5 ways to make the most of your CBT therapy sessions

Now that you have taken the brave step of reaching out for help and since you are investing time and effort in coming to sessions, I’d like to offer you some tips on making the most of your CBT therapy sessions. Here's how best to navigate the process and  work towards the life you want.

First task. Let's clear up any misconceptions about therapy. Of course CBT is a talking therapy, but it might be more truthful if we called it a talking and doing therapy. Emotional change only comes from thinking and doing things differently. It will never be as effective to only talk about your problems. Talking may help you to understand why you feel the way you feel or think the way you think; of course, this can be helpful. But, if you think of therapy as like playing a musical instrument, such as the guitar, you will never succeed at playing by just talking, thinking or reading about guitars. Progress comes from practice, perseverance and commitment. Making changes are the way to experience the progress you are looking for, and CBT is most effective when approached as an active therapy.

The more you can do between sessions influences the amount of time you may spend in therapy. If at one far end of the scale, you only turn up to sessions to talk with your therapist, then it goes without saying progress will be slower.

Here are 5 tips to make the most of your therapy sessions.

1 Get yourself a therapy notebook
Even though we all carry phones around, and these can be helpful for on-the-fly notes, slowing down and putting pen to paper really does help to clarify the kinds of thoughts we are having, and can even help us to see our thoughts for what they are. We can better identify patterns of thinking which may be contributing to our problems.

To get the most out of therapy it is beneficial to make notes before, during and after sessions.

Before sessions Make a note of anything which would be helpful for you to discuss in your therapy session. However, since CBT is a goal-oriented therapy, if it is on a different topic entirely, you may have to weigh up whether this is something you would like to spend time discussing. 

Perhaps something might occur to you during the week which you wish you had told your therapist and which you think may be relevant to your treatment. If so, make a note, so you don’t forget.

During sessions Keep your pen handy during sessions and be ready to write down anything you find helpful or that you will want to remember. You never know when you might have a lightbulb moment. And it’s a good discipline to get into so that you remember any tasks you might have planned for between sessions… Therapists don’t like to nag, they really don’t.

After sessions Reflecting on a session is a good way to make the most of your latest session. Find some time, ideally while the session is still relatively fresh in your mind, and ask yourself a couple of simple questions. What stood out for you in the session today? How are you feeling now? What did you find helpful today? Did you (even in any small way) experience different feelings or think differently about yourself, others or the world in general? What friendly, compassionate and kind thing could you say to yourself now, which would support you to go about the rest of your day?

2 Learn to journal
During CBT we will cover different ways of journaling your thoughts, feelings, behaviours and physical sensations / symptoms. Practising noticing your own particular patterns is going to be important, because if we would like to change how we think and act, then we first need to notice our own tendencies which may be unhelpful and maintaining any difficulties we might be experiencing.

I’ll often supply different thought records and templates so you can practise noticing, then working towards reframing or managing your thinking in a new and helpful way.

3 Be clear about your goals
Even if your initial therapy goal is quite general, such as learning to manage your anxiety, or to cope better with life’s challenges, as therapy continues, it will be helpful to spend time reflecting on what specifically you want to be doing differently. As the weeks go by, it will help you enormously to have a picture of what you would like to aim for, the more specific the better. As with all goals, it’s important for your goals to be specific, measurable, achievable and to have an idea of when you would like to do this by. Goals help therapy to remain on track, although it is fine to step off the pathway from time to time. Life is like that and we can accept that sometimes life throws curveballs during your time in therapy and these may be more pressing to talk about at times.

4 Be honest
This is important on different levels. I really encourage my clients to understand that they are the expert on themselves and to be as honest as they can about how they think and feel. This will help your therapist to devise the best plan for you. If ever you don’t understand a concept or the rationale for an exercise, point it out, so your therapist can be more helpful. If you have struggled with an exercise, let your therapist know. 

5 Do your homework
Homework, or as some might call it, an action plan, consists of between sessions tasks. You might be working towards managing your thinking in a different way, practising mindfulness or relaxation techniques, or journaling. You might be changing what you do and approaching rather than avoiding difficult situations, places, conversations or people. You might be learning to relate to yourself in a kinder, more compassionate way.

In CBT we focus on using evidence based techniques, but it is only in the practice of these where you will learn what works best for you. Even if you think it might not work for you, can you be willing just to see that as an unhelpful thought which may be standing between you and feeling better.

Many tasks in CBT need to be repeated in order to experience a benefit, so be prepared to practice and repeat a task for at least a week or two to see what benefits you experience. Once you know what works for you, you’ll feel encouraged to keep doing it.

So these were the five things I’d like you to know. If that all sounds like a lot of hard work, you probably already knew that nobody ever said therapy was easy. It isn't, but it can be the most rewarding and valuable experience. It can be emotional and it can (clients say) even be fascinating. I wish you well in your therapy and much courage to try new and helpful ways of thinking and acting.

Ali Binns is a CBT therapist based in Bath, UK. To find out more click on the links at the top of the page.

Mindfulness for beginners: breathing exercise

Thinking is great, except when it's not! Our brains are wonderful things - our thinking brains enable us to plan, speak, connect, problem-solve, create, invent and imagine. Unfortunately our minds have a natural tendency to seek out the negative. Many of the thoughts that stick around are the ones that can lead to worry and rumination. These thoughts can seem to pop up out of nowhere.

