Cognitive Behaviour Therapy

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Expert CBT Therapist: Cognitive Behavioural Therapy (CBT) is about training the mind. The way our minds work, the way we analyse things, the way we react to things, all stem from our life experiences, ingrained pre-programed thought and analysis pathways –‘epigenetics’[1]– and learned cultural norms, determine how we think about and react to things.

About CBT Cognitive Behaviour Therapy

During our life time these reactive pathways evolve in response to new experiences, some suddenly, for example, in reaction to witnessing something traumatic or otherwise witnessing something significant but not traumatic, but mostly in a learned sense as we gradually plod through life. For example, a person, prior to the birth of their own child, or the child of a close friend or relative, may have paid scant regard to the ethical and nurturing role of a parent (or uncle/aunty/God-parent etc’) -only to find that that role, in all its forms, now becomes a primary concern in their decision making processes. Their thought pathways have shifted, notwithstanding that in just about all living creatures their exists at the primordial[2] level an instinctual predilection of nurturing.

As our circumstances change, so do our reactive pathways – what seemed important then, may no longer seem as important now. Sometimes this can be very challenging. People used to the way things have always been may be faced with a sudden change which in various ways offends them. The loss of a significant other, such as in a death of a loved one,  a partner in a relationship for example, might cause the affected person to feel as though they have lost part of themselves and have trouble in reconciling their new norm as it were. Grief for instance is a natural emotion but, when that grief intensifies overtime, rather than dissipating, this might have a lot to do with the way the affected person’s cognitive processes are firing.

On the other side of the equation, some people experience such good-fortune in their lives that they became obsessed with the fear that they could lose it all in the snap of fingers, indeed their whole perceived self-worth could be lost in a blink of an eye. These thoughts of dread can be overwhelming for some people causing them to go on to develop phobias such as those phobias mentioned above, including  ‘Agoraphobia’[3] and/or Pistanthrophobia[4]  which are conditions closely linked to anxiety and/or depression related disorders.

Treatment for Anxiety with CBT

Some people, having experienced a bad dream will be so disturbed from it that they will develop an irrational heightened awareness or forbearance to whatever the theme of the dream was, usually one of an apocalyptic nature, and go on to develop seemingly strange avoidance strategies in their day-to-day life to avoid whatever the disturbing, though illusionary, correlation was as though it was real, for example, a prediction or premonition of an ominous future reality – to them. This is different to sub-conscious rational thought process.[5]  

In some cases, a person acting out such-like avoidance strategies, could appear patently weird or eccentric to others – for example refusing to walk on cracks in a footpath lest they be swallowed up by the earth as happened to them in their dream(s). Another, though less obvious irrational behaviour, might be that of a person who dreamt of a plane crash – that person going on to develop ‘aviophobia’ (irrational fear of flying) notwithstanding even though the dream may have only been very vague without them appearing in it at all. These types of reactive thoughts and behaviours could (and do for many people) seriously constrain them in their ability to function in their normal lives’ -particularly if required as part of their job to travel- or even in respect to going on holidays with their family which might involve a flight. This particular phobia has been known to manifest in the affected person vociferously insisting and pleading with others not to fly.

So, we can see that the way we perceive things bears direct correlation to our cognitive evaluation of things.[6] Cognitive misperception is at the core of CBT. If for example one perceives a sense of dread in reaction to something (a stimuli), such may well be a perfectly valid reaction, however, when that something, otherwise viewed objectively, ought not result in such a sense of dread, then that person may be experiencing a cognitive misperception, which can, and often does, trigger extreme anxiety and/or even depression and conditions much worse. This phenomena has also been described as a ‘common mental error that leads to misguided thinking’.

