What Is CBT? How Cognitive Behavioural Therapy Helps with Anxiety, Depression & More

Dr Marianne Trent (: 00:00

Struggling with your thoughts, wondering why you feel stuck or how to finally move forwards. Cognitive behavioural therapy or CBT is one of the most widely researched and used therapies in the world today, but what actually happens in CBT and how does it help whether you are considering therapy, supporting someone else or training to be a psychologist yourself? This episode is for you. I'm chatting with sahan, a qualified CBT therapist. I'm Dr. Marianne, a qualified clinical psychologist. Please like and subscribe for more and Sahan and I both hope you find it really useful. Hi, welcome along to this baring Psychologist podcast. I'm Dr. Marianne and I am a qualified clinical psychologist. I'm joined by my wonderful guest for today, Sahan. Hi Sahan.

Sahana (: 00:45

Hi Marianne. Thanks for having me.

Dr Marianne Trent (: 00:48

Thank you for being here. And you are here in your capacity as both an aspiring site, but also a qualified CBT therapist, don't you?

Sahana (: 00:58

Yeah, it'll be interesting to talk about CBT in a different setting. Normally I'm used in a therapy setting or work setting. So yeah, I'm very excited to share my thoughts.

Dr Marianne Trent (: 01:08

Perfect. And I know you'll do a brilliant job. So the aim of today for anyone watching is that we're going to think from a service user perspective about what CBT is, what it might be used for, and I guess a bit about what they can expect if they're understandably feeling maybe a bit nervous because they've received maybe a letter or an email through the post telling them that they've got their first CBT appointment and they're like, oh, that's really normal, isn't it? To feel nervous about stuff that maybe you've not done before?

Sahana (: 01:40

Yeah, of course. I think CBT is quite well known, but I think a lot of people haven't actually tried it before. So yeah, getting that letter through the post and not knowing what it's about, is it going to be, I've had clients say, is it going to be beyond my control? Are you going to read into my body language? So there are a lot of myths out there that would be helpful just to bust them. But yeah, it would be helpful to clarify that a bit more today.

Dr Marianne Trent (: 02:11

And obviously I know when I've worked in services for the NHS, sometimes we're offering services to people. I actually find it really hard to leave the house because they might be feeling really anxious and maybe even with something like social anxiety, which CBT can be really useful for the idea of sitting kind of across from someone that can feel really difficult, can't it?

Sahana (: 02:31

Yeah. So I've always spoken to you Marianne about my social anxiety and actually CBT has personally helped me and I've always, the equivalent I would draw doing CBT when you have social anxiety is therapists are like, you're scared of spiders but you, you're going to sit there with a spider, we're going to expose you to that. So it's definitely nerve wracking, but there are ways to work around it. So since the pandemic, obviously we've made therapy more accessible, so I'm offering remote therapy but also across NHS as well. That's an option out there and I think we try to make it as accessible as it can be and work around those barriers that people might initially face when trying to access therapy.

Dr Marianne Trent (: 03:17

Amazing. So I guess if it feels insurmountable, maybe speak to the service and ask for maybe whether there's any accommodations that can be made.

Sahana (: 03:26

Oh, a hundred percent. So usually what we would actually do is do an assessment to gauge are there any practical barriers, any barriers when it comes to mental health that are good, inhibit them from getting the help that they need, and then to cater towards that even there's been a rise in being neurodivergent and then we actually at the start of the assessment ask are you neurodivergent? Or even if you're not diagnosed, is there any adaptations we can make just to make therapy a bit more accessible? So yeah, definitely if there's anything as always we might miss something. So definitely do raise it with us or let them know. I do think the one thing that we would want is that honesty and rather than just suffering in silence. So yeah, a small call or a simple question can really help iron out things and make it a little bit more, I dunno, seamless to ease into a very difficult process.

Dr Marianne Trent (: 04:22

Exactly. We want people to be set up to thrive and to do really well at this. We don't want them to be thinking it's already outside their comfort zones. So tell us, CBT stands for cognitive behavioural therapy, but what is it?

