A nice description of cognitive behavioural therapy is: “Learning to convert unhelpful thoughts into helpful ones”. However, that includes only the cognitive part of this treatment method. CBT is actually two forms of therapy that have been combined: cognitive therapy by Aaron Beck (1921) and behavioural therapy by Albert Ellis (1913).

The cognitive part of the therapy looks at thought patterns and whether this may involve interpretations of certain situations or people that are incorrect, or undesirable. These may generate automatic, irrational, thoughts. These irrational thoughts can lead to dysfunctional behaviour, or behaviour that contributes to the problems someone is experiencing. This creates a vicious circle of thoughts and behaviour. Therefore, behavioural therapy is of great importance for the effectiveness of this therapy to break the cycle.

Irrational thoughts create an expectation that something bad is about to happen, without there being any concrete indications that this will actually be the case. This often occurs as a result of past experiences that had a significant negative impact. This learned behaviour, creates an expectation that the bad experience can happen again in certain similar situations. Subconsciously you may act to reduce the fear, or even start avoiding certain situations, without even realising you are doing so, or why you are doing so. This can have a significant and unwanted impact on your life and relationships.

Bitten by a dog
To illustrate this better, here is an example of a child who was bitten by a large dog as a small boy. Since then the boy perceives all large dogs as dangerous. Even in adulthood, if he sees a dog 30 meters away, he immediately reacts by walking the other way. The thought that precedes this is "that dog will bite me" and / or "that is a dangerous dog". His response is, without thinking about it, to immediately walk the other way.

A bigger problem arises with the arrival of new neighbours, who have a large dog. The man likes to sit outside in his garden. However, since the dog moved in next door, and despite the high fence between the gardens, he no longer uses his garden. He fears that the dog will jump over the fence, and he reacts to that that fear by not going out alone anymore. He only goes into the garden when someone else is there. His thought or reasoning is "the other person will also watch the dog, and be able protect me if it jumps over the fence." This way of acting is called safety behaviour.

Challenging your Automatic Thoughts
CBT ensures that these thoughts and behaviours are broken, including by challenging them, checking whether they are really correct. We do this using the following method:

• Event: Description of the original event, visualised as if you were looking through a camera
• Thoughts: Define and share the specific thoughts that are triggered by the event
• Feeling / Behaviour: what feeling or behaviour is the result of these thoughts?

A second step in CBT is exposure. During the CBT sessions you may practice exposure to your fears. In addition, new thoughts and behaviours are learned that are much more efficient. As a result, depressing, stressful and / or anxious thoughts can disappear or diminish significantly.

I treat the following mental health problems with CBT:

• Anxiety disorders
• Mood disorders
• Burnout
• Post-traumatic stress disorder (PTSD)