You may have heard of cognitive behavioural therapy (CBT) before, or even know a bit about it (all about how thoughts and behaviours influence how we feel), but what always impresses me is how almost unavoidable CBT has become. In the UK, CBT is the number one recommended treatment for most mental health disorders (according to NICE guidelines), and if you go for therapy through the NHS you are very likely to have CBT (unless of course you ask for something different). Like all things though, one idea or approach having a monopoly isn't always the best route, especially for something as personal and flexible as therapy, so how did we get here?
You will perhaps be unsurprised to hear, it all started with Freud. He and his students talked of analysing dreams, unconscious desires, and 'psychosexual stages', but he ran into some problems. Almost none of these ideas were observable, testable, or even effective at time (with many patients left feeling worse than before)! In response, two schools of thought developed, which have permeated popular psychology today...
Heard of Pavlov's dog? This was a turning point for 'behaviourism', the idea that observable behaviours are the key to psychology. Pavlov found that when ringing a bell, his dogs would salivate before seeing any food, as they has associated a stimulus with a response; it became known as classical conditioning. With time, behaviourists adapted these ideas, suggesting that people are the product of years of classical conditioning, as well as operant conditioning (being rewarded or punished), or social learning (watching others make associations or get rewarded or punished). Famously, some researchers took a boy called Little Albert and taught him to fear rabbits and mice and all sorts, in a cruel but effective attempt to show that fear is not repressed or coming from dreams (looking at you Freud), but are the result of every day associations.
Now, this all sounds great, but behaviourists didn't really like thinking. I don't mean they didn't think, but more that they saw thoughts as insignificant. Thankfully, others disagreed, and pointed out the thoughts are actually pretty key to being human. We think about getting up, what to eat, who to talk to, what they thought of us, what we think of ourselves, and so much more. All. The. Time. And so from a mental health point of view, they argued that our thoughts are the problem, not the behaviours. 'Behaviours are just the results of thoughts' they said, and if we have more rational thoughts (i.e. not jumping to conclusions or discounting the positives), then we'll all act and feel happier. Great theory, but sadly, missing the whole behaviour part of humankind, which leads us to...
Cognitive behavioural therapy! As you have probably worked out by know, combining cognitive and behavioural theories gave us the popular therapy that is known today. This really started developed in the 1970s, and since then has become the most researched psychotherapy of all time; this has helped it to become so highly recommended for use in the UK. By combining so many ideas together, CBT can now recognise now only the associations and rewards that might drive behaviours, but also the distortions in our thinking that can lead to us being upset, anxious, angry, or whatever other emotion.
New elements have been added since the 70s, new evidence has come out supporting CBT for more than depression and anxiety, and new ways of delivering it emerge all the time. If you go through the NHS' 'IAPT' service, you can receive CBT via a website at any time you like, via the phone through short sessions, face to face with a therapist, or in a group. There are even books you work through (which are very good I've got to say!). There's more than one way to skin a cat, and there's definitely more than one way to get CBT.
At the beginning of this article, I was keen to suggest that CBT is problematic in how dominant it is, and although this is merely an idea, I think it is an important idea to consider. Lots of other therapies are less promoted as they haven't had the same research grants. Therapy based on Freud's work still has some positive evidence today, and new therapies are promising! Personally, I have read a lot about Acceptance and Commitment Therapy (ACT), as well as Compassion Focused Therapy (CFT), and the evidence-base for these are growing.
CBT is undoubtedly the best-evidenced therapy around these days, but if you have tried CBT, or feel that it doesn't sound right for you, don't despair! There are many ways to explore and work on yourself, and they all have rich histories of theory and ideas that appeal to different people. I love CBT as it is focused on working on problems in the here and now in a way that treats the patient/client as the expert (nobody knows them better than them self), but if acceptance, compassion, or exploration of the past feel important to you, those therapies are becoming more available (even in the NHS) day by day.
Thanks for reading my nerdy and boring history of CBT! Lots of love, Jan Talks Psych xoxo
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