CBT can be hugely helpful

This is where CBT can be hugely helpful in assisting such a person develop strategies to recognise, manage, and hopefully overcome, harmful and potentially ruinous behaviours stemming from misaligned cognitive processes. CBT can also be used in conjunction with other therapies to ensure clients receive an individualised and personal therapeutic treatment program tailored to their particular needs.[7]


Cognitive Behavioural Therapy can be particularly effective for –

  • Anxiety and related disorders such as irrational fears and related phobias, obsessive-compulsive disorder and post-traumatic stress disorders;
  • Depression and related disorders;
  • Low self-esteem and related disorders including feelings of worthlessness or guilt;
  • Hypochondria and related disorders;
  • Substance dependence;
  • Problem gambling;
  • Eating disorders;
  • Insomnia and related sleep deprivation related disorders;
  • Persistent and non-diminishing feelings of Grief and Bereavement;
  • Marriage or relationship problems;
  • Insomnia;
  • Difficulty thinking, concentrating or making decisions;
  • Unexplained fatigue or loss of energy;
  • Certain emotional or behavioural problems in children or teenagers; and
  • Cognitive Dissonance.

Note: The theory of ‘Cognitive dissonance‘ is a phenomenon whereby we have a natural drive for consistency, in that our belief system must be consistent with itself and it must be consistent with our actions; but that consistency doesn’t always happen to align, hence the related term ‘cognitive misalignment‘, thus distress can arise as a result. We can see this in some cases of PTSD where people are haunted by their actions contrary to their set of beliefs. Learn more about cognitive dissonance >

Cognitive Behavioural Therapy can also help you achieve your goals

Sometimes we doubt our own abilities which end-up holding us back. This could be concerning a promotion at work, for example – you may lack the level of assertiveness necessary to get your vison for the future across to those people assessing your abilities. It could even be in your relationships with work colleagues who don’t pay enough attention to your ideas. Indeed, no one wants to be seen as a ‘shrinking violet’ nor do they want to be seen as an Ogre, unless of course there is a undesirable personality trait in play.[8] It may even be happening in your family environment where your views, wants and wishes seem to be worth less than others; particularly where there is a male (dominate) – female (submissive) dynamic, which exist in many families and cultures.

Achieve your personal goals with Cognitive Behaviour Therapy

That being said, one’s ability to be assertive, without being threatening, is a key element to achieving equality of opportunity, and thus attainment of one’s own goals, even if that is just to be heard. Indeed, one’s level of agreeableness is central to one’s ability to be assertive as to their wants, needs and desires. But assertiveness should not be confused with dominance. Unchecked dominance – in particular – aggressive dominance can lead to toxic relationships.

At CBT Counselling & Psychotherapy a relatively significant part of our practice is about ‘assertiveness training’ which is based on the principle that we all have a right to express our thoughts, feelings, and needs to others, as long as we do so in a respectful way.

Remember, when we don’t feel like we can express ourselves openly, we may become depressed, anxious, or angry, and our sense of self-worth may suffer.

How CBT therapy works

Cognitive behaviour therapy focuses on changing unhelpful or unhealthy thoughts and behaviours. It is a combination of two therapies: ‘cognitive therapy’ and ‘behaviour therapy’. The basis of both these techniques is that healthy thoughts lead to healthy feelings and behaviours.

Cognitive Therapy

Cognitive therapy

The aim of cognitive therapy is to change the way a person thinks about an issue that’s causing concern. Negative thoughts cause self-destructive feelings and behaviours. For example, someone who thinks they are unworthy of love or respect may feel withdrawn in social situations and behave shyly. Cognitive therapy challenges those thoughts and provides the person with healthier strategies.

Many techniques are available. One technique involves asking the affected person to come up with evidence to ‘prove’ that their problematic belief is justified. The deconstructive critique of that evidence can shed a new light on their self-held belief, and can go a long way to helping the person to realise that their belief is false; or if not entirely false, that it is irrational in terms of the levels taken to.

  • Classical conditioning – sometimes, as part our getting to understand a client’s cognitive processes we might examine how they form associations between stimuli. Previously neutral stimuli are paired with a stimulus that naturally and automatically evokes a response. After repeated pairings, an association is formed and the previously neutral stimulus will come to evoke the response on its own. Classical conditioning is one way to understand one’s reactive pathways of behaviour.

