Content or function – the revolution in cognitive behavioural therapy

There are changes happening in cognitive behavioural therapy! CBT has been the gold standard of treatment in all sorts of problems for years and years and years. Actually decades. But, the third wave of CBT is here and it has brought huge changes to CBT.

Cognitive behavioural therapy (if you want more info on CBT, look here) has traditionally looked at the rationality of people’s thinking. For example: your boss lets you know he wants a meeting with you. You may immediately assume that he is upset with you and you are going to be reprimanded. Or alternatively that you are about to get an award! These can all be rational or irrational thoughts, depending on the basis on which they rest. If you believe that you rarely do anything right, that you are a waste of a life, that will colour your perception of the invitation to the meeting and you will automatically decide you’re in trouble. If you believe you are the best thing to have wandered the earth and no one can measure up to you this will colour your perception. Neither of these beliefs may be grounded in reality and are therefore irrational. In CBT we look at the content of thoughts and challenge irrational thinking.

But a revolution is taking place. A whole new branch has arisen where we don’t go into the content. One of the newer approaches, metacognitive therapy, directs us to look at the value of thoughts. And if they have no value (they make us miserable, anxious, unhappy), we simply notice they are there and choose not to focus on them. This is akin to what we find in the third wave approaches where we use meditation skills to notice what our thoughts are and then to chose to focus on our current experience, instead of our fears or worries or regrets.

We can almost divide all the work in CBT into these two broad areas. Work that is content driven and work that is more focused on the usefulness of thoughts.


The photo is of the Blue Nile Falls in Ethiopia