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Cognitive Behavioural Therapy Cbt

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A CBT therapist aims to help people suffering from emotional problems by helping them to identify the ways in which their thinking may be causing their problem. A first step in CBT is therefore the identification of "Negative Automatic Thoughts" (or "NATs" for short) - these are the thoughts that accompany unpleasant or unhelpful emotions such as depression or anxiety.

A closely related aim of the CBT therapist is the identification of so-called "Thinking Errors". These are habitual (and unhelpful) ways a person has of thinking about themselves, others, and the world around them. These thinking errors will often twist or distort experiences, acting to make the person seem a failure, others as hostile, and the world as dangerous or unpleasant.

The identification of NATs and related Thinking Errors is half the battle in CBT - once a person is aware of their unhelpful thoughts and mental habits they can then choose to think in more rational, healthy ways. A CBT therapist can guide them through this (fairly straightforward) process.

As a Psychiatrist and therapist working in Edinburgh I use CBT techniques extensively. Some of my clients are quite happy with the results they get from simply challenging their NATs and Thinking Errors - they feel much better and have no desire to delve further. However, the majority of clients are keen to "get to the bottom" of why they had their emotional problems in the first place. I tend to encourage this further work as it helps to reinforce the progress made to date and, in my opinion, helps to prevent the client from relapsing at some future date.

This further work involves a search for "Negative Core Beliefs" (or "NCBs"). These are the unhelpful beliefs that a person has had throughout their later childhood and adult life. They are core components of the person's personality and they are the root cause of the person's Thinking Errors and ultimately their NATs. If a CBT therapist can help a person to change their Negative Core Beliefs (or, more realistically, find more rational and healthier alternatives), then the person's Thinking Errors and NATs will diminish, and their emotional problems will lessen (usually!).

A difficulty with NCBs is that a person is rarely aware of them. Even when someone is competent at identifying NATs and Thinking Errors, the cause of these problems may be hidden. But we can use NATs and Thinking Errors as clues.

In my experience as a Psychiatrist in Edinburgh I have found two techniques of most benefit in the search for the NCBs of my clients.

Firstly, there is the method of "Repeated Questioning". I ask the client what a particular NAT he has identified means to him - he will give an answer, and I then ask him what that answer means to him. He will give a second answer, and I then ask him what that second answer means to him, and so on. Within a short space of time, the client ends up with a global statement that can't be taken any further. This is a Negative Core Belief. It's probably best demonstrated with an example:

Client:"There's loads of litter around Edinburgh" (He's angry)

CBT Therapist:"What does that mean?"

Client:"That I'm the only one who cares about it"

CBT Therapist:"What does it mean if you're the only one who cares about it?"

Client:"People don't care about things that aren't their personal property"

CBT Therapist:"And what does it mean if people only care about their own stuff?"

Client:"People are only out for themselves"

("People are only out for themselves". This is the client's Negative Core Belief - a global statement that is uncompromising and will clearly influence the way he views and interacts with others in other areas of life, not simply littering!)

A second method of identifying Negative Core Beliefs is to look for the "themes" that run throughout a persons many NATs and Thinking Errors. Such themes may be "I'm a failure" or "There's no point to life" (very common in depression), or perhaps "The world's a dangerous place to live" (common in anxiety conditions).

Once a client's Negative Core Beliefs have been identified, the CBT therapist will (along with the client) try and explore alternative and more rational ways of thinking about the self, others, and the world in general. This is where real, sustained recovery from emotional problems is made and I will discuss this in a follow-up article entitled "Cognitive Behavioural Therapy (CBT) and Negative Core Beliefs (NCBs) - Treatment".

Dr Steve Last is a Psychiatrist and Therapist in Edinburgh. He makes extensive use of CBT techniques to treat problems such as depression, anxiety, and OCD. Please visit http://www.drstevelast.co.uk for further information about psychological problems and CBT.

