Skip to 0 minutes and 17 seconds In cognitive behaviour therapy we have a particular way of looking at how people make sense of the world about them. And one of the ways we do this, we call the hot cross bun model. So the cognitive behavioural model has four core components in it. Two are already implied by the name. So we’re interested in cognition, that means thinking, the things that go on inside our heads. So sometimes that would mean memories as well and thoughts about the future as well as the past. Thinking and behaviour. So we’re interested in what people do and how that affects their feelings, and how when they feel in a different mood they might behave in different sorts of ways.
Skip to 0 minutes and 54 seconds Next we have the feelings themselves, the emotions. So these are happiness, sadness, anger, that kind of thing. And finally and importantly, there’s the physical reaction. So we have to– these sorts of emotions and those sorts of events. So our heart beating faster, our hands sweating, butterflies in our stomach. Those are all the physical reactions that are part of our model. So we have these four components. All of them relate to each other. So although we can talk about them separately, in real life they don’t happen on their own. So we put them into a model that we call the hit cross bun.
Skip to 1 minute and 31 seconds So each of these four components is linked to each of the others, and what you see in the picture is that each one has got an arrow going to each of the others. So if you change one thing, everything else will change as well. CBT really focuses on the thoughts and behaviours and that’s because they’re actually more accessible, they’re slightly more straightforward for us to get to. If I say to you, OK well one symptom of anxiety or depression is your heart beats fast, or you start sweating, so stop that and you’ll feel better, that’s very difficult to do. How can we do that? What if I say to you, well just cheer up, make yourself feel better.
Skip to 2 minutes and 8 seconds We know that’s difficult, otherwise we would do it all the time. So we go for thinking and behaviour because we can actually influence those. We have more control over those parts of the system if you like.
Fundamentals of CBT: An introduction to the CBT model
In this video, Professor Shirley Reynolds introduces you to the CBT model using a hot cross bun analogy first used by Christine Padesky. We have seen that anxiety and depression can influence how people perceive the world in a number of ways, including:
preferentially attending to threatening or negative information
interpreting neutral information in a negative or threatening way
remembering negative or threatening information more readily than neutral or positive information.
Research has indicated that these biases may contribute to and maintain depression and anxiety related difficulties by leading to a narrowed and inaccurate sense of the world; in other words, things appear more threatening and negative than they actually might be. Let’s think back to how one person with anxiety described their experience:
‘It feels like you’re scared of bad outcomes that you can’t change by yourself, it changes the person’s thoughts to negative ones that simply aren’t true.’
In essence, the Cognitive Behavioural approach highlights the link between how people think, how people feel (both emotionally and physically) and how they behave in response to these thoughts and feelings. These factors (thoughts, emotions, physical feelings and behaviour) influence each other and stem from the way in which we perceive the world around us. Generally speaking, this perception of the world around us can be more important in determining how we feel than the nature of world itself (there are of course obvious exceptions, for example, being exposed to war or other environments which have an important bearing on well-being). So the way in which we process information from the world around us (ie the life situations and events that occur) is key in determining how we react to the world – in other words, the way in which you think about things (cognitions) can influence the way in which you feel (emotions and physical feelings/sensations), and what you do as a consequence (behaviour).
This CBT model, which highlights the impact of a situation by examining thoughts, emotions, behaviour and physical sensations is known as the 5 areas model, or more commonly in the UK at the ‘hot cross bun’ (for those who are not familiar with this term, a hot cross bun is a spiced sweet bun made with currants or raisins, marked with a cross on the top, and traditionally eaten in the UK at Easter). This term was first coined by Christine Padesksy.
As we have seen from the examples, anxiety and depression can lead us to interpret information about the world around us as more threatening and negative than they really are. This in turn may influence how we think, feel and behave (we will explore how this may manifest itself in anxiety and depression over the next couple of sessions).
The Cognitive Behavioural approach helps us to better understand how and why difficulties around anxiety and depression persist; a key part of the treatment involves exploring and addressing the thoughts (or cognitions) and behaviours that can maintain and amplify very difficult and unpleasant emotions. CBT can help individuals consider alternative interpretations of events and to change the behaviours that interfere with recovery. During the remainder of the course, we will look in more detail about maintenance cycles in anxiety and depression, and specific techniques that are used to address these difficulties.
CBT is very useful in terms of helping us to make sense of what often feels like overwhelming difficulties by breaking them down into smaller parts and seeing how different aspects may influence each other and keep the problems going. CBT is an effective treatment for anxiety and depression and is recommended by the NHS in England. It’s in no way a ‘quick fix’ for difficulties, and we’ll see over the coming sessions that it requires work and effort on the part of the patient. However, by engaging in a course of CBT, patients can learn the skills necessary to address their current difficulties and to help them stay well in the longer term.
During the remainder of the course, we will use the CBT approach to explain what keeps anxiety and depression going and we will introduce you to specific techniques that are used to address these difficulties. We will also hear from patients who have been referred for CBT and the therapists who provide support with this treatment approach.
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