How does Cognitive Behavioural Therapy work?

CBT can help you to make sense of overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you. These parts are: A Situation - a problem, event or difficult situation.
 
From this can follow:
  • Thoughts
  • Emotions
  • Physical feelings
  • Actions
Each of these areas can affect the others. How you think about a problem can affect how you feel physically and emotionally.
 
All these areas of life can connect like this: 5 Areas
 
What happens in one of these areas has an affect in all the others.
 
There are helpful and unhelpful ways of reacting to most situations, depending on how you think about it. 
 
An example:

The Situation

You've had a bad day, feel fed up, so go out shopping. As you walk down the road, someone you know walks by and, apparently, ignores you. This starts a cascade of:
 
 
Unhelpful
Helpful
Thoughts: He/she ignored me - they don't like me. He/she looks a bit wrapped up in themselves - I wonder if there's something wrong?
Emotions:

Low, sad and rejected. Concerned for the other person, positive.
Physical feelings: Stomach cramps, low energy, feel sick. None - feel comfortable.
Actions: Go home and avoid them. Get in touch to make sure they're OK.
 
The same situation has led to two very different results, depending on how you thought about the situation.
 
How you think has affected how you felt and what you did. In the example in the left hand column, you've jumped to a conclusion without very much evidence for it - and this matters, because it's led to:
 
  • having a number of uncomfortable feelings.
  • behaving in a way that makes you feel worse.
If you go home feeling depressed, you'll probably brood on what has happened and feel worse. If you get in touch with the other person, there's a good chance you'll feel better about yourself.
 
If you avoid the other person, you won't be able to correct any misunderstandings about what they think of you - and you will probably feel worse.
 
This 'vicious circle' can make you feel worse. It can even create new situations that make you feel worse. You can start to believe quite unrealistic (and unpleasant) things about yourself. This happens because, when we are distressed, we are more likely to jump to conclusions and to interpret things in extreme and unhelpful ways.
 
CBT can help you to break this vicious circle of altered thinking, feelings and behaviour. When you see the parts of the sequence clearly, you can change them - and so change the way you feel. CBT aims to get you to a point where you can 'do it yourself', and work out your own ways of tackling these problems.

Facing a fear of flying

Step 1: Look at photos of planes.

Step 2: Watch a video of a plane in flight.

Step 3: Watch real planes take off.

Step 4: Book a plane ticket.

Step 5: Pack for your flight.

Step 6: Drive to the airport.

Step 7: Check in for your flight.

Step 8: Wait for boarding.

Step 9: Get on the plane.

Step 10: Take the flight.