Approaches Cognitive Behaviour Therapy (CBT)

The main ideas in CBT

In CBT, the way we interpret a situation shapes how we feel and what we do. Two people might receive the same text from a friend, 'Can we talk later?' One reads it as a request. The other wonders whether the friend is annoyed, feels a knot in their stomach and replays their last conversation all evening. Because thoughts, feelings, body sensations and actions affect one another, a change in one, such as a new action or a different reading of a thought, can flow on to the rest.

CBT describes common thinking traps, such as mind reading (assuming you know what others are thinking) and catastrophising (jumping to the worst outcome). Most people fall into them at times, and CBT offers ways to recognise them and check them against the facts. Beck also described core beliefs, such as 'I'm not good enough', which often form early in life and can sit beneath many automatic thoughts.

Common CBT techniques

A thought record captures a situation, the thoughts and feelings that came with it, and a more balanced view. A behavioural experiment tests a worried prediction, such as 'If I ask a question in class, people will think I'm silly', against what actually happens. For anxiety, graded exposure means approaching a feared situation in planned steps, starting with the least difficult, to find out whether it is more manageable than expected. For low mood, behavioural activation gradually builds enjoyable or meaningful activities back into the week, since waiting for motivation to return can keep low mood going. Problem-solving and slow breathing are also common.

What CBT involves

CBT is structured and focused on the present. It begins with an assessment of your current difficulties, their history and your goals. Many CBT treatments were designed for particular conditions, so a diagnosis can guide the choice of methods, although one is not needed to begin. The assessment leads to a formulation, which maps the patterns of thinking and behaviour that keep a difficulty going and shapes a treatment plan agreed with you.

Sessions usually review the week's practice, focus on one situation or skill, and end by agreeing what to practise next. Australian health information commonly suggests six to twenty sessions, weekly or fortnightly, of around 50 minutes to an hour, although the right number depends on the person and the concern. CBT can also be provided by telehealth or in groups.

CBT for children and teenagers

With children, CBT becomes more concrete and playful, with drawing, games and thought bubbles, and a worry might be given a name or character. It generally suits children from around primary school age, once they can begin to put thoughts and feelings into words. Parents and carers often join some sessions or learn the same skills to coach their child at home.

For teenagers, CBT is closer to the adult form, with more room for their own goals and a say in how their family is involved. Research supports CBT for several concerns in young people, particularly anxiety. Macquarie University's Cool Kids program, which teaches children and their parents skills for managing anxiety, is a well-researched Australian example.