This is called ‘cognitive restructuring’. The person learns to identify and challenge negative thoughts, and replace them with more realistic and positive thoughts. Of course, CBT requires the administering therapist to have the necessary relevant skills to be able to help the person achieve this type of cognitive restructuring.

Behaviour therapy

Behavioural therapy is a term used to describe a broad range of techniques used to change maladaptive behaviours. The goal is to reinforce desirable behaviours and eliminate unwanted ones. Behavioural therapy is rooted in the principles of behaviourism, a school of thought focused on the idea that we learn from our environment.

There are a number of different types of behavioural therapy. The type of therapy used can depend on a variety of factors, including the condition that is being treated and the severity of the symptoms; for example –

Applied behaviour analysis (ABA): is a type of therapy that focuses on improving specific behaviours, such as social skills, communication, reading, and academics as well as adaptive learning skills, such as fine motor dexterity, hygiene, grooming, domestic capabilities, punctuality, and job competence. It has also been shown that consistent (ABA) can significantly improve behaviours and skills and decrease the need for special services.

Aversion therapy: this process involves pairing an undesirable behaviour with an aversive stimulus in the hope that the unwanted behaviour will eventually be reduced. For example, someone with an alcohol use disorder might take disulfiram, a drug that causes severe symptoms (such as headaches, nausea, anxiety, and vomiting) when combined with alcohol.[9]

Dialectical behavioural therapy: is a form of CBT that utilises both behavioural and cognitive techniques to help people learn to manage their emotions, cope with distress, and improve interpersonal relationships.

Exposure therapy: utilises behavioural techniques to help people overcome their fears of situations or objects. This approach incorporates techniques that expose people to the source of their fears while practicing relaxation strategies. It is useful for treating specific phobias and other forms of anxiety. (See ‘Passive Avoidance‘ below)

Rational emotive behaviour therapy: (REBT) focuses on identifying negative or destructive thoughts and feelings. People then actively challenge those thoughts and replace them with more rational, realistic ones. (See ‘Passive Avoidance‘ below)

Social learning theory: centres on how people learn through observation. Observing others, being rewarded or punished for their actions, can lead to learning and behavioural change.

Some people have described CBT as having cleared the ‘fog’ in their brain. Brain fog is a common anecdotical description given when someone can’t think clearly, as opposed to rationally. Brain fog might manifest in symptoms such as ‘memory problems’ – ‘lack of mental clarity’ –‘poor concentration’ and/or ‘inability to focus’.

Rational emotive behaviour therapy

This phenomenon can be caused by a range of things such as ‘Chronic stress’ – ‘mental fatigue’[10], ‘lack of sleep’ – ‘hormonal changes’ – ‘diet’ – ‘medications’ and/or medical conditions’[11].

Treatment with CBT

The structure of CBT treatment will vary according to the person’s particular problem(s). However, CBT typically includes undertaking the following processes:

  • assessment – this may include filling out questionnaires to help you describe your particular problem and pinpoint distressing symptoms. You will be asked to complete forms from time to time so that you and your therapist can plot your progress and identify problems or symptoms that need extra attention;
  • personal education – your therapist provides written materials (such as brochures or books) to help you learn more about your particular problem. The saying ‘knowledge is power’ is a cornerstone of CBT. A good understanding of your particular psychological problem will help you to dismiss unfounded fears, which will help to ease your anxiety and other negative feelings;
  • goal setting – your therapist helps you to draw up a list of goals you wish to achieve from therapy (for example, you may want to overcome your shyness in social settings). You and your therapist work out practical strategies to help fulfil these goals;
  • practise of strategies – you practise your new strategies with the therapist. For example, you may role-play difficult social situations or realistic self-talk (how you talk to yourself in your head) to replace unhealthy or negative self-talk;
  • homework – you will be expected to actively participate in your own therapy. You are encouraged to use the practical strategies you have practised during the course of your daily life and report the results to the therapist. For example, the therapist may ask you to keep a diary.

