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What is Cognitive Behavioural Therapy?
In the United States in the late 1960s, two American psychologists, Aaron Beck and Albert Ellis, developed a form of therapy that we know today as CBT, or Cognitive Behavioural Therapy, one of the most influential and compelling of all mainstream therapeutic methods. CBT was from the first designed to help clients suffering from three especially pervasive and stubborn mental complaints: anxiety, depression and obsessive thoughts.
Beck and Ellis insisted that patients tormented by this painful trinity were not to be termed ‘ill’ in any blanket or indiscriminate way. They were to be thought of as first and foremost beset by distinctive varieties of flawed or erroneous thinking — what Beck and Ellis now termed ‘cognitive distortions’ — and that if only these twisted patterns of thoughts could be robustly identified, pointed out to clients in therapy and then made into objects of study, then they might loosen their hold on sufferers’ minds and herald a significant shift in mood and sense of possibility. The anxious, depressed or obsessive were not ‘mad’ or inherently damaged, argued Beck and Ellis, they were — once one listened closely to what they were saying — simply in the grip of certain eminently classifiable and alterable errors of reasoning.
In order to facilitate their treatment, Beck and Ellis drew up a list of Cognitive Distortions which to this day underpins the work of CBT therapists and is typically given to clients at the start of their first session. Among these distortions, we find the following:
The central problem of those dominated by catastrophic thinking is that they have very little idea that they are remotely responsible for thinking in such a way. They remain wholly convinced that they are analysing their particular situation with impeccable and immutable logic, even as they ruthlessly mangle the facts, blur the evidence, jump from one shaky premise to another and concoct conclusions from a medley of fantasies and ogre-filled nightmares. Confident of the solidity of their minds, they have no chance whatsoever to be on guard against their own deductions.
In the circumstances, the first task of the CBT therapist is to make catastrophists aware that they might be such a thing, it is to render them suspicious of their deductive logic in the name of one day helping them to approach their situation with greater solidity and wisdom. Part of healing involves teaching them to become increasingly distrustful of how they are reaching their ideas. Is it really true, a CBT therapist might probe, that one unkind joke means that everyone hates them, or that a single critical voice has to mean the end of every single professional hopes? The CBT therapist can concede that not everything might have gone perfectly but does this have to mean that total and wholesale disaster are also inevitable and imminent? With gentleness and compassion, the sufferer is nudged to perceive how much they might be catapulting themselves into despairing analyses which are scarcely warranted by the evidence on the ground.
2. Favouring Emotions over Facts
One of CBT’s favourite mantras is that ‘emotions are not facts’, a way of drawing attention to sufferers’ tendencies to insist on interpretations of events that owe little to what has actually happened and everything to the internal voices and presumptions which are being overlaid across reality. It might seem as if an email was saying a particular ominous thing, but was that actually and truly what was said? One might feel as if an ex partner was unbearably angry but did they really express any rage? To what extent is one filling in blanks? On what basis is one coming to a particular verdict? Once again, the CBT therapist attempts to prime a sufferer to be more sceptical in the face of their minds’ rock solid and harrowing suppositions.
3. Discounting the Positive
As CBT therapists know, what tends to underpin anxiety, depression and obsession are vicious forms of self-hatred. The sufferer expects the worst because they feel themselves to be the worst. Therefore, one of the early tasks of therapy is to keep pointing out how much effort the sufferer is surreptitiously expending on filtering out all positive news about themselves in order to cling with manic fervour to the darkness. If everyone hates us as much as we insist, CBT asks, why then have we been asked out to dinner a number of times of late? If we’re a complete failure, how come we enjoy rather a lot of respect at work? If everything is terrible, why does someone nevertheless love us?
4. Mental Filtering
CBT therapists will speak of a mental filter that is placed across our minds and doesn’t let in any grain of news that might point towards kindness, hope, calm or worthiness. As ever, the task is to alert the sufferer to the existence of such a filter, so that it’s unfairness may become easier to spot and protest against. We aren’t necessarily horrific or doomed; what is sure is that there is an extremely unforgiving piece of material covering up the access point between us and the world at large. Apparently every story in the news is ushering in a given viewpoint, but how representative is our access to news? Who and what are we reading? What have we — in the interests of self-torture — chosen not to listen to?
5. Magnification and Minimization
Two other related terms that CBT wishes to attune us to are magnification and minimization. As sufferers, we magnify whatever is difficult and worrying and minimise whatever is kind and good — all without, of course, the slightest awareness that we might be doing so. We continue to insist that our minds can be relied upon, even as they gravely skew and muddle the rich and diverse data that comes their way.
Challenging how we are thinking is at the heart of CBT therapy. A therapist will typically probe at our foremost convictions, laying them out for us to see in a way that we might energetically have avoided doing hitherto. For example, that: I have done something very bad for which I can never be forgiven. Or that: Absolutely no one can be trusted. Or that: I am cosmically hateful and eternally alone. And then the therapist might encourage us to ask — with tact and loving scepticism — but is any of this actually true?
Unusually, CBT is keen on giving participants homework to complete between sessions. Typically, a CBT therapist might ask their client to keep a log of all their most panicky, despairing thoughts — and then every few hours, to submit each one of them to patient reason so as to disarm their customary injustice: Has one actually harmed any one? Has one really offended a friend? What did that person really say? And so on, until the mind slowly learns to disentangle its coils of nastiness and nets of self-loathing. Some of the homework can involve deliberately exposing oneself to situations which one has falsely concluded must go a certain way — in order to test one’s own premises. The person convinced that everyone will hate them might try calling a friend and seeing what happens; someone afraid that everyone is mocking them might dare to walk down the street and thereby observe that everyone is far too wrapped up in themselves to give them a moment’s thought.
A conclusion that anyone who submits themselves to CBT should quickly reach is that their mind really doesn’t work very well at all. This could sound like a worrying and sad thought but it is in fact the very opposite; it is at the heart of hope and healing, for once we know that our reasoning is in the hands of malevolent drunken demons, we can start to set in place some guardrails to protect us against the self-destructive, appalling conclusions which we keep being drawn to. It’s by knowing that we can’t think too well that we may start to think with a little more fairness and accuracy.
The question of why we should be drawn to awful thoughts is not — for that matter — something that CBT is especially interested in. To get answers to this, we would need to look in the direction of more traditional psychodynamic psychotherapy, which suggests that it is generally our childhood and its challenges that hold the important clues. It is some kind of trauma long ago that means that we have become relentlessly suspicious of ourselves and unremittingly certain that disaster awaits. The catastrophe we fear will happen has — somewhere in the forgotten early years — already happened.
CBT, though it can respect such analyses, sets itself a narrower — albeit equally useful — goal. It doesn’t care so much what happened back then, it wants to help us to perceive how we now think: how unkind, jumpy, selective and cruel our mental processes can be and what we are missing out on as a result. It wants to retrain us in the art of thinking so that we no longer have to torture ourselves with such unremitting energy going forward.
In the hands of CBT, we’ll be on the path to recovery once we can modestly accept that we are — when it comes to our emotional lives — very bad and unfair thinkers indeed.