Cognitive Behavioural Therapy Cbt

What can be done about Negative Core Beliefs? There are several options open to a CBT Therapist, but in my experience as a Psychiatrist and Therapist in Edinburgh I find that the following method is particularly effective.

Firstly, the method is to challenge these Negative Core Beliefs, in much the same way that a CBT Therapist would challenge a person's Negative Automatic Thoughts. The CBT Therapist and the client can look for evidence that the Negative Core Belief is true, and then look for evidence that it is false. The client is then in a position to make a reasoned judgement as to whether it is rational and healthy to continue holding their Negative Core Belief. If they don't think it's rational, then they can begin to look for alternative beliefs that better explain the evidence.

An example of this method might be challenging a client's Negative Core Belief that "People are dangerous". Evidence in favour of this belief might be that they had unpleasant and frightening experiences growing up - perhaps their father was abusive, or they were severely bullied at school. Experiences as an adult may also play a role - the overbearing boss at work, or the "friend" who turns out to be rather two-faced etc. Evidence against the belief that "People are Dangerous" could include the fact that their mother and grandparents were kind and loving, and that she had a few friends at school who were supportive. Perhaps most of her work colleagues now are nice and trustworthy, and the boss is renowned for being unpleasant and cantankerous to everyone.

With evidence of this sort compiled both "for" and "against" the belief, the client can weigh it up and make a judgment. In this particular case, the evidence may seem roughly evenly balanced both "for" and "against". In which case the client may decide not to totally reject their original belief, but modify it somewhat. They may decide that the statement: "Some people are dangerous, but some aren't" is a better description of the evidence. Learning to live with this new modified belief will almost certainly lead to the client having less emotional problems.

However, this is easier said than done. After all, your Negative Core Beliefs have been with you a long time - they can seem like an integral part of who you are, and as such, you can't just "turn them off" like that. They're well-trodden paths that can feel very comfortable and familiar, even if (in the long run) they cause you a lot of problems.

What a CBT Therapist may suggest is that rather than trying to actively eliminate your Negative Core Belief, it can be more productive to focus your attention on actively cultivating your new, alternative Core Belief. In my experience as a therapist in Edinburgh, one of the most powerful ways that a client can employ in order to start thinking in newer, healthier ways is to start behaving as if they already truly believed the new Core Belief. That is, to make a conscious decision to act in accordance with their new belief. In the example given, the client will act as if they already believed the new core belief "Some people are dangerous but some aren't". They will (quite consciously and deliberately) assume that people are not always dangerous and act in accordance with this (e.g. smile, be friendly, trusting etc), and make a conscious note of the results of such behaviour. Ordinarily the results will be pleasant, positive, and re-inforcing of the new belief. By repeating this behaviour day-in and day-out it will become second-nature, and the client will, deep down, really start to believe their new Core Belief. No longer will they see all other people as inevitably dangerous, and their instinctive initial responses to others will reveal a mature and trusting attitude.

This CBT technique of acting "As-If" is a very powerful way of inculcating real sustainable changes in your Core Beliefs. As a Therapist in Edinburgh I always encourage my clients to use this method in their day to day lives, in addition to keeping a close eye on any Negative Automatic Thoughts or Thinking Errors they may be having. Emotional problems tend to be very resilient to change, so you need to be on their case at all times to prevent relapse.

Dr Steve Last is a Psychiatrist and Therapist in Edinburgh. He uses CBT techniques to treat common problems such as depression, anxiety, and OCD. Please visit http://www.drstevelast.co.uk for more information about psychological problems and CBT.

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Dr Steve Last, Edinburgh has sinced written about articles on various topics from Health. Dr Steve Last is a Psychiatrist and Therapist in Edinburgh. He makes extensive use of CBT techniques to treat problems such as depression, anxiety, and OCD. Please visit http://www.drstevelast.co.uk for further information about psychological problems and. Dr Steve Last, Edinburgh's top article generates over 2900 views. to your Favourites.

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