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Oct 24, 2013

Can cognitive behavioural therapy really change our brains?

Category: News
Posted by: Claire

What is cognitive behavioural therapy?

CBT is based on the idea that problems aren't caused by situations
themselves, but by how we interpret them in our thoughts. These can then affect
our feelings and actions.

Situation affects thoughts, which then affect feelings and actions The way we think about a
situation can affect how we feel and how we act

For example, if someone you know walks by without saying hello, what's your

You might think that they ignored you because they don't like you, which
might make you feel rejected. So you might be tempted to avoid them the next
time you meet. This could breed more bad feeling between you both and more
"rejections", until eventually you believe that you must be unlikeable. If this
happened with enough people, you could start to withdraw socially.

But how well did you interpret the situation in the first place?

Common errors in thinking style

  • Emotional reasoning - e.g. I feel guilty so I must be guilty

  • Jumping to conclusions - e.g. if I go into work when I'm feeling low, I'll
    only feel worse

  • All-or-nothing thinking - e.g. if I've not done it perfectly, then it's
    absolutely useless

  • Mental filtering - e.g. noticing my failures more than my successes

  • Over generalising - e.g. nothing ever goes well in my life

  • Labelling - e.g. I'm a loser

CBT aims to break negative vicious cycles by identifying
unhelpful ways of reacting that creep into our thinking.

"Emotional reasoning is a very common error in people's thinking," explains
Dr Jennifer Wild, Consultant Clinical Psychologist from Kings College London.
"That's when you think something must be true because of how you feel."

CBT tries to replace these negative thinking styles with more useful or
realistic ones.

This can be a challenge for people with mental health disorders, as their
thinking styles can be well-established.

How do we break negative thinking

Some psychological theories suggest that we learn these negative thinking
patterns through a process called negative reinforcement.

Spider Graded exposure can help people
confront their phobias

For example, if you have a fear of spiders, by avoiding them you learn that
your anxiety levels can be reduced. So you're rewarded in the short term with
less anxiety but this reinforces the fear.

To unlearn these patterns, people with phobias and anxiety disorders often
use a CBT technique called graded exposure. By gradually confronting what
frightens them and observing that nothing bad actually happens, it's possible to
slowly retrain their brains to not fear it.

How does cognitive behavioural therapy
work on the brain?

Primitive survival instincts like fear are processed in a part of the brain
called the limbic system. This includes the amygdala, a region that processes
emotion, and the hippocampus, a region involved in reliving traumatic memories.

“Start Quote

It seems that CBT really can change your brain and rewire

End Quote Dr Paul Blenkiron, Consultant Psychiatrist

Brain scan studies have shown that overactivity in these
two regions returns to normal after a course of CBT in people with phobias.

What's more, studies
have found that CBT can also change the prefrontal cortex, the part of the brain
responsible for higher-level thinking.

So it seems that CBT might be able to make real, physical changes to both our
"emotional brain" (instincts) and our "logical brain" (thoughts).

Intriguingly, similar patterns of brain changes have been seen with CBT and
with drug treatments, suggesting that psychotherapies and medications might work
on the brain in parallel ways.

How effective is cognitive behavioural

Of all the talking therapies, CBT has the most clinical evidence to show that
it works.

Studies have shown that it is at least as effective as medication for many
types of depression and anxiety disorders.

But unlike many drugs, there are few side effects with CBT. After a
relatively short course, people have often described long-lasting benefits.

"In the trials we've run with post-traumatic stress disorder [PTSD] and
social anxiety disorder, we've seen that even when people stop the therapy, they
continue improving because they have new tools in place and they've made
behavioural and thinking style changes," Dr Wild explains.

Find out more

Two people talking

  • Watch David, 25, and Wayne, 24, use CBT to help with their mental health in
    Inside My Mind on BBC Three,
    7 August 2013 at 8pm, and afterwards on iPlayer

  • Find out more about mental health in the It's a Mad World season on
    BBC Three

CBT may not be for everyone, however.

Since the focus is on tackling the here and now, people with more complicated
roots to their mental problems which could stem from their childhood, for
example, may need another type of longer-term therapy to explore this.

CBT also relies on commitment from the individual, including "homework"
between therapy sessions. It can also involve confronting fears and anxieties,
and this isn't always easy to do.

Ultimately, as with many types of treatment, some people will benefit from
CBT more than others and psychologists and neuroscientists are beginning to
unravel the reasons behind this.