Passive Avoidance‘ can drive anxiety related disorders

CBT often engages ‘psychoanalytic’ processes,[12] a form of analysis which delves into one’s past, to help identify ‘passive avoidance’ which has a clear link to anxiety related disorders, including phobias. Indeed, passive avoidant behaviour can sit deep in one’s unconscious so as not to be plainly obvious to the sufferer.

Treatment for Passive Avoidance anxiety related disorders

The underlying subject of the avoidance, may lay dormant, simmering beneath the surface, until an emotional response is triggered by a particular stimuli, causing the sufferer to react (objectively) drastically and irrationally. For example, a particular smell or song could trigger a drastic and irrational emotional response to the previous loss of a loved one; similarly, a particular expression on someone’s face, otherwise objectively benign, could trigger a drastic and irrational response if interoperated as a threat (fear response) causing the sufferer to retreat or to lash-out.

There are many possible combinations of stimuli triggers and seemingly irrational behavioural responses, some of which could stem back to a repressed childhood trauma or some other type of repressed anguish. Sometimes this type of behaviour is diagnosed as ‘Neurosis‘, however, neurosis is of a more generalised ‘worrisome tendency’ type of behaviour as opposed to an extreme, drastic and/or irrational reactive behaviour stemming from an unconscious phenomena.

Of course, avoidance is a natural and adaptive response to danger. Animals, including humans, cannot survive without the ability to avoid harm. Nevertheless, avoidance can have detrimental consequences – excessive and/or unnecessary avoidance is a hallmark of anxiety disorders. The idea is that basic emotions such as anger, fear, happiness, sadness, and disgust evolved for particular functions. It is likely, for example, that the basic emotion of fear evolved to enable an organism (including a human) to rapidly detect and respond to danger in its environment. Much research has been conducted on the brain’s fear system in both animals and humans. The fear system involves a range of neural areas, in particular the ‘amygdala’, and this system is especially sensitive to naturally occurring fear-relevant stimuli, such as for example, snakes or angry faces. From this perspective, it should come as no surprise that different emotions may be characterised by quite different patterns of cognitive biases.

By uncovering and examining such reactive cognitions through psychotherapy, it is possible to teach a sufferer different ways to  recognise and manage these the underlying avoidance and cognitions  so as to at least significantly reduce the intensity of the reactive behaviour with the view to eradicating it altogether.

Before choosing CBT, issues you may like to consider include:

  • CBT may not be the best form of therapy for people with any type of brain disease or injury that impairs their rational thinking;
  • CBT requires you to actively participate in treatment. For example, you may be asked to keep detailed diaries on thoughts, feelings and behaviours. If you are not prepared to put in the work, you may be disappointed with the results of CBT;
  • CBT involves a close working relationship between you and your therapist – “therapeutic relationship”.[13] Professional trust and respect is a key feature of the relationship;
  • Practise of strategies – you practise your new strategies with the therapist. For example, you may role-play difficult social situations or realistic self-talk (how you talk to yourself in your head) to replace unhealthy or negative self-talk;
  • While CBT is considered a short-term form of psychotherapy, it may still take months or longer for you to successfully challenge and overcome unhealthy patterns of thinking and behaviour. CBT may disappoint you if you are looking for a ‘quick fix’.

“If there is no struggle, there is no progress.” ~ Frederick Douglass[14]

CBT is a great option if you’re struggling with Depression or Anxiety. Indeed, CBT is the most widely-used therapy for Anxiety & Depression related disorders.

CBT is a great option

As we have seen, Cognitive behaviour therapy (CBT) is an effective treatment for a wide range of mental and emotional health issues, including for anxiety and depression. Indeed, research has shown CBT to be particularly effective in the treatment of panic disorder, phobias, social anxiety disorder, and generalised anxiety disorder, major depressive disorder (MDD) among many other conditions. To learn more about anxiety or depression related disorders please click on the buttons below:

While it is never too late to seek out professional help, the sooner you do the better the possibility of assisting you identify and alleviate the problems affecting you.

