Cognitive behaviour therapy (CBT) to promote SEAL

In this second e-bulletin, Tina Rae considers the use of cognitive behavioural therapy approaches for staff and students in educational contexts, considering how a positive change can be bought about by identifying and replacing dysfunctional, inaccurate or unhelpful thoughts, emotions and behaviours with more realistic positive and useful ones.

Cognitive behaviour therapy (CBT) reveals the role that thoughts play in relation to both our emotions and our behaviours. This approach provides individuals with a way of talking about themselves, their world and people who inhabit it, so that they are more able to understand how what they do effects both their thoughts and feelings, and vice versa.

Many therapists, counsellors, mentors and SENCOs are currently making use of cognitive behaviour therapy approaches in order to support positive change and emotional well-being in the students they support. This kind of approach is a specific goal-orientated therapy, and it frequently results in positive change within a relatively short period of time. This is very unlike traditional psychotherapy, which can, for some individuals, take many years to produce any kind of positive result or outcome.

This approach focuses on the role that thoughts play in regard to both emotions and behaviour, and advocates that change in thought processes can have a significant effect upon altering behaviours. Unlike many of the talking treatments that traditional therapists have used, CBT focuses upon the ‘here and now’, as well as ways to improve the individual state of mind in the present time. This is innovative in the sense that there is no focus on the causes of distress or past symptoms. There has been a great deal of recent research which concludes that CBT is an effective intervention for treating young people’s psychological difficulties and problems. However, adaptations have been made which usually involve altering the pacing and speed of this process in order to ensure its effectiveness.

Restructuring thought processes

Young people, particularly adolescents, can often be flooded with anxious and negative thoughts and doubts. These messages will tend to reinforce a state of inadequacy and/or low levels of self-esteem. The process of cognitive behaviour therapy helps to support young people in reconsidering these negative assumptions. It also allows them to learn how to change their self-perceptions in order to improve their mental and emotional state - this is the key aim of this kind of intervention. Changing negative thought patterns or opinions will help young people to become more able to control and change their behaviours, but this does take practice. This is why another key element of the approach is the requirement to learn, and to put into practice, the skills or strategies discussed in any session.

ABC

The CBT approach breaks overwhelming problems into smaller parts. This allows the student to see how they’re connected and how they affect the individual. Doing this follows a process of A, B, C.

• A, or the activating event, is often referred to as the ‘trigger’ − the thing that causes you to engage in the negative thinking.
• B represents these negative beliefs, which can include thoughts, rules and demands, and the meanings the individual attaches to both external and internal events.
• C is the consequences, or emotions, and the behaviours and physical sensations accompanying these different emotions. It is important to highlight and discuss with the students how the way that they think about a problem can affect how they feel physically and emotionally. It can also alter what they do about it. This is why the key aim for CBT is to break the negative, viscous cycle that some students may find themselves in. For example, if you think that you will get your work wrong you feel angry, and then you don’t give it a try in case it is wrong.

Core beliefs

Core beliefs are the strong, enduring ideas that we may have about ourselves. This kind of belief system gives rise to rules, demands or assumptions which in turn produce automatic thoughts. Core beliefs generally fall into three main categories: beliefs about yourself; beliefs about other people in the world; beliefs that are either positive or negative. What is important is to identify our core beliefs and to also consider why these may or may not be unhelpful. In this way we can begin to identify negative automatic thoughts (NATs).

What are NATs?

Negative core beliefs can cause us to engage in a number of faulty thinking strategies. Individuals will tend to focus on negative automatic thoughts. Some of these thoughts that students may hold about themselves could include the following:

• I always look fat.
• I don’t understand this homework.
• He thinks I’m stupid and thick.
• She gave me a dirty look.
• I’m just such a dunce.
• I can’t do that and I’ll never be able to do it.

When working with students in identifying such faulty thinking, the main aim is to encourage them to break the cycle. These NATs can arise from a number of errors in our thinking, including the following six types of faulty thinking:

1. Doing ourselves down – only focusing on the negatives and seeing bad things about ourselves.
2. Blowing things up or catastrophising – making things worse than they really are.
3. Predicting failure – setting your mind ready to predict failure at all costs.
4. Over emotional thoughts – this is when your emotions become extremely powerful and cloud your judgement.
5. Setting yourself up – setting yourself targets that are too high so that you know then you will fail.
6. Blaming yourself – thinking that everything that goes wrong is your own fault.

When working with young people, it is important to allow them time to consider the effects that these NATs can have prior to them beginning to implement some changes.