Sahana (: 04:39

So if I was to describe it as a one-liner, like a newspaper liner, it's the relationship between your thoughts, feelings, and your behaviours. So usually I like to explain why it's important to look at those three areas and I'd like to show a bit of a cycle that kind of showcases those three areas. So when we talk about situations or how we feel, we usually say that a situation makes us feel some type of way. So we might say, I got really anxious at that party, but actually if it is just that a situation makes us feel some type of way, then that same situation would have the same feeling for every single person. And that's not the case, that's not what we find. So our emotions can vary in terms of its intensity, but also we might even have complete different emotions. And what that really boils down to is the meaning we attach to those situations.

(: 05:35

So by meanings we can call them our thoughts, we might have mental images, we might have past memories that might come up even if it's related to an upcoming situations, but that really dictates how we feel. So if we have a look at this particular example, the thought is I'll embarrass myself and one might feel slightly anxious and that can have a knock on effect in terms of how we behave them. So we might be less inclined to go to that party on a similar wavelength, if someone thinks I'm really excited it's about big day, I'm going to celebrate that same situation, party could be excitable, it can bring on emotions of joy and then the behaviour would be completely different. So it'd be eager to go, eager to plan set up. So these three components have a knock on effect with each other and keep that cycle going. And cognitive behavioural therapy or CBT basically looks at breaking down those patterns. So by focusing on the behaviours or the thoughts that would naturally have a knock on effect on our emotions. So if we shift our thoughts from, I'll embarrass myself to, well, let's see how it goes. We might be more open and curious as opposed to feeling quite anxious.

Dr Marianne Trent (: 06:54

Perfect. So nicely done. And I guess it might be useful for us to think about when we would intervene. So of course if we are feeling a little bit anxious about something, maybe doing something like this today or before we went on camera, we were talking about something that I'm doing that's new and different. You're like, do you feel nervous about that? And I was like, well, not in that particular instance, but often in this instance I do and it's absolutely fine to feel those feelings, especially if they are novel. But I think we're looking at when it becomes so that you aren't functional or so that your wellbeing is affected. So we are not aiming to immunise people against normal emotions, but it's when they're crippling or paralysing, isn't it that we owe it to themselves to intervene or ourselves even.

Sahana (: 07:45

Absolutely. So I'll embarrass myself. It might be a very normal thought to have, but again, I think it lies down to the severity of how you might feel that way and the frequency as well. So as I've told you, when I went for CBT for social anxiety, the level of impairment that I had, I couldn't even order a restaurant. My best friend had to do it, I couldn't talk. So it had such a restrictive impact on my life and that's when CBD can be really useful. So we're not trying to normalise or make scary of everyday situations, everyday natural reactions like feeling nerves or nervous in a pet fatigue situation isn't a problem at all. It's when it starts having that ripple effect and it's so intense and it's difficult to deal with, that's when CBT can be a really helpful intervention. I also think the nice thing about CBT is that its perspective is all of these problems, if you'd call it actually stem from really natural emotions. So social anxiety, we all have a natural tendency to want to be liked to be impressionable. We're social creatures, we want to be accepted. But if it becomes more pervasive and it controls various aspects of your life to really great lens. So CBT can actually help people if they're feeling quite restricted and limited with their anxieties or low mood to live a richer quality life so that it doesn't have such pervasive control over them.

Dr Marianne Trent (: 09:27

Everybody deserves to have a good shot at thriving and actually for a variety of reasons, maybe from bullying or the way that we've been raised or just the people that we find ourselves maybe working alongside, we can feel really undermined and that can get to us. Often we do the thing called formulation, don't worry, we make sense. So if we're using a longitudinal formulation, we look at what might have contributed to this, what we think about as the precipitating factors we Could you tell us a little bit more about that?

Sahana (: 09:58

Yeah, so CBT really banks on that. So it looks out what keeps the problem going. So it has a very much a here and now focus. So I might tell my clients, if you fell down the stairs and now you're afraid of walking down the stairs, just because you knew how you fell down the stairs doesn't necessarily mean that will get rid of the problem. We need to look at what's keeping the problem going. So what might set it off might not carry on, it might look very different. Now the actual problem, so within the context of, so when you mentioned formulation, Marianne, what I showed there is a skeletal version, a very simplified version, but it kind of looks at what keeps the problem going. Is it the thoughts is is it the behaviours? And that's largely down to working together with the client with full consent and knowledge and just asking them and exploring that problem in a detailed analysis I suppose. So that way once we've identified, okay, so these are the things that keeps the problem going, we can then look at, well what can we do to manage them and not let that interfere our lives so much so we can dismantle that cycle basically.