If you've ever suffered from stress, anxiety or depression, you'll know the sort of thoughts. The ones that hang about and really get to you. Nobody's immune. Research suggests that we have between 50,000 to 70,000 thoughts a day and around three-quarters of these are negative. You can thank your brain for that too. In evolutionary terms, this tendency to seek out threatening messages was useful for survival. Operating on a better-safe-than-sorry policy, our ancient ancestors who survived were the ones who could best negatively predict that a long curving object on the jungle floor was a snake and so stayed safe. The understanding being that positively presuming the said object was a stick would have been a risk to our survival as a species.

We're all living with the legacy of these tricky brains which are hardwired to seek out threats in our environment. Once we're suffering from anxiety or stress, and our fight or flight reflex has kicked in, our minds begin to race in an attempt to quickly evaluate threats, negative thoughts increase and we can soon get caught up in spirals of negative thinking. Fortunately, we can learn to manage the rise of negative thoughts, simply by paying attention to them with mindfulness exercises. The simplest technique is mindfulness of breath.

This is an ideal mindfulness exercise for beginners as it's portable and do-able. All you need is a few moments and your breath - which you always carry with you! Mindful breathing helps you to distance yourself from the content of negative thoughts, as, over time, you come to notice and understand that thoughts are often nothing but thoughts, and certainly they're not always facts. Learning to notice and let go of unhelpful thoughts can be key to combating anxiety and depression.

Here's how to practise mindfulness of breath. (You may like to spend anything between 5 and 15 minutes for this exercise.)

Begin by finding a place to sit, and, close your eyes. Adopt an upright posture, alert yet relaxed to enable you to pay attention. The aim isn't specifically to relax (although this is often a welcome side effect).

Settle as you are, noticing your feet upon the floor, hands in your lap and any points your body makes contact with your seat. Bring your attention to your breath now. Simply follow the rise and fall of your breathing. There's no need to try to change your breath at all. Just allow it to be as it is, letting it do its own thing, accepting things just as they are. Notice and follow the breath in your abdomen. If you like, you can place your hand there to feel this gentle movement. 

Be curious about the sensations of your breath, in and out. Become aware of where else you notice the breath in your body. Perhaps you feel it in your chest, or the sensations of the breath entering your nose. Bring your attention to wherever you feel it most, and see what sensations you discover. 

If at any point during this exercise, your mind does wander, you might be relieved to know, this is completely normal. Simply make a note of where your mind has wandered and bring your focus back to your breathing. It can help to note with a simple word, such as 'thinking', 'feeling', 'planning', 'judging', 'remembering', what your mind was doing and return your focus to your breath. Every time you notice your mind has wandered know that this is part of the exercise - you've managed a moment of mindfulness. Treat your mind as if it were a bouncy puppy, who needs to be reminded to come back to heel, over and over again. There's no need to get cross with it, only gentle reminders are needed to begin to train your mind to stay present, instead of running back to the past or taking a wander into the future.

Continue paying attention to your breathing for your chosen time (some people find a timer helps). When you're ready to bring this exercise to a close, begin to notice the sounds around you, and the feeling of your feet on the floor, and your body in the chair. Slowly open your eyes, and take in the sights around you. Give yourself a couple of moments to take everything in, and move into the rest of your day.

Mindfulness of chocolate

Are you one of those people who tends to scoff a bar of chocolate and then wonder where it's gone? Or do you savour each piece, making it last, feeling satisfied and content, getting the most from every moment? If you're the latter, then congratulations, you're well on the way to mindful awareness.

If not, here's a taster of mindfulness you can try at home, or at your desk, any time you choose. This is one of my favourite exercises when I am introducing clients to the benefits of Mindfulness, because it's simple and begins the practice of focus and present moment awareness. During the exercise, just try as best as you can, to keep your focus on the chocolate... Here's how to experience a mindful moment and discover the benefits of being present.

You will need: Your choice of square of chocolate, chocolate button, Minstrel or Smartie (just one, yes!) If you don't like chocolate, simple, try substituting the chocolate with a small piece of dried fruit, or other small treat. 

Spend about 20-30 seconds on each step...

1. Unwrap the wrapper, listening to the sound of the paper and slowly remove your piece of chocolate.

2. Take the chocolate in your hand and use your eyes to take in every detail of that chocolate - shape, texture, colour, any patterns. What do you see? And use sense of touch to take in the weight, the temperature and the texture. What do you find?

3. Now move the chocolate to your nose and breathe in the scent of the chocolate. What are its qualities? How do you sense the smell of the chocolate?

4. Take the chocolate to your ear and, this might seem strange, but tap the chocolate and see what noise it makes... Again, what do you notice?

5. Bring the chocolate to your lips and rest it there for a moment. What do you notice happening? What do you want to do? Do you notice any thoughts?

6. Place the chocolate in your mouth and just rest it there. What happens now? Resist the urge to chew! 

7. After a short while, you can now bite into the chocolate. What do you notice? Flavour, taste, relief that you can now eat the chocolate?

8. Savour the chocolate for as long as you like and reflect on what you noticed during this exercise.

Many people say they didn't realise how much they miss when they ordinarily munch through their chocolate. If we can pay this much attention to a single piece of chocolate, think about how the magic of this mindfulness practice widens out into how much we miss in everyday life when we act on autopilot and tuck in to life, without really paying attention to what is going on around us and inside of us. Who knew there was so much to a piece of chocolate?