CBT Cognitive Behavioural Therapy in Edinburgh

CBT or cognitive behavioural therapy is one form of psychotherapy. “Cognitive” refers to the perception the client has, for example ingrained or learnt negative beliefs or associations. Sometimes these are referred to as “toxic thought patterns”. Behaviour, as the name suggests refers to making choices to behave differently.

CBT is a “general” therapy, just like “general counselling” so although it is described here, more important is the information also included on trauma informed CBT, DBT and ACT as examples of more advanced types that are more likely to be suited to trauma therapy.

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What is CBT Cognitive Behavioural Therapy?

Cognitive behavioral therapy (CBT) is a type of psychotherapy that focuses on the interconnectedness of thoughts, feelings, and behaviors. It is based on the idea that our thoughts influence our feelings and behaviors, and by changing our thinking patterns, we can change how we feel and act.

CBT is a structured and goal-oriented therapy that is often used to treat a wide range of mental health conditions, including depression, anxiety disorders, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and eating disorders. 

• Thoughts, feelings, and behaviors are interconnected: CBT emphasizes that our thoughts, feelings, and behaviors all influence each other. For example, if you have negative thoughts about a situation, you may feel anxious or depressed, which can then lead to avoidance behaviors.
• Focus on the present: CBT primarily focuses on current challenges and issues rather than delving into past experiences.
• Goal-oriented: CBT is a goal-oriented therapy, with the therapist and client working together to identify specific goals and develop strategies to achieve them.
• Collaborative approach: CBT is a collaborative therapy, with the therapist and client working together as a team.
• Skill-based: CBT teaches clients specific skills and techniques to manage their thoughts, feelings, and behaviors.
• Structured and time-limited: CBT is typically a structured and time-limited therapy, with a set number of sessions.

Here are some of the techniques used in CBT:

• Cognitive restructuring: Identifying and challenging negative or unhelpful thoughts and replacing them with more balanced and realistic ones.
• Behavioral activation: Encouraging clients to engage in activities that bring them pleasure or a sense of accomplishment.
• Exposure therapy: Gradually exposing clients to feared situations or objects to reduce anxiety.
• Relaxation techniques: Teaching relaxation techniques, such as deep breathing or progressive muscle relaxation, to manage anxiety and stress.
• Problem-solving skills: Helping clients develop effective problem-solving skills to address challenges.

CBT has been shown to be an effective treatment for a wide range of mental health conditions. It can help individuals:

• Reduce symptoms: CBT can help reduce symptoms of anxiety, depression, and other mental health conditions.
• Improve coping skills: CBT teaches individuals new skills and strategies to manage their thoughts, feelings, and behaviors.
• Increase self-awareness: CBT helps individuals become more aware of their thought patterns and how they influence their emotions and behaviors.
• Prevent relapse: CBT can help individuals develop strategies to prevent relapse of their mental health condition.

If you are considering CBT, it is important to find a qualified therapist who is trained and experienced in this approach. The therapist will work with you to develop a personalized treatment plan that addresses your specific needs and goals.

How does CBT work?

CBT is largely based on self analysis. Much of the work therefore is the client learning to analyse themselves. The findings are often scored as a percentage or out of ten. For example a scary activity might be ranked out of 10 for how scared the person feels. Strategies are then developed in order to improve the outcome and experience, and the effect is then scored again. With perseverance the client should see a drop in the fear score, or perhaps an increase in a pleasure score such as confidence or calmness.

Alongside self analysis some CBT therapists analyse the client, thus assisting in identifying thought patterns and suggesting possible strategies. The level of intervention and reflection varies between therapists.

Who provides CBT generally?

A lot of the therapists who provide CBT are only trained in that model of psychotherapy. Often these people are referred to as wellbeing practitioners or CBT therapists. They are normally represented by the BABCP, a CBT professional body.

Other therapists who provide CBT are psychotherapists, counsellors or psychoanalysts who are trained in a range of therapy methods, but who include CBT as one of the methods they use. Hypnotherapists, NLP practitioners and Life coaches also often employ CBT.

Criticisms of CBT

CBT is often seen as rather cold and not holistic. It’s experimental method, although useful, can leave clients feeling dehumanized, experimental subjects rather than people.

Some people also often feel that the analysis method tends to identify common sense strategies that they perhaps long since tried themselves.

