Introduction to Cognitive Behavioural Therapy

A brief overview about CBT for teachers.

“Thoughts are just ideas. Just because you think something doesn’t necessarily mean that it’s true”

- Dr. Mark Fefergrad, psychiatrist and CBT expert

This section will briefly outline Cognitive Behavioural Therapy (CBT) and the rationale for its use to impart mental health literacy and skills within this curriculum. Individual sections in this manual will present key CBT principles in greater detail paired with the relevant chapters in Harry Potter and the Prisoner of Azkaban so that teachers can see which concepts they need to impart as they read through the book. 

What is Cognitive Behavioural Therapy and how do we use it?

CBT is the most commonly used talk therapy to treat mental health problems in both youth and adults worldwide.  It is effective for managing anxiety and depression as well as a myriad of other conditions.  It is in wider use than many other therapies because it is brief (often taking a few months to learn), easy to understand, and most people can integrate its skills into their lives with a bit of practice. 

Please note that, in implementing this curriculum, teachers are not expected to deliver “therapy” to their students and should not attempt to do so.  Instead, the goal is to read Harry Potter and the Prisoner of Azkaban and use the CBT frame to teach students to have a greater awareness of what they and their peers are thinking and feeling, how they are behaving and how these three elements interact.  Along the way they will learn basic CBT skills that can be used to manage distress when it happens. 

Ideally, this curriculum would act like a “vaccine”.  Vaccines prevent people exposed to viruses from getting sick.  Our hope is that youth at-risk of mental disorders could use knowledge from this curriculum to avoid becoming ill in a similar way.  Even if that is not possible, the curriculum could help them to recognize the need to seek treatment sooner and could also make CBT delivered by a trained therapist work faster as they would already be familiar with much of its content. And since we all have a mental health, we hope that these skills will be of use for all youth, even those who are not at risk of a serious mental disorder. We know that everyone will inevitably experience distress throughout life and we all need a plan for how to cope with it.

Definitions

‘Cognitive’ refers to what we think and how we think.

‘Behaviour’ refers to everything that we do.

‘Therapy’ is a word used to describe a systematic approach used by doctors including psychiatrists and psychologists to treat a mental disorder.

‘Feelings’ refers to our emotions which are sometimes experienced as pleasant (e.g. happy, excited, relaxed) and sometimes experienced as unpleasant (e.g. sad, worried, embarrassed, ashamed, lonely, angry)

*‘Distress’ refers to mental discomfort or suffering. 

 *‘Resilience’ refers to the ability to recover from and/or overcome difficulties.

*Note that distress and resilience are not formal CBT terms.  But they are important here because CBT and all other therapies are about helping people to be resilient in the face of distress.  One hundred percent of people will experience distress at times in their lives.  This is in contrast to mental disorders which are common but still not experienced by most people.  We want youth to be able to recognize signs that they are in distress. We also want them to respond by using strategies that they have learned in order to be resilient regardless of whether or not they have a diagnosable psychiatric condition.

 The central idea in Cognitive Behavioural Therapy (CBT) is that our thoughts about an event or an experience powerfully affect the way we respond to it both voluntarily (i.e. behaviourally) and in ways that are out of our control (emotionally and/or physically). I n other words, we feel and behave the way we think.  See the following sequence for an overview of how this works:

cbt.png

A

Activating Event/Trigger

  • real external event that has occurred

  • future event you anticipate occurring

  • internal event in your mind

B

Beliefs & Meanings About the Event

  • thoughts

  • personal rules

  • demands you make on yourself, the world, and/or other people

  • meanings you attach to external and internal events

C

Consequences/ Emotional & Behavioural Response

  • emotions (pleasant or unpleasant)

  • physical sensations (panic, shaking, dizziness)

  • behaviours (constructive or self-defeating actions)

The Vicious Cycle

Here is a real life example of the dynamic influence of our thoughts, feelings and behaviours.

Vicious cycle updated.png

While we cannot directly control our feelings, we can run “experiments” with our thoughts to test how accurately they reflect reality and with our behaviours to test whether changing them might make us feel differently.  For example, we could look at the student above’s past successes when writing tests or participating in activities and use them to challenge the idea that the student is “stupid”.  Or we could encourage him or her to take a risk and go to the party to see whether it results in a better mood (spoiler alert: chances are it will!).

Therefore, CBT works on the principle that we can live more happily and productively if we think and act in healthier ways. 

 CBT concepts that will be discussed in detail in this curriculum include (see individual sections/units):

•      Risk and protective factors for distress and mental health problems

•      Cognitive distortions (“thinking errors”)

•      Cognitive reframing (how to challenge your thoughts about a situation)

•      Fear hierarchies (building up confidence to face increasingly anxiety provoking situations)

•      Behavioral activation (getting out and doing things)

•      Core beliefs (beliefs about the self, the world or the future that influence our thinking)

In summary, sometimes our thinking patterns and behaviours can keep us stuck in distressing moods and relationships. If we can understand the link between our thoughts, feelings and behaviours, and learn to think about ourselves and situations in more helpful ways, we can feel happier, calmer and more confident, lead a more meaningful life, and be able to enjoy more positive relationships.