Thursday, 1 February 2018

The Truth about CBT (Cognitive Behavioural Therapy)


I've wanted to write this piece for a a long time, but I needed the dust to settle before I felt fully able to turn back and reflect on my own personal experiences with CBT. It stands for Cognitive Behavioural Therapy, and it's a kind of psychological therapy used to treat mental health problems, trauma, phobias and more.

I've found that, especially in the media, CBT and other therapies are misrepresented. Sometimes they are presented as clinical and sterile, and sometimes (particularly in print press) they are presented as woolly and fluffy solutions. I found the reality to be very different. My experiences of CBT have been positive, but the process itself is an emotional roller-coaster. I want to share with you a few realities, from someone that's been there more than once.

How does CBT actually work? 

Your therapist will work with you to question your thoughts and behaviour and the reasons behind them, and provide you with strategies to practice that are designed to change your thoughts and behaviour for the better. It's designed to break the negative cycle by encouraging you to interrupt those thoughts and behaviours one step at a time. Each week you will discuss how the previous week went, and get some 'homework' (for example mine included include practicing a new coping strategy and observing my thoughts in a particular situation and writing them down).

Every therapist will have different techniques but the idea is essentially the same. It's a proactive form of therapy that I found very empowering. It helped me to feel more in control of my mind and to stop dwelling on past experiences. You can access CBT in person with your therapist, and depending on the area you can also use an online service where you have a Facetime-style call with them. I've used both and can say there is little difference and that the online service has a shorter waiting list as well as a greater choice of therapists and appointment times.

CBT and me (a little disclaimer)

The first time I took a course of CBT was back in 2010 while at university. It stopped me from quitting and moving back home and I went on to do brilliantly in my studies. I've been back for more CBT since, but despite it being a huge part of my life I've never talked about it much online. Although I think we're much better at talking about this stuff now than we were back then, I know that many are still reluctant to share their own stories and that intense stigma still exists in some homes, workplaces and social circles.

Most of my close friends and family are aware that I've struggled with anxiety and at times depression since I was a teenager, but that doesn't mean I find it easy to talk about. I don't feel the need to go into all of the nitty gritty details of what goes on in my head in this post because a) no blog post in the world could ever be long enough and b) I firmly believe that you can be honest and open about your personal experiences without baring your entire soul and turning your skull inside out.

It's not for everyone

Cognitive Behavioural Therapy (and other kinds of therapy that generally speaking involve sitting on a big, badly upholstered chair and crying a lot) requires you to be open enough and accepting enough of your current situation to want to change. CBT gives you the tools to understand your mental health and take steps to changing it for the better. It doesn't do all of the work for you. If you don't get on with it and feel like you're not ready, then that's OK. Other forms of therapy do exist, some of which are available through the NHS. Medication can also help - whether you use it short term to get over a bad patch or (like me) on a long term basis to keep your brain on an even keel there is absolutely nothing wrong with doing so.

It's not a 'nice' experience

Therapy is incredibly cathartic and can be very empowering, but not in the way that a good wardrobe clear out will make you feel fresh and shiny and new. You're here to exorcise a few demons and put the foundations in place to actively bring about a change in your brain. It can be uncomfortable and emotionally exhausting. Although you will always work progressively towards your end goal, each step involves breaking down a rigid pattern of thoughts and behaviours that you may have been practicing your entire life. Every single session we would uncover some way in which I had been mentally sabotaging myself and set about creating ways for me to face up to my biggest fears and deepest denials. 

It's not a quick fix

The courses of CBT I've been on have been anywhere from 6-10 sessions. You can't undo years of anxiety in a 45 minute session. Expect set backs, expect tears, but above all take your homework seriously and you can also expect to make slow, postive progress towards getting better. Like me, you may end up finding yourself needing to go back into therapy at some point, or you may choose to see someone regularly long-term. That doesn't mean that you've failed. This is a process. This is a journey.

Not all therapists are created equal

Some people describe finding the right therapist as being a little like dating. You may need to talk to a few different therapists or counsellors to find one that you're comfortable opening up to and who you 'click' with. They are not there to be your friend or your shoulder to cry on, but you need to feel like you can talk to them about the deep, dark crap in your brain. It's also completely ok to specific whether or not you would like a male or female therapist/counseller - the person providing you with treatment should be someone you feel can understand and relate to your problems.

The outcome is worth it

It might seem like I've made CBT sound like a brutal process, but if you're at the point in your mental health journey where you want to change and start healing, it's also a very rewarding experience. If you're going through CBT or counselling of any kind then I would recommend keeping a journal or diary (or even just typing into the Notes app) to record your progress. You'll look back and be surprised at how far you've come and how much you've learnt about yourself.

A note on how to get CBT sessions in the UK

When at university I accessed CBT through my GP, who referred me to the student union's welfare service. They provided me with sessions for free and the waiting list was only a couple of weeks. If you're a student you should also be able to go directly to your student welfare service to access help with mental health problems.

As a proper "grown up" in the real world I accessed CBT for a second time through my GP when things got really bad. The reality is though that unless you're determined an immediate safety risk to yourself or others you will be either put onto a waiting list that is months long or directed to a local charity with a slightly shorter waiting list and very awkward appointment times. The UK government doesn't take mental health seriously, so if you can afford to access private counselling or CBT while you're waiting for a referral to come through then don't wait. I got worse and worse while I waited for an appointment letter and although I got my treatment in the end, it is crystal clear to me that our government doesn't see mental health as a priority.
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