Both criticisms tend to relate to CBT used in isolation without being integrated into a more well rounded style of therapy.

CBT has also been criticized as politically motivated from an ideological standpoint. The problem some people have with it is that it seeks to change perception and behaviour to an acceptable social norm. This can be reduced by looking at the individual using psychoanalysis and ensuring that change is authentic to the individual.

A recent study by Pybis, Saxon, Hill & Barkham (2017)* concluded that the effects of counselling and CBT were comparable, and highlighted that research generally was over focused on outcome and not variability between services. It also showed that initial sessions of counselling were MORE effective and that CBT was only significantly more effective with 18-20 sessions. Since CBT interventions are often less than 6 sessions, it therefore might make sense to have short term counselling / integrative psychotherapy rather than the frequently available short term CBT (Short term often = 6 sessions or less).  Our service is multi-modal and integrative, seeking to utilise the best of different approaches. Therefore CBT clients are often offered counselling and mindfulness alongside their CBT support.

*Pybis, Saxon, Hill & Barkham (2017) “The comparative effectiveness and efficiency of cognitive behaviour therapy and generic counselling in the treatment of depression: evidence from the 2nd UK National Audit of psychological therapies” [accessed 15.07.2017]

CBT requires the client to be well self regulated. Higher cognitive function and processing is required for the process to work. When someone is extremely dysregulated, those parts of the brain required for CBT to work are not available and the client can not enguage sucessfully, no matter how motivated they are. Therefore in serious long term conditions such as long term depression and complex trauma, a “pre therapy” stage is introduced in CBASP for long term depression, and a stabilisation stage is used in complex trauma treatment.

Specialised Cognitive Behavioural Therapy –  Trauma Informed CBT

Trauma-informed CBT is an approach to cognitive behavioral therapy (CBT) that integrates an understanding of trauma and its impact on individuals. It recognizes that people who have experienced trauma may have unique challenges and vulnerabilities, and it adapts CBT techniques to create a safe and empowering therapeutic environment.

Here are key principles of trauma-informed CBT:

• Understanding Trauma:
  • Prevalence of trauma: Trauma-informed CBT recognizes that trauma is widespread and can affect anyone, regardless of background or experiences.
  • Impact on thoughts, feelings, and behaviors: Trauma can significantly impact an individual’s thoughts, feelings, and behaviors, leading to challenges with anxiety, depression, emotional regulation, and interpersonal relationships.
  • Sensitivity to triggers: Trauma survivors may have specific triggers that can elicit strong emotional or physical reactions. Trauma-informed CBT aims to identify and manage these triggers to create a safe therapeutic space.
• Creating a Safe and Empowering Therapeutic Relationship:
  • Collaboration and trust: The therapist prioritizes building a strong therapeutic relationship based on collaboration, trust, and mutual respect.
  • Empowerment and choice: The individual is actively involved in the therapeutic process, with choices and control over their treatment goals and interventions.
  • Transparency and pacing: The therapist is transparent about the treatment process and adapts the pace to the individual’s needs and tolerance.
• Adapting CBT Techniques:
  • Psychoeducation: Providing education about trauma and its effects can help individuals understand their experiences and reactions.
  • Cognitive restructuring: Identifying and challenging negative or distorted thoughts related to trauma, while also validating the individual’s experiences and emotions.
  • Behavioral activation: Encouraging engagement in activities that promote positive emotions and coping skills, while being mindful of potential triggers.
  • Relaxation and grounding techniques: Teaching relaxation and grounding techniques to manage anxiety, hyperarousal, and flashbacks.
  • Trauma processing: Incorporating trauma-focused techniques, such as exposure therapy or EMDR, if appropriate and with the individual’s consent.

Benefits of Trauma-Informed CBT:

• Reduced trauma-related symptoms: Can help decrease symptoms of PTSD, anxiety, depression, and other trauma-related challenges.
• Improved coping skills: Provides individuals with tools and strategies to manage triggers, regulate emotions, and cope with stress.
• Increased self-awareness: Enhances understanding of the impact of trauma on thoughts, feelings, and behaviors.
• Empowerment and self-efficacy: Empowers individuals to take control of their healing process and develop greater self-efficacy.
• Improved quality of life: Can lead to improved overall well-being, relationships, and quality of life.