Dr Marianne Trent (: 11:14

Amazing. And is this going to be a super heavy thing for clients to do in between sessions because often actually clients do want homework or homework so that they can practise some of these skills. What are people likely to be sent away with or asked to do?

Sahana (: 11:32

Yeah, I think in the earlier sessions the therapist usually takes the lead with between session exercises or homework or as you would say, homework which I've started using now. What it would usually involve is collecting data, that's what I'd call it. So have a go at this week, just see how you're getting on, jot down some of the things that trigger your cycle and that can really help us to really reinforce is this the problem that we're actually working on? And that's really important during the early stages because one of the underpinnings of CBT is that we want to have a problem of focus. If we spread ourselves too thinly, we might not have any real benefits. So if we have an overarching problem and we're working towards that and we're bringing our awareness skills to the table, you essentially become your own therapist really through that experience.

(: 12:23

And once you then collect the data, then we then move on to the intervention part where we would then give tools and techniques for them to try. So there's quite a lot of between session exercises and people don't really expect that when the first two sessions normally I'd spend time just assessing suitability for CBT with them, does it meet their expectations? Because at the end of the day, we don't want people to feel like that they have to do something like a certain approach because they've been told to, it's a very much a collaborative effort that ccbt. So we usually ask them, how do you feel about homework or between session exercises? Is it daunting for you? Is it not your cup of tea writing things down, this is what CBT looks like, this is how it works, so how do you feel about that? So having those sorts of conversations is really important so that way we are on the same page and that collaborative tone is there from the get go.

Dr Marianne Trent (: 13:22

Yeah, it is not something that's being done to you. It should be feeling like something that you're part of and we're kind of working with your window of tolerance. We don't want someone to be feeling over aroused, under aroused, so hyper aroused, hypo aroused so that they're not able to be functioning. And I guess with CBT often there'll be an element of behavioural activation doing something a bit different and seeing how that goes. But what that is not, it's not flooding. So actually if social anxiety is what you're being seen for in between session one and two, the therapist should not be saying to you, right, go out and stand in the middle of Leicester Square. That's not fair. That wouldn't be right, that wouldn't be okay. But what they might say is, could you maybe consider being in the background when the postman comes to the door and your partner answers it, literally trying to break down on a scale almost of one to a hundred, what would be step one and helping you to manage yourself to make changes.

Sahana (: 14:28

I think that's the great thing about CBT, the fact that it's graded, it's a gradual approach. It's not we're putting you into the deep end, off you go, let's see if you manage. But also the activities that they'll do is aligned with their values and we make sure that it's meaningful and important to them. So that way there is that motivation to do that, which is yeah, I really feel held back when I'm in the staff room and I'm so anxious I can't even talk to my colleagues. So we kind of gradually build activities to work towards that point where they are able to do that specific situation. It can be quite empowering but I think most importantly it's done together with the client. We don't want to kind of do activities where it's not challenging at all because then what are we really learning here?

(: 15:20

And I think that's very much the essence of CBT. We're sort of asking ourselves all the time. Myself as a therapist, I always ask, what did I learn about this session from you today and what did you learn about this session from this session rather so that generally that learning component is there underpinning all of this. So we want to make sure that the distress or the discomforts there enough for them to kind of take away something from that experience. So we're constantly working like detectives really testing out hypothesis and we're not literally holding magnifying glasses but we're looking at these thoughts with a magnifying glass rhetorically speaking and we think, well is this true? How likely is it, can we find this out? Does it feel safe enough but albeit a bit uncomfortable? And then we kind of roll with it and see how we get on.

Dr Marianne Trent (: 16:13

Alright, so let's try and kind of get a sense of maybe an imaginary person with real problems that might benefit from CBT and how we do that. So if I pluck a random made up person out of my head, Jay, he's 32, he has been cheated on by his partner and it's led to his mood really lowering. It's also led to him thinking he's not good enough and he's feeling lots of shame and that everybody knew about this and have got things that they're saying about him and maybe his manliness, it wasn't enough to satisfy his partner, he tried to go back on a dating website but it was really crippling for him and led to him feeling really anxious, really self-critical impacting on his work. He's feeling like he doesn't want to go to work kind of people at work and they all know and it's the referral comes in and it's all feeling too much. How could our treatment with Jay progress with CBT?

