Cognitive Behavioural Therapy (CBT) is an effective psychotherapy
for a wide range of emotional and psychological problems. The basic tenet of CBT is that our emotions are affected by our cognitions. To put it another way – the way we think affects the way we feel.
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.
Some 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.
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” (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.
Cognitive Behavioural Therapy, or CBT, is a an effective psychotherapy for a wide range of emotional problems. The theory underlying CBT is that our thoughts directly affect the way we feel – if we think in depressed ways then we will feel depressed. As such, a primary aim for a CBT therapist is to help a client recognise when they’re thinking in unhelpful ways. This article is a brief overview of one method of doing exactly this. I’ll use the example of someone suffering from social anxiety, a common problem amongst people I work with as a Psychiatrist and therapist in Edinburgh.
The first step for the client is to start “recording their thoughts” when they feel anxious – that is, writing down (in brief sentences) what’s going through their head. This may sound a little strange at first, but it really is an essential part of the CBT method. Ideally the client should stop and write down what they’re thinking at the moment they’re thinking it, but writing it down at the end of the day is also acceptable. They should write down everything they were thinking of – this will usually produce quite a list of thoughts and statements and beliefs. In addition, the client should note both how they felt (physically and emotionally) and the situation in which these feelings occurred.
In my example, the client would record that the situation was a social gathering of work colleagues after work. His heart was racing, he felt hot and sweaty, and he was a little light-headed (physical feelings). He described his emotional feeling as “very anxious”. Afterwards, when back at home, he wrote down the following thoughts that he remembered having at the time: “I don’t know anyone very well”, “I’ve got body odour”, “They’re all friends”, “This place is too busy”, “I hate these things”, “I want to go home”, “I’m going to faint and make a fool of myself”, “I’ve got to get out of here”
This list of thoughts that he has recorded is a list of what a CBT therapist would call “Negative Automatic Thoughts”. They’re “Negative” in that they tend to hinder the person’s motivation and ability to engage with activities, and contribute to emotional problems. They’re “Automatic” in that they seem to occur “just like that”, popping into the person’s head as if from nowhere. Indeed, unless the person specifically focuses his attention on what he’s thinking – as in the thought-recording exercise – they may pass unnoticed. All that the person would then be aware of is a sudden feeling of anxiety and a desire to leave the situation.
These Negative Automatic Thoughts (or NATs) cause emotional problems (in this case, social anxiety). Thinking in this way triggers the “Fight or Flight” response to perceived threat, leading to the physical symptoms
of anxiety such as a racing heart and nausea. If the person didn’t have these NATs (i.e. he didn’t think thoughts such as “I’m going to faint”) then the “Fight or Flight” response would not kick-in. No physical symptoms of anxiety would result, and he would be free to enjoy the social do.
Having identified the client’s NATs, the next step is to find alternative, more helpful ways of thinking about the situation. This is best done by examining the NATs for their rationality or “truthfulness”. A CBT therapist (along with the client) does this by conducting a “trial” for a particular NAT. In this example I will take the NAT “I’m going to faint and make a fool of myself” – this NAT was described by the client as the most distressing thought (in CBT parlance, this would be called the “Hot Thought”).
In a trial, evidence is presented “for” and “against” the party concerned. It’s the same in a trial for Negative Automatic Thoughts. So what evidence is there that the statement “I’m going to faint and make a fool of myself” is true? Very little – the client felt physically unpleasant and was anxious. And the evidence that says the thought is false? Much greater – he didn’t actually faint, he’s never actually fainted in all the times when he’s felt anxious, and it’s a well known fear of people experiencing anxiety that they will faint. And besides, there seems little evidence to suggest that even if he did faint, his colleagues would be anything other than concerned about him.
The verdict? That his NAT “I’m going to faint and make a fool of myself” is irrational and false.
Next, it’s time to identify an alternative thought that does actually fit with the evidence. How about “My heart is racing and I feel uncomfortable because I’m anxious, but I won’t faint and my anxiety will pass with time”? This seems a more accurate statement of the situation, and is clearly less likely to exacerbate his anxiety symptoms. Thinking in this way will reduce his anxiety and enable him to stay out longer with his colleagues, which in turn will help to reduce his anxiety.