Strategies to implement change- behavioural experiments

One of the most helpful interventions for developing new and more positive belief systems, and for challenging these negative automatic thoughts, is to test the evidence. Students can engage in the following questioning process:

• What is the evidence for this thought?
• What is the evidence against this thought?
• What would my best friend say if they heard my thought?
• What would my teacher say if he heard my thought?
• What would my parents or carers say if they heard my thought?
• What would I say to my best friend if s/he had this same thought?
• Am I making mistakes? For example, blowing it up, forgetting my strengths or good points, self-blaming or predicting failure or thinking that I can mind read what others are thinking?

This kind of strategy is particularly useful in terms of reinforcing the need to gather accurate evidence. What we believe about ourselves is not always true. It is not how others always see us and these kinds of beliefs need to be challenged in this way. Using this sort of questioning process, and gathering evidence in the form of such a behavioural experiment, is a particularly positive strategy for beginning to identify and challenge unhelpful beliefs that students may carry.

Further strategies to implement change

Reframing is another useful tool for students to learn and practice. Negative thoughts can be reframed into more positive, balanced and realistic ones. For example, ‘I am just fat’ could be reframed as ‘I need to lose some weight and tone up a bit but my overall shape isn’t that bad’, or ‘I always get the maths work wrong’ could be reframed as ‘some of these sums are difficult but I know I can do the basics – I just need to work hard and find help in order to improve my skills.’

Distraction is also a useful strategy by which to banish NATs. Students can be encouraged to control their thoughts by thinking of something else. For example:

• They can describe in detail what they see around them in order to feel calmer. They can attempt to name all of their favourite bands.
• They can use self-talk techniques and repeat a positive coping message until the negative automatic thought has gone.
• They can ‘bin’ the thoughts by writing them down and then screwing them up and putting them into the bin – symbolically eradicating these negative thoughts.
• Students can also keep a positive diary in order to record positive automatic thoughts (PATs) that may occur during the day, and also engage in realistic goal setting which involves practice.

Overall, what is important when students are engaged in learning and developing these skills is for adults to encourage them to set targets. Remind them that we do not move forwards unless we set realistic goals for ourselves. These should be broken down into small, achievable steps and the ultimate goal continually focused upon. Setting targets allows us to visualise where we want to be in the future and if we feel that we have nowhere to go, nor nothing to move towards, then ultimately we will not be able to affect the change necessary.

The ‘change your mind’ programme

This programme was developed and trialled within high schools in the London Borough of Hillingdon and provides practitioners with a user-friendly resource with which to teach students the key skills and strategies of cognitive behaviour therapy approaches. The 12 sessions in the programme are divided as follows:

Session 1: Problem identification and making links
Session 2: Core beliefs
Session 3: Focus on feelings
Session 4: Focus on feelings 2
Session 5: Control those feelings
Session 6: NATs and PATs
Session 7: Faulty thinking
Session 8: Find the facts
Session 9: More on your core beliefs
Session 10: Thought control
Session 11: Changing behaviours
Session 12: Problem solver

This is a truly practical resource which aims to inform young people about a range of strategies to enable them to prevent the escalation of difficulties, both now and in the future.

What is important to remember is that this is not a substitute for any individualised interventions which are delivered by appropriately trained clinicians. However, ensuring that all young people have access to this kind of approach and resource will hopefully ensure students with both a general well-being and an overall ability to cope with negative feelings and threats to self-esteem during their development.

Finally, it may be helpful to draw your attention to a range of publications and useful resources as follows:

• Green, H., McGinnity, A., Meltzer, H., Ford, T. & Goodman, R. (2005) Mental Health of Children and Young People in Great Britain, 2004. Office for National Statistics on behalf of the Department of Health and the Scottish Executive. Palgrave MacMillan
• Harrington, R. (2000) ‘Cognitive behavioural therapies for children and adolescents’. In: Gelder., Lopez-Ibor, J.J. & Andreasen, N.C. (eds). New Oxford Textbook of Psychiatry. New York: Oxford University Press
• Rae, T. & Egan, S. (2009) Teaching Tools 3: Cognitive Behavioural Approach for Secondary Staff and Students. London: Optimus Education
• Stallard, P. (2002) Think Good - Feel Good. A Cognitive Behaviour Therapy Workbook for Children and Young People. Chichester: John Wiley & Sons Ltd

This e-bulletin issue was first published in February 2010

About the author: Tina Rae, a senior educational psychologist in the London Borough of Hillingdon and the emotional literacy co-ordinator for Chantry SEBD school in West Yiewsley. Tina has extensive experience of teaching, research, programme development and consultancy across the country