If you are looking for an expert Cognitive Behaviour Therapist in Sydney CBD, look no further than CBT Counselling & Psychotherapy. We look forward to helping you.

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[1]  ‘Epigenetics‘ In biology, epigenetics is the study of heritable phenotype changes that do not involve alterations in the DNA sequence. The Greek prefix epi- (ἐπι- “over, outside of, around”) in epigenetics implies features that are “on top of” or “in addition to” the traditional genetic basis for inheritance.

[2]Primordial‘, in biology terms refers to “origin’ – “originally or earliest formed in the growth of an individual or organ; such as, a primordial leaf; a primordial cell”. Primordial status is constituting a beginning; giving origin to something derived or developed; original; elementary: primordial forms of life; first formed;
pertaining to or existing at or from the very beginning.

[3]  ‘Agoraphobia’ is a fear of places and situations that might cause panic, helplessness or embarrassment. Agoraphobia is an anxiety disorder that often develops after one or more panic attacks. Symptoms include fear and avoidance of places and situations that might cause feelings of panic, entrapment, helplessness or embarrassment. Treatments include talk therapy and (possibly) medication.

[4]  ‘Pistanthrophobia’ is an enormous fear of trusting people because of awful past experiences. It is that awful feeling of being jealous in a new relationship because someone else hurt you in the previous one.

[5]  The unconscious mind is frequently viewed as consisting of irrational processes. Given that much more brain activity occurs unconsciously than consciously, approximately on the order of 20 to 1, it is doubtful even at a surface level that there is no rational aspect to unconsciousness. Freud believed that consciousness represents only a small portion of mental activity. Modern-day neuroscience research supports this position: The energy consumed by unconscious active messaging, referred to as the default mode network, occurring during sleep, daydreaming, anesthesia, and other states, is 20 times greater than the energy used to respond consciously. Regulation over emotional and related psychological processes occurs entirely unconsciously and is highly rational; irrationality only transpires when this regulation fails and excessive negative emotional-cognitive states arise, such as fear of benign entities. Refer to- “The Rational Unconscious: Implications for Mental Illness and Psychotherapy” – (Brad Bowins, M.D., F.R.C.P.C.)

[6]  On the face of it, the difference between ‘perception’ and ‘cognition’ might seem obvious. They simply play different roles in our mental life. Perception is what puts us in contact with our present surroundings, while cognition is what makes us able to form beliefs, make decisions, and so on. More particularly, perception is the ability to capture, process, and actively make sense of the information that our senses receive. It is the cognitive process that makes it possible to interpret our surroundings with the stimuli that we receive throughout sensory organs.

[7]  i.e.: Acceptance & Commitment Therapy – Behavioural Therapy – Bereavement & Greif Counselling – Cognitive Analytic Therapy (CAT) – Dialectical Behaviour Therapy – – Exposure Therapy – Humanistic Therapy – Mentalisation-Based Therapy – Medical Nutrition Therapy (MNT) – Logotherapy (Resilience Training) – Mindfulness-based Cognitive Therapy – – Motivational Interviewing Therapy – Supportive Psychotherapy – Psychodynamic Psychotherapy – Person-Centred Therapy – Narrative Therapy. To learn more about these types of therapies we offer please click on this link >>

[8]  For example – ‘Narcissistic personality disorder’ — is one of several types of personality disorders which is a mental condition in which people have an inflated sense of their own importance, a deep need for excessive attention and admiration, troubled relationships, and a lack of empathy for others. Usually, these types of people are self-absorbed, entitled, callous, exploitative, authoritarian, and aggressive. Some are physically abusive. These unempathetic, arrogant narcissists think highly of themselves, but spare no disdain for others. Other similar personality traits include – ‘antisocial personality disorder’, ‘borderline personality disorder’, ‘histrionic personality disorder’, sociopathic disorder, psychopathy, paranoia, schizoid and schizotypal disorders, and obsessive-compulsive personality disorder.