Sahana (: 17:18

I mean there's a lot there isn't there. And I think in the first two sessions I like to just create a bit of a problem list where they can kind of get it all in there so that way we've kind of got the main problems but also if there's any knock on effects that's also on there. So when you mentioned dating zine, that's a key trigger at the minute, but also it started off because of the relationship breakdown and perhaps there's some self-doubts as well about how he sees himself or maybe some negative thoughts for example, I'm not good enough. So we'll write that all down on a bit of a list and then we'll kind of cluster them. Are these problems relevant to each other? Are they linked to each other? So then that makes a problem a little bit more manageable and actually we realise it's the same problem having a knock on effect and having these symptoms.

(: 18:15

I suppose once we've identified the problem of focus, and it could be anxiety, we could specify that a bit more. We don't have to do that at this stage, but we could just label it as anxiety. But then we also look at their goals for therapy. Does it align with that anxiety problem of focus? So if they're saying, I really want to become confident when I'm out there going on dates or on dating apps, I'd like to put myself forward for that and anxiety is what's stopping me from doing that. So then we kind of coincide both. And once we do that, then what happens is we start building on that skill of awareness. So this is the stage where I might take the lead a little bit more and I might say, okay, well let's find out what happens and how often it happens.

(: 19:07

It can't just be dating scenes, there must be more to this, but that's okay. Often we're not aware, so let's try and hone in on that skill of awareness from the get-go. I'm already kind of fostering that sense of agency to them. You become your own therapist, go out into the real world and find out what's going on. I dunno. And I'm very open about that. I don't know that's what you are here for. You're the expert of your difficulties and I'm the expert of ccbt, so let's work together here. So they'd go out and they'd bring back their data sheet of a week's worth of triggers and that will then give us a great understanding of what are the areas that needs working on and what are some of the things that keeps the problem going. And I showed you the previous cycle, Marianne, that's kind of what we draught up together and it's done together with the client.

(: 20:01

It's always everything. Every part of this is done with the client and I always ask for feedback. I ask them, does that make sense or have I went off the rails? And usually it'd be like, yeah, no, I get that or add to that, can I add a little bit more to that? There's something else that's just come up now. So we kind of build on that model and then we start looking at the intervention side of things. So what do we need to look at working on or managing? So if it is that there's intense avoidance, so they're not even on dating apps at all because I thinking I'm going to make a full of myself, I'm going to overshare or I feel ashamed, I dunno how to tell them about anything that's happened in my past. We look at managing sort of negative automatic thoughts we call them and there's lots of different interventions, but we might look at that as a set intervention, give them some worksheets to work towards managing their thoughts.

(: 21:02

We're not trying to replace the thoughts of something positive, but just kind of bringing it back to more realism and then that can have a knock on effect. So if they're thinking, I don't know how I'm going to cope, I dunno if I can even tell them, I can never be myself with another person, a potential partner that might shift from that to actually, yes, I've had an awful experience in the past and my brain is obviously on the lookout for that, but that doesn't mean it's always going to be that way. Maybe there are people out there that can understand me and it can take time over time. I can build that trust and open up to them about my relationships. So already the thoughts shifted to something more grounded and balanced and then the anxieties might be reduced, might not completely go away, but then that will then promote it would then put enough doubts in those thoughts to then test them out.

(: 21:57

I always rely on scepticism. If someone's completely like, no, I'm not doing it, then we kind of work on right, what's going on here? We need to get a bit of flexibility there or maybe there's a reason why a very valid reason why there's something there that's not explored. But if it's more that actually it's anxiety, it's coming from the past and it's manifesting there. Now Jay might find that actually maybe I could give this a go. Yeah, I feel really nervous, but maybe I can instal a dating app and just text someone or swipe someone that I'm interested in. So already there is a shift there isn't there? From not being on dating apps at all, being engulfed by that fear to, well let's just see how it goes. It's scary, but we can find out.

Dr Marianne Trent (: 22:42

And I guess we don't want him to forget that this has been really sad and that he wanted this to work out. But also we want him to believe that he deserves to be in a relationship where if just being kind of monogamous is really important to him, that's someone that wants to treat him in that way with respect for what they've got together and that there is a possibility that can happen again in the future.

