Welldoing spoke to Avy Joseph, CBT practitioner and author of Cognitive Behaviour Therapy: Your route out of perfectionism, self-sabotage and other everyday habits with CBT (published by Capstone) to find out more about CBT, self-acceptance and negative self-talk.


How would you explain CBT?

Cognitive Behaviour Therapy is a form of therapy or counselling that has the view that most emotional and mental health problems arise from faulty thinking and the remedy is found in changing the faulty thinking, as well correcting unhelpful behaviour. It focuses on present problems and present thinking, in contrast to the earlier forms of psychotherapy.

CBT is an umbrella term comprising a number of different counselling models. Two of the main schools of CBT are Cognitive Therapy (CT, developed by Aaron Beck) and Rational Emotive Behaviour Therapy (REBT, developed by Albert Ellis). My book is predominantly based on the REBT model of CBT.

CBT models are evidence-based theories and have a structured framework and process of therapy. REBT looks at the person as whole and is a humanistic and philosophical model that is grounded in helping people to acknowledge the past, present and future. It is a model of acceptance. 


What is CBT most useful for?

The REBT model of CBT is useful for emotional problems like anxiety, depression, hurt, guilt, shame, unhealthy anger, unhealthy envy. Such problems can be clinical as in Obsessive Compulsive Disorder, panic disorder, clinical depression, Generalised Anxiety Disorder, social anxiety, eating disorders, to name but a few. CBT is also useful for sub-clinical problems found such as presentation anxiety, fear of failure, procrastination, relationship problems, stress etc. It is also useful as a psycho-educational model which cab be taught at schools and for enhancing sporting performance and goal achievements.



What are the biggest misconceptions about CBT?

There is a misconception that CBT is just one school developed by one person. It is actually an umbrella term which includes CT, REBT, Mindfulness-based CBT, Acceptance and Commitment Therapy etc. Some critics have used the term CBT when in fact they were discussing just one particular school of CBT.

General misconceptions include:

- CBT ignores the past. It doesn't. The issue the client or patient may be disturbed about can be a past, present or future issue.

- CBT doesn't think a therapeutic relationship is important. Again, untrue. Forming a therapeutic alliance and rapport with our clients/patients is very important. This misconception might be influenced by telephone based CBT offered by the NHS for sub-clinical problems.

- CBT is not deep enough because it focuses on the 'here and now'. Not true. It's focus is on identifying core unhealthy beliefs and you cannot get deeper than that. All of the CBT models are based on how a problem is maintained as opposed to how the problem was created or acquired.



How are self-acceptance and problem solving abilities connected and how can CBT help with this?

Self-acceptance means acknowledging the fact that we are fallible human beings. We make mistakes, we fail, we can behave in unhelpful ways, we get neurotic, we can judge one another unfairly, and so on.

Judging ourselves leads to poor psychological and emotional health and impacts our performance adversely. Believing that you would be a total failure and worthless if you were to fail leads to anxiety and depression. In such a state your mind would be pre-occupied with beating yourself down as opposed to thinking in a solution or problem solving way.

This is isn't soft psychology and self-acceptance does not mean that you 'don't mind failing' or somehow 'approve' of failing. It means acknowledging the disappointment and judging the behaviour or performance, but not the self in its entirety. Problems of self-esteem are created because a person makes their worth conditional to success or perfection.

CBT advocates self-acceptance and helps you learn how to accept yourself as a fallible human being. This leads to a focus on one's goals and creates a problem solving mind in the face of disappointments and failures.



What are 'negative automatic thoughts' and how can people change their internal dialogue?

Negative automatic thoughts are thoughts that appear when you are in a specific situation e.g. going for a job interview. You just go along with them without analysing them. They are a consequence of holding an unhealthy belief that is triggered in a specific situation.

Self-talk is your inner voice. Unlike negative automatic thoughts it happens at normal speed in your head. It is important that we ensure our self-talk is helpful and realistic. Talking to yourself in a negative way, for example, will have an impact on how you perceive yourself which in turn impacts your performance and ultimately your ability to achieve your goals. To change your self-talk you would need to change your unhelpful self-beliefs and then commit to changing your negative self into its helpful and constructive version. This has to be repeated until it become a good habit.