Behaviour therapies deal solely with behaviour; this is their defining characteristic. So, they have nothing to do with thoughts and feelings. However, if one believes that thoughts and feelings influence or help to determine behaviour, ^ then it might be useful to work on them as well as directly on the behaviour ^ itself. This is certainly a widespread everyday belief.
The various types of cognitive behaviour therapy (CBT) were developed as a -way of achieving this, aimed at dealing with both behaviour and maladaptive ^ beliefs. The simple aim of CBT is to bring about the control of unpleasant emo- ^ tions and feelings by helping to provide patients with better ways of interpreting < their experiences. To take a commonplace example, very anxious or very depressed ^ people distort their thinking in ways that are, naturally enough, dominated by ^ anxiety or depression. The cognitive behaviour therapist helps them to find ways of changing that type of thinking and so alleviate the anxiety or depression.
Behaviour is not forgotten; it becomes relevant at the end of the therapeutic -process. New thoughts or new ways of thinking lead to new ways of testing other behaviour and of doing new things. For example, someone who is experiencing i large-scale mood changes, particularly in the negative direction, might be encouraged to keep a precise record of any changes of mood that occur at work and at ^ home. Keeping and reviewing such a record might well lead to changes in the 1 person's ideas about 'things that go wrong at work and make me irritable at < home'. In this instance of CBT, behaviour (keeping records) has been suggested that, in turn, alters beliefs or ideas or ways of thinking that, in turn, alters feelings about the situation.
Cognitive behaviour therapists help patients replace one type of thought with another. For example, typical thoughts might be: 'Why am I always so useless?', 'Why does nothing go right for me?', 'There I go again, messing up as usual.' Such thoughts only help to drive the person down into greater depths of negative moods and feelings. Alternative thoughts that might be prompted are: 'I'm good at this', 'I can cope with this; I've coped with much worse', 'This is a challenge that I know I can meet.' If this type of thought replacement seems like the 'power of positive thinking', long known in self-help books, then it is because it is. Positive thinking does carry a great deal of power.
Like many therapies, then, CBT is verbally based and deals with changing beliefs in order to change behaviour. Nevertheless, it is important to say that the successful performance of something is more effective for a person than simple changes in beliefs. For example, actually taking an examination successfully or going to a party or giving a speech without breaking down with anxiety is clearly more effective than simply believing that one might be able to without actually trying it. Both changed beliefs and changed behaviours are important, but it is changes in behaviour that lead to greater feelings of self-efficacy. This, then, helps to set up a positive feedback system, a very non-vicious spiral.
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