Sahana (: 23:06

Yeah, absolutely. I think CBT, although it focuses on the here and now, if it is connected to a relevant past experience, I think it's really important to acknowledge that it's obviously coming from a place, a place of hurt, a place of fear, even a place of trauma. So for Jay, that relationship, it probably meant the world to him, hence why his brain is on that overdrive to protect him and not put him through any kind of that sort of situation again. So it's really important to validate that place so we're not dismissing it and saying, well focus on the here and now and you'll be back to how you were, but actually realising that's really devastating that you'd been through something like that. It's no wonder that you feel the way you do it makes a lot of sense. And then thinking about does it align with what you want, how you are and the way you're dealing with this.

(: 24:06

And it's down to the individual really, whether they're ready to think about doing something different. It might be that in a complete different scenario, Marianne, if they're not ready and they're thinking I'm really, really lost and this relationship has taken such a toll on me, I don't even know where to start. That's a person that really needs that time and space to process things and they might not be quite suitable for CB two, which we'll talk about a little bit more later. But yeah, it's really important to validate. That's one of the fundamentals. You need to understand the person, their story, what have they been through, what are their difficulties, does it connect with the past and kind of connect with that story and almost build that picture at the back of your mind, but also share it with them as well. So you are on the same page as them at all times.

Dr Marianne Trent (: 25:05

Amazing. And I appreciate how long is a piece of string and different services are different, but what is maybe typical for what someone can expect for number of sessions they might be offered for CBT?

Sahana (: 25:17

So I work at an adult service at the minute, so it really does depend, like you said on the service. So it can go up to 20 sessions. On average though it's 12 sessions. So it really depends on the nature of the problem, what we usually do to help facilitate that and to make sure it's not abruptly ending or you're not sure where it's headed. We do regular reviews, so I do every four sessions, I do a bit of a check-in, how are we at, where are we at, how are you feeling? Is this something that fits your needs? Sometimes CBT might not be it, the structure might not work well for that individual. So it's important to capture early and in the first couple of sessions when we explain these are the principles, this is what's expected, does this fit your bill? Is this what you're looking for? And if they're like, no, actually I really don't like worksheets. And that's for us to then think about, well what apps can we look at? But in general, if they're happy with CBT, we look at every four sessions. Also just depends on the clinician really about are we headed in the right direction or have we drifted and does it require a bit more work? And then we might extend the sessions with justified reasons.

Dr Marianne Trent (: 26:32

Yeah, I guess we don't want this kind of video or podcast episode to put someone off if they've already got it booked, it's much better to go along, try it and then if you think it working for you, talk to the clinician about that they might well be able to help make the right referral for the thing that might be the thing that works. So please don't just not turn up or just drop out. Always talk to the person because that ultimately is going to help you to get where you are going to be having your needs best met. I think.

Sahana (: 27:02

Absolutely. I do think generally speaking, although as clinicians we strive to make sure that it's collaborative, we're always constantly asking for feedback. We Mario, we're asking, is this all right, does this work for you? And it's not that we're ensure we just want to make sure that they're on the same page as us really. But often what we find is there is still this sort of air of the clinicians, the expert, they know what they're talking about, they're the ones spearheading this and if they know what they're doing and I should just follow suit, it can't be further from that. That is so far from the truth. And actually what would honestly help, and I always say this to my clients, is if there is a bit of you that feels like, oh I don't really like this, I don't even connect with a therapist, lemme know there's nothing personally taken that whatsoever, just let me know.

(: 27:56

Rather you let me know than struggle in silence because by being transparent, you are asserting your rights there aren't you, which is this isn't really working for me. I'd like to explore other options or other pathways here and I just want to foster that a little bit more because I don't think that's done enough from my experience, I don't see a lot of that despite trying to create that sort of environment, there is still that discrepancy of well the therapist knows, this clinician knows that. I'm just going to follow and see where it goes. So yeah, if we do ask, how are you feeling about this? How are you finding it? The best thing is to be transparent so we can be on the same page

Dr Marianne Trent (: 28:40

And when we're stretching and we're growing actually things might not always feel super comfortable but they shouldn't feel so awful that it's painful or overwhelming. And it's making me think about when I'm doing personal training sessions with my lovely personal trainer and sometimes even when I'm doing the exercise I go, I'm going hate it, hate it, really extra laugh. But it doesn't mean that I don't want to do it, it's just that actually, oh this is harder than I thought and I know if I was by myself I wouldn't do this, but because I'm with you, I feel safe to do this and I know you'll keep me safe. So it is okay to have a little bit of that discomfort because that can mean that we're growing.