• In conclusion, trauma-informed CBT is a valuable approach for individuals who have experienced trauma. By integrating an understanding of trauma into CBT techniques, therapists can create a safe and empowering therapeutic environment that promotes healing, growth, and resilience.

DBT: enhanced CBT known as Dialectic Behavioural Therapy

Dialectical behavior therapy (DBT) is a type of therapy that was originally developed to treat borderline personality disorder (BPD), but it is now used to treat a variety of mental health conditions. DBT is based on the idea that people with BPD and other mental health conditions often have difficulty regulating their emotions. This can lead to impulsive behaviors, self-harm, and relationship problems.

DBT teaches people skills to manage their emotions, tolerate distress, and improve relationships. DBT also emphasizes the importance of acceptance and change. It teaches people to accept themselves and their emotions, while also working to change unhealthy behaviors.

DBT is typically conducted in both individual and group settings. Individual therapy focuses on helping people identify and change their unhealthy behaviors. Group therapy provides a supportive environment where people can practice their new skills.

DBT has been shown to be an effective treatment for BPD and other mental health conditions. It can help people reduce their symptoms, improve their quality of life, and decrease their risk of self-harm and suicide.

Here are some of the key skills taught in DBT:

• Mindfulness: Paying attention to the present moment without judgment.
• Distress tolerance: Learning to cope with difficult emotions and situations without resorting to unhealthy behaviors.
• Emotion regulation: Identifying, understanding, and managing emotions.
• Interpersonal effectiveness: Communicating effectively and building healthy relationships.

If you are considering DBT, it is important to find a qualified therapist who is trained in this approach. The therapist will work with you to develop a personalized treatment plan that addresses your specific needs and goals.

Acceptance and Commitment Therapy: another more advanced form of CBT

Acceptance and Commitment Therapy (ACT) is a type of therapy that focuses on accepting difficult thoughts and feelings rather than trying to change or avoid them. It encourages taking actions that align with one’s values, even in the presence of challenging emotions.

Here’s a breakdown of the key ideas:

• Acceptance: Instead of struggling with unwanted thoughts and feelings, ACT teaches you to acknowledge and accept them as a normal part of the human experience.
• Cognitive Defusion: Learning to see thoughts as just thoughts, not facts or rules that you must obey. This helps create distance from them and reduces their power over you.
• Being Present: Focusing on the present moment, rather than dwelling on the past or worrying about the future.
• Self-as-Context: Recognizing that you are not your thoughts or feelings, but the observer of them. This creates a sense of separation from difficult emotions.
• Values: Identifying what truly matters to you in life and what kind of person you want to be.
• Committed Action: Taking steps towards living a life that aligns with your values, even when faced with challenges or discomfort.

ACT has been found to be helpful for a variety of mental health conditions, including anxiety, depression, PTSD, and chronic pain. It can also be used to improve overall well-being and quality of life.

Style of CBT at Scotlandtherapy

Stuart, the senior practitioner, is at core a psychoanalyst. Since 1994 while still in training he has used CBT as a method in his practice. Stuart considers CBT a very useful tool, which often feeds information back into psychoanalysis or clinical hypnotherapy (cognitive behavioural hypnotherapy). He does not usually use it in isolation.

Both therapists combine NICE and research recommended methods like CBT within a more multi-modal and holistic approach in order to adapt to individuals and provide the most customised service possible.

Variations include Dialectic Behavioural Therapy (developed for borderline personality disorders), Neurological Cognitive Therapy (using neuroplasticity change), MBCT (mindfulness based cognitive therapy), Acceptance and Committment cognitive therapies (ACT) and Cognitive Behavioural Analysis.

Stuart has a clinic in Edinburgh as well as seeing clients online. Full range of Stuart’s competencies and qualifications HERE

Qualifications and Registrations

Both practitioners are more widely registered than just CBT practitioners. Stuart is a psychoanalyst and clinical hypnotherapist with wider counselling and psychotherapy training. He is registered as a Fellow of the  National Association of Counsellors Hypnotherapists and Psychotherapists.

We provide CBT cognitive behavioral therapy and psychoanalysis.

Stuart completed extensive accreditation over 18 months with the NACHP including assessment of his CBT, analytic and humanistic provision. He has also completed post qualification competence training in CBASP, and CPD training in CBT for depression and MBCT for depression.

More information can be found at my individual practice site HERE

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