| Cognitive Behavioural Therapy (CBT) is an effective | | | | these problems may be hidden. But we can use |
| psychotherapy for a wide range of emotional and | | | | NATs and Thinking Errors as clues. |
| psychological problems. The basic tenet of CBT is | | | | In my experience as a Psychiatrist in Edinburgh I |
| that our emotions are affected by our cognitions. To | | | | have found two techniques of most benefit in the |
| put it another way - the way we think affects the | | | | search for the NCBs of my clients. |
| way we feel. | | | | Firstly, there is the method of "Repeated |
| A CBT therapist aims to help people suffering from | | | | Questioning". I ask the client what a particular NAT |
| emotional problems by helping them to identify the | | | | he has identified means to him - he will give an |
| ways in which their thinking may be causing their | | | | answer, and I then ask him what that answer means |
| problem. A first step in CBT is therefore the | | | | to him. He will give a second answer, and I then ask |
| identification of "Negative Automatic Thoughts" (or | | | | him what that second answer means to him, and so |
| "NATs" for short) - these are the thoughts that | | | | on. Within a short space of time, the client ends up |
| accompany unpleasant or unhelpful emotions such as | | | | with a global statement that can't be taken any |
| depression or anxiety. | | | | further. This is a Negative Core Belief. It's probably |
| A closely related aim of the CBT therapist is the | | | | best demonstrated with an example: |
| identification of so-called "Thinking Errors". These are | | | | Client: |
| habitual (and unhelpful) ways a person has of thinking | | | | "There's loads of litter around |
| about themselves, others, and the world around | | | | Edinburgh" (He's angry) |
| them. These thinking errors will often twist or distort | | | | CBT Therapist: "What does that |
| experiences, acting to make the person seem a | | | | mean?" |
| failure, others as hostile, and the world as dangerous | | | | Client: |
| or unpleasant. | | | | "That I'm the only one who cares |
| The identification of NATs and related Thinking Errors | | | | about it" |
| is half the battle in CBT - once a person is aware of | | | | CBT Therapist: "What does it mean |
| their unhelpful thoughts and mental habits they can | | | | if you're the only one who cares about it?" |
| then choose to think in more rational, healthy ways. | | | | Client: "People don't care about |
| A CBT therapist can guide them through this (fairly | | | | things that aren't their personal property" |
| straightforward) process. | | | | CBT Therapist: "And what does it |
| As a Psychiatrist and therapist working in Edinburgh I | | | | mean if people only care about their own stuff?" |
| use CBT techniques extensively. Some of my clients | | | | Client: |
| are quite happy with the results they get from | | | | "People are only out for |
| simply challenging their NATs and Thinking Errors - | | | | themselves" |
| they feel much better and have no desire to delve | | | | ("People are only out for themselves". This is the |
| further. However, the majority of clients are keen to | | | | client's Negative Core Belief - a global statement that |
| "get to the bottom" of why they had their emotional | | | | is uncompromising and will clearly influence the way |
| problems in the first place. I tend to encourage this | | | | he views and interacts with others in other areas of |
| further work as it helps to reinforce the progress | | | | life, not simply littering!) |
| made to date and, in my opinion, helps to prevent | | | | A second method of identifying Negative Core Beliefs |
| the client from relapsing at some future date. | | | | is to look for the "themes" that run throughout a |
| This further work involves a search for "Negative | | | | persons many NATs and Thinking Errors. Such |
| Core Beliefs" (or "NCBs"). These are the unhelpful | | | | themes may be "I'm a failure" or "There's no point to |
| beliefs that a person has had throughout their later | | | | life" (very common in depression), or perhaps "The |
| childhood and adult life. They are core components of | | | | world's a dangerous place to live" (common in anxiety |
| the person's personality and they are the root cause | | | | conditions). |
| of the person's Thinking Errors and ultimately their | | | | Once a client's Negative Core Beliefs have been |
| NATs. If a CBT therapist can help a person to | | | | identified, the CBT therapist will (along with the client) |
| change their Negative Core Beliefs (or, more | | | | try and explore alternative and more rational ways of |
| realistically, find more rational and healthier | | | | thinking about the self, others, and the world in |
| alternatives), then the person's Thinking Errors and | | | | general. This is where real, sustained recovery from |
| NATs will diminish, and their emotional problems will | | | | emotional problems is made and I will discuss this in a |
| lessen (usually!). | | | | follow-up article entitled "Cognitive Behavioural |
| A difficulty with NCBs is that a person is rarely aware | | | | Therapy (CBT) and Negative Core Beliefs (NCBs) - |
| of them. Even when someone is competent at | | | | Treatment". |
| identifying NATs and Thinking Errors, the cause of | | | | |