Sahana (: 29:20

Yeah, no, absolutely. I think our brain does that I think doesn't it? The moment it feels discomfort, I hate it, stop doing it. It's like you said, but if you push past it a little bit and you actually might find that this is so rewarding and it's such an achievement looking back on it, right? We've always been there. Even just doing, I'm like, oh, there's a bit of that resistance where the brain's like, oh, do you really want to be doing this? But actually now that I'm here, it feels great. I feel like I'm really structuring myself here and I think that's the key. I think we stop usually before we get to that point. We, the moment we feel discomfort, we're like, oh, I'm just going to stop now. I don't really like it. Just because it's uncomfortable and you don't really like it doesn't mean that it's a bad thing actually.

(: 30:13

And I think that's where the wise part of the brain is when you kind of push through just a little bit. If it's within your window of tolerance, like you said Marianne, when you look back on it, you actually feel, wow, I really did do that. I really put myself out there in the podcast and spoke about CBT and in Jay's instance it's like, wow, when was the last time I'd ever actually opened up to someone on my terms? What a great feeling. But again, it's like to say that, well I don't want to be feeling any kind of discomfort to do that. It's like putting the horse behind the carton, isn't it? We can't really achieve that. So I think that's important to keep in mind. So that's a really good point, Marianne.

Dr Marianne Trent (: 30:56

And we've got these things called safety seeking behaviours, haven't we? So when I'm going to get in my car and go out shortly, I'm going to put my seatbelt on and that's an adaptive safety seeking behaviour. But if I'm standing in a shop and I'm feeling a bit hot and flustered and I think, oh, I better get my water out my bag. Oh, that's not helping, I'll vent my top a bit, try a bit there. Oh no, no, I'm not going to cope with all this noise and it's too much. And I leave the shop and then I get outside and I go, thank God I did that. I never would've coped actually, I probably in different circumstances with enough resources would've coped sufficiently to buy my bread and my milk. But I've almost invalidated myself. I've drafted and pulled in that safety seeking behaviour, which has made me feel like that saved me.

(: 31:45

Then I've got outside and my kind of distress levels have dropped. Okay. But I guess often when I'm thinking with clients, I think about actually how much longer would it have needed until you naturally plateaued anyway and then you did cope. And often what we find is that people will put in these safety seeking behaviours just at the point when they were going to ride it out anyway. And then they begin to think, well I always need that and I know that CBT can help people to focus in on their safety seeking behaviours and think about which ones are adaptive actually make really good sense and which ones maybe we can just maybe implement a little bit later or use a little bit less, think about using a different one that gets us to stay in that situation so that we can have that incredible feeling of mastery and satisfaction that comes when a client says to, oh my god, I did it. I felt anxious but I stayed. And then I had this really great chat with someone and it went like really? And you almost see someone come back online and once you've almost taken control of that beast and you've shown it actually I'm not having a panic attack, I'm not doing that, I've ridden it out. It almost inoculates or kills off the panic. It can't get you in the same way.

Sahana (: 33:08

Absolutely. I think recognising the difference between adaptive and safety seeking behaviour is really important. I think especially when working with, if someone's autistic and they're naturally needing to self-soothe in social situations, it makes 'em overwhelmed. That's an adaptive behaviour because that's kind of helping them deal with that situation in that moment so that they can engage in day-to-day life and do their thing. However, that same behaviour can be a safety seeking thing when they don't go out at all and they're afraid and worried about judgement . So if I was to even bring up an example or working with someone and made up client, if they're going to go out somewhere and thinking I'm going to be so overwhelmed, I don't even want to bother going out, actually, what are some of the adaptive strategies that you've got there? Is it headphones? What else do you do?

(: 34:02

Is there anything that you can go with? So that way when they put these resources in place, they're still able to go to that situation and despite having these resources to help ride the wave actually to put themselves out there like that and to come back and say, actually I went and did it and I really enjoyed myself. Yeah, I had a minute or two, I went out for a break, got some fresh air, put my headphones on. Well actually I went back in and I got down on the dance floor and I had a really good time and it was on my terms. That's what we want to see more of safety seeking behaviours. What we tend to find out is they might feel like, oh this is really helpful in the moment, but it might not be on your terms in the long run.