Cognitive Behavioural Therapy (CBT) says that “we feel the way we think”. An important first step in the recovery from emotional problems is to learn to identify and challenge our irrational thoughts (or “NATs”). As a Psychiatrist and therapist in Edinburgh I have found this to be an effective (and surprisingly quick) way of relieving some of the burden of difficulties such as depression and anxiety. But it is just a first step, and most clients will benefit from a more in-depth CBT approach that addresses not just their Negative Automatic Thoughts but also their Negative Core Beliefs.
Cognitive Behavioural Therapy (or CBT) is an effective treatment for a wide range of psychological and emotional problems
. The underlying theory of CBT is that our emotions are affected by our cognitions – put another way, “We feel what we think”. As a Psychiatrist and Therapist in Edinburgh I use CBT techniques extensively in the treatment of common problems such as depression, anxiety, and obsessive compulsive disorder (OCD).
CBT views emotional problems as the result of unhealthy and irrational thinking. It employs terms such as Negative Automatic Thoughts and Thinking Errors to describe the different ways in which unhealthy thinking can cause emotional problems. Having identified these unhealthy thinking habits, CBT also provides us with the tools to develop alternative, healthier ways of thinking about ourselves and the world around us. By thinking in a more balanced way we will feel better emotionally. Please see my articles on Negative Automatic Thoughts and Thinking Errors for a more detailed explanation of the above methods.
However, Negative Automatic Thoughts and Thinking Errors are not the whole picture. Many people will wonder why they have such ways of thinking when other people don’t. CBT uses the term Negative Core Belief to describe the fundamental root cause or causes of a person’s emotional difficulties.
A Negative Core Belief (or NCB) is a strongly held, intrinsic belief that a person holds about either themselves, others, or the world in general. Frequently people will have NCBs about all 3 categories. NCBs are usually an integral part of a person’s personality – so much so that they’re often blissfully unaware that they even have such a thing. One of my other articles on NCBs outlines ways that people can identify their NCBs – this article will focus on their causes.
Negative Core Beliefs arise most commonly during childhood and adolescence. This period would seem critical in the development of a person’s personality – it is the time when they first form opinions about themselves, others and the world around them. In lay terms, we are “impressionable” in our younger years.
If our experiences during these years are generally positive and empowering, then we are likely to develop healthy Core Beliefs. If we have loving parents, a pleasant and supportive schooling experience, and are lucky enough to have good friends when we are growing up etc, then we are very likely to see ourselves, others, and the world in general in a positive light. We may end up with Core Beliefs such as “I’m a generally nice person” or “People are usually OK”.
Unfortunately, this is not the case for everyone. Children grow up in violent or abusive households, children are bullied at school, children are ostracised by their peers – all these experiences can have a detrimental effect on a person’s core beliefs. Even seemingly minor experiences – perhaps having “pushy” parents or over-critical teachers – can influence our views of the world. Negative Core Beliefs are the result of such an environment, examples of such beliefs being “I’m bad” or “People are aggressive”.
It can seem reasonable (even logical) that a child forms these beliefs. After all, they’re young and have limited alternative experiences to compare. If your father is aggressive, or your teacher critical, then it can easily seem like every adult is aggressive or critical. Also, these people are powerful figures in your early life – role models – and you are likely to believe what they say. A father saying “You’re bad” or a teacher calling you “Useless” is, as far as you can see, the truth. You begin to believe that these are undeniable facts about yourself, facts that obvious to everyone.
These beliefs are the conclusions that are formed in a child’s mind based on his or her limited experience. You only have your parents judge how all parents are, and you only meet a certain number of teachers and schoolmates in your formative years. As a child, your view of the entire world is based on these few contacts and experiences.
The Core Beliefs we form as a child and adolescent tend to persist throughout our adult lives. This is not a problem if they are healthy, but Negative Core Beliefs predispose the individual to emotional difficulties. If you go through life believing, deep down, that you’re a bad person or a failure, then you’re prone to seeing much of your adult experiences in these terms. If a loved one is upset then you feel guilty even if it wasn’t your fault, or the passing comment by a boss can seem like the end of the world. Negative Core Beliefs are the cause of Negative Automatic Thoughts and Thinking Errors – and these are the causes of emotional difficulties.
Finding the cause of a clients Negative Core Beliefs is an important step in the treatment of their emotional problems. Please see my other articles on the Identification and Treatment of Negative Core beliefs.