you see it, is that you have been mistreated.

If you then discover that the person who bumped into you is blind, your feelings may alter. The situation is the same, but your perceptions, understanding and interpretations have changed. A different understanding of the person who bumped into you will probably allow you to be more sympathetic and reduce your anger.

Automatic Thoughts or Thinking Habits

The term 'automatic thoughts' refers to the images, daydreams, fantasies and train of thoughts that go through your mind in response to everyday situations. These thoughts appear to arise by reflex, without prior reflection or reasoning. This happens because we generally pay little attention to the way we think and so do not notice when a particular thought or image becomes a habit.

When something becomes a habit, you behave automatically. The advantage in being able to react automatically is that you are able to do routine things more quickly so you have time to think about creative things and to plan what you will do next. The disadvantage is that you have less control over your feelings and behaviours.

The secretary, who automatically said 'of course' to her boss' request to work late, found herself becoming more and more irritated as the afternoon progressed. Her automatic thought that she should do as the boss requested conflicted with her wish to watch a favourite show on television. Her annoyance set off a further stream of automatic thoughts along these lines: 'He's just using me. He didn't even ask if I had anything planned for tonight. He's taking advantage of my good nature.' By the time she arrived home, she was in such a bad mood, she was unable to enjoy the remainder of the show.

Because automatic thoughts occur spontaneously and naturally, you may not realise that they are simply your interpretations and not facts. Automatic thoughts seem more believable because they are so familiar. When you repeat something to yourself, you are reinforcing a pathway (or circuit) in your brain and so the more likely it is that you will believe it. In this way you can come to believe things that are not true. Automatic thoughts are like a well worn, comfortable pair of shoes which are secure and familiar in the way they slip on. Because of this familiarity, new ways of interpreting events will often seem untrue. New thoughts, like new shoes, need to be worn in if they are to feel like yours.

You may forget that other people view things differently. For instance, you may feel quite offended or hurt if friends forget your birthday, not realising that they don't fuss over anyone's birthday – not even their own. You can't assume that other people automatically understand how and why you feel the way you do.

Points to remember

Simply by paying attention, you can become more aware of your automatic thoughts.

When Do Automatic Thoughts Become a Problem?

Thinking habits only become a problem if you find yourself frequently feeling down or easily upset and your feelings are interfering with your ability to effectively handle everyday and major stresses.

Automatic thoughts become a problem if they prevent you from learning or trying alternative ways of coping with stress. The person who thinks it's no use, 'I'll never get them to accept my idea', or, 'I can't do anything about this', blocks herself from exploring alternatives.

If you tell yourself often enough that you cannot cope, then you will end up believing it and so stop yourself from learning new ways of coping.