(: 34:51

And that can be for any situation. So when you're going to the supermarket and you're overwhelmed and you're like, I'm going to leave now, it might feel like it's on your terms in that moment, but then in the long run, the next time you think about the supermarket you might think, oh lemme just go with someone. Or you know what, lemme just order online. It kind of almost build over time, don't it? And then it becomes this, your life becomes very shut off and very small. But by recognising that and actually thinking, you know what, if I can't stay in the supermarket for 10 minutes, let me try for five minutes, that's an achievement. If you leave the moment, the anxiety kicks off and then you might realise that actually the distress, like you said, starts plateauing a little bit and that is scientifically proven.

(: 35:36

So CBT is based on empiricism, so it's just a fancy term that basically means it's based on science really. We're not sort of spewing pop psychology or it's not based on nothing. It's based on real evidence and it's well known that once your anxiety kicks off, if people kind of stay in the situations, it doesn't sustain, it can't go on forever. It has to come down. And people, like you said, Marianne don't really, just as they're about to, I guess desensitise or habituate or just as it's about to plateau, they don't really get there. They kind of withdraw, pull out before then and that is a safety behaviour.

Dr Marianne Trent (: 36:20

Absolutely. Just before we finish, Ana, who might not be a good candidate for CBT or what kind of conditions might not be a first choice for CBT?

Sahana (: 36:32

Yeah, so I think it depends. So I'll bring on a few different factors because CBT can be quite structured. So usually you'd set an agenda and then typically that involves a bit of a check-in. How did you get on with the between session exercises, looking tool, looking at tools and then setting what are you going to look at? If people don't really connect with that kind of structure, then it might not be for them and that's okay. There are other approaches. It's not that therapies failed you, it's it's not your cup of tea. That's completely fine. Another thing I wanted to bring up is if there are a lot of life stresses, and what I mean by that is I'm not saying that you shouldn't go to therapy, there's so much going on, but if there were a lot of social stresses, if you're having housing issues, financial difficulties and that takes precedent over your anxiety disorders or low mood, then perhaps I always say the kindest thing to do is look at how we can best support you on that.

(: 37:33

And it might not be CBT therapy, it might be something else. Another thing I wanted to mention, which I want to show a bit of a cycle to demonstrate this, Prochaska and Clemente created this cycle for health related behaviours and changes when it comes to that. So typically we want CBT is most effective when people are in that preparation stage or the action stage and we can really then bolster them to be able to look at making those changes and sustaining them and preventing relapse. However, on some occasions clients might be quite unsure, they might not be sure whether they're ready for that change. The more sort of figuring out what's going on with them and for that, that would require a different approach I think. So that's why I always show the cycle, where are you at in this sort of cycle? Are you still thinking that there's a problem but you're not quite ready to change but you want to talk about it? That's not necessarily CBT, but there is another approach for that like counselling. But if you really want to create that change, you're ready for that, but you're sort of wanting that extra bit of support, then absolutely we can work together.

Dr Marianne Trent (: 38:47

Absolutely. Super du well thank you so much for your time today. You are going to be joining us for another episode where we think about how someone can train as a CBT therapist if they wanted to or what a career in CBT might look like and what next steps are possible from that as well. So if you've enjoyed listening to me and Sahan, please do drop some sahan, love into the comments and yeah, we'll be back along very soon with the second episode. Thank you so much for your time today, Sahan.

Sahana (: 39:15

Thank you. Thank you so much. It's been nice talking about CBT in this context. I appreciate you having me.

Dr Marianne Trent (: 39:21

Oh, you're so welcome. Thank you so much. Thank you so much for watching and of course for my guest Sahan in her time talking with us about what CBT is. If you have found it helpful, please do drop a comment, drop a like consider subscribing to the channel if you'd like to see more from me, especially if you'd like to see more from Sahan. She's back along next week too. If you are watching this video because you would like to consider accessing therapy, please do consider checking out the Talking Heads book. It's your guide to help you to find a qualified regulated therapist in the uk. And it's a book that I wrote with my colleague, Dr. Tara. Of course, like any of my books, any of my resources, there are links in the description and in the show notes. Come and grab your free psychology success guide on my website, www.aspiringpsychologist.co.uk.

Jingle Guy (: 40:18

If you're looking to become a psychologist, then let, with this podcast you'll with.