[9] Important: Aversion therapy (as opposed to ‘Covert conditioning‘), is usually only administered by a Psychiatrist or other similarly qualified medical professional. Aversion therapy, is designed to cause a patient to reduce or avoid an undesirable behaviour pattern by conditioning the person to associate the behaviour with an undesirable stimulus. The chief stimuli used in the therapy are electrical, chemical, or imagined aversive situations. In the electrical therapy, the patient is given a lightly painful shock whenever the undesirable behaviour is displayed. This method has been used in the treatment of sexual deviations. In the chemical therapy, the patient is given a drug that produces unpleasant effects, such as nausea, when combined with the undesirable behaviour; this method has been common in the treatment of alcoholism, in which the therapeutic drug and the alcohol together cause the nausea. In ‘Covert conditioning‘, developed by American psychologist Joseph Cautela, images of undesirable behaviour (e.g., smoking) are paired with images of aversive stimuli (e.g., nausea and vomiting) in a systematic sequence designed to reduce the positive cues that had been associated with the behaviour.

[10]  Mental (brain) fatigue is a temporary trouble or problem. Mental fatigue may make it hard to pay attention or focus on a task. You may feel mental fatigue after doing work that takes a lot of mental energy. You may feel mental fatigue if you feel a lot of stress for a long period of time. Potential causes include medication, stress and ailments such as depression, fibromyalgia and autoimmune disease. Emotionally challenging experiences like divorce or death of a loved one can also contribute to brain fatigue. Prima-facie it is different to ‘Chronic fatigue syndrome’ (CFS) which is a disorder characterised by extreme fatigue or tiredness that doesn’t go away with rest and can’t be explained by an underlying medical condition. CFS can also be referred to as myalgic encephalomyelitis (ME) or systemic exertion intolerance disease (SEID).

[11]  Medical conditions that may cause or contribute to ‘brain fog’ include: ‘anemia’ – ‘depression’ – ‘anxiety’ – ‘diabetes’ – ‘Sjögren syndrome’ – ‘migraines’ – ‘Alzheimer’s disease’ – ‘hypothyroidism’ – ‘autoimmune diseases such as ‘lupus’, ‘arthritis’, and ‘multiple sclerosis’ – dehydration. This is by no means an exhausting list of such medical conditions.

[12]  ‘Psychoanalysis‘ is defined as a set of psychological theories and therapeutic techniques that have their origin in the work and theories of Sigmund Freud. The core of psychoanalysis is the belief that all people possess unconscious thoughts, feelings, desires, and memories; and that the unconscious mind, includes all of the things that are outside of our conscious awareness, such as early childhood memories, secret desires, and hidden drives. According to Freud, the unconscious contains things that we might consider to be unpleasant or even socially unacceptable. We bury these things in our unconscious because they might bring us pain or conflict. While these thoughts, memories, and urges are outside of our awareness, they still influence how we think and behave. In some cases, the things that are outside of our awareness can influence one’s behaviour in negative ways and lead to psychological distress.

[13]  The’ therapeutic relationship‘ is an extremely important part of therapy; it is the context in which healing takes place. As a client, you need to feel understood, comfortable and safe enough to reveal the details of the difficulties that you’re having, and to have the confidence to try a new way of solving your problem. According to Carl Rodgers (who is widely regarded as one of the most eminent thinkers in psychology – and best known for developing the psychotherapy method called client-centred therapy and for being one of the founders of humanistic psychology) there are three conditions core to the therapeutic relationship – ‘empathy’, ‘congruence’ and ‘unconditional positive regard’. The therapeutic relationship in Cognitive Behavioural Therapy (CBT) has been argued to play an essential role in positive outcomes in therapy.

[14] Frederick Douglass‘ was an American social reformer, abolitionist, orator, writer, and statesman. After escaping from slavery in Maryland, he became a national leader of the abolitionist movement in Massachusetts and New York, becoming famous for his oratory and incisive antislavery writings: –

Charles Pratten Principal CBT Counselling & Psychotherapy Sydney

Author: Charles Pratten

Principal CBT Counselling & Psychotherapy

Title: About CBT Cognitive Behaviour Therapy

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