Cognitive behavioural
therapy (CBT) is a type of talking therapy that's used to treat a wide
range of mental health problems, from depression and eating disorders to
phobias and obsessive-compulsive disorder (OCD). It recommends looking
at ourselves in a different way that might prove useful for all of us in
everyday life. But what happens to our brains when we have CBT?
What is cognitive behavioural therapy?
CBT is based on the idea that problems aren't caused by
situations themselves, but by how we interpret them in our thoughts.
These can then affect our feelings and actions.
The way we think about a situation can affect how we feel and how we act
For example, if someone you know walks by without saying hello, what's your reaction?
You might think that they ignored you because they don't like
you, which might make you feel rejected. So you might be tempted to
avoid them the next time you meet. This could breed more bad feeling
between you both and more "rejections", until eventually you believe
that you must be unlikeable. If this happened with enough people, you
could start to withdraw socially.
But how well did you interpret the situation in the first place?
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Common errors in thinking style
- Emotional reasoning - e.g. I feel guilty so I must be guilty
- Jumping to conclusions - e.g. if I go into work when I'm feeling low, I'll only feel worse
- All-or-nothing thinking - e.g. if I've not done it perfectly, then it's absolutely useless
- Mental filtering - e.g. noticing my failures more than my successes
- Over generalising - e.g. nothing ever goes well in my life
- Labelling - e.g. I'm a loser
CBT aims to break negative vicious cycles by identifying unhelpful ways of reacting that creep into our thinking.
"Emotional reasoning is a very common error in people's
thinking," explains Dr Jennifer Wild, Consultant Clinical Psychologist
from Kings College London. "That's when you think something must be true
because of how you feel."
CBT tries to replace these negative thinking styles with more useful or realistic ones.
This can be a challenge for people with mental health disorders, as their thinking styles can be well-established.
How do we break negative thinking styles?
Some psychological theories suggest that we learn these
negative thinking patterns through a process called negative
reinforcement.
Graded exposure can help people confront their phobias
For example, if you have a fear of spiders, by avoiding them
you learn that your anxiety levels can be reduced. So you're rewarded in
the short term with less anxiety but this reinforces the fear.
To unlearn these patterns, people with phobias and anxiety
disorders often use a CBT technique called graded exposure. By gradually
confronting what frightens them and observing that nothing bad actually
happens, it's possible to slowly retrain their brains to not fear it.
How does cognitive behavioural therapy work on the brain?
Primitive survival instincts like fear are processed in a part
of the brain called the limbic system. This includes the amygdala, a
region that processes emotion, and the hippocampus, a region involved in
reliving traumatic memories.
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“Start Quote
Dr Paul Blenkiron, Consultant PsychiatristIt seems that CBT really can change your brain and rewire it.”
Brain scan studies have shown
that overactivity in these two regions returns to normal after a course
of CBT in people with phobias.
What's more, studies have found that CBT can also change the prefrontal cortex, the part of the brain responsible for higher-level thinking.
So it seems that CBT might be able to make real, physical
changes to both our "emotional brain" (instincts) and our "logical
brain" (thoughts).
Intriguingly, similar patterns of brain changes have been
seen with CBT and with drug treatments, suggesting that psychotherapies
and medications might work on the brain in parallel ways.
How effective is cognitive behavioural therapy?
Of all the talking therapies, CBT has the most clinical evidence to show that it works.
Studies have shown that it is at least as effective as medication for many types of depression and anxiety disorders.
But unlike many drugs, there are few side effects with CBT.
After a relatively short course, people have often described
long-lasting benefits.
"In the trials we've run with post-traumatic stress disorder
[PTSD] and social anxiety disorder, we've seen that even when people
stop the therapy, they continue improving because they have new tools in
place and they've made behavioural and thinking style changes," Dr Wild
explains.
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Find out more
- Watch David, 25, and Wayne, 24, use CBT to help with their mental health in Inside My Mind on BBC Three, 7 August 2013 at 8pm, and afterwards on iPlayer
- Find out more about mental health in the It's a Mad World season on BBC Three
CBT may not be for everyone, however.
Since the focus is on tackling the here and now, people with
more complicated roots to their mental problems which could stem from
their childhood, for example, may need another type of longer-term
therapy to explore this.
CBT also relies on commitment from the individual, including
"homework" between therapy sessions. It can also involve confronting
fears and anxieties, and this isn't always easy to do.
Ultimately, as with many types of treatment, some people will
benefit from CBT more than others and psychologists and neuroscientists
are beginning to unravel the reasons behind this.
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