What do RTW Professionals need to know about CBT?
Basics of CBT
- Cognitive Behavioural Therapy (CBT) is based on the idea that thoughts, actions and feelings all influence one another. Therefore, modifying a person’s unhelpful thoughts will result in modifications to unhelpful behaviours and emotions.
- CBT involves relatively short-term treatment focused on specific goals.
- An individual who sees a cognitive behavioural therapist will be asked to take an active role in their own treatment. They will help identify problems, brainstorm solutions and be asked to keep a thought diary and conduct behavioural experiments. This is sometimes called ‘therapeutic homework’.
- Although it is a relatively short term therapy, CBT tends to have long term benefits, as clients learn new ways of thinking and behaving that make difficult situations and emotions easier to handle in the future.
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CBT is an evidence-based form of therapy. Clinical studies have shown it to be effective in treating:
- Depression;
- Anxiety;
- Back pain;
- Chronic fatigue syndrome;
- Fibromyalgia;
- Substance abuse;
- Eating disorders;
- Bipolar disorder; and even
- Psychotic illnesses.
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It can also assist people who have problems with:
- Procrastination;
- Low self esteem;
- Social anxiety;
- Panic attacks;
- Insomnia; and
- Perfectionism.
- CBT is a more effective treatment for depression than medication alone. People who undertake CBT for depression or anxiety have a lower chance of relapse than people who only use medication to cope with their difficulties.
Case study: How might CBT assist delayed RTW?
The table below breaks down an example of delayed RTW, from the perspective of CBT.
| SITUATION | |
|---|---|
| Sam works in a warehouse. For most of the day, he performs repetitive lifting with bends and twists. Over the last month, his lower back has become increasingly sore but he continues working without complaint, despite the pain. One day he lifts a heavier than usual pallet, feels a sharp and sudden pain, and cannot move. Sam's supervisor insists that he see a doctor and the doctor recommends that Sam take at least two weeks off work. |
| THOUGHTS | |
|---|---|
|
In the month before the episode of acute back pain, Sam thinks, "If I tell my supervisor about my pain he will think I'm weak and stop giving me shifts." |
After the acute episode, Sam thinks, "It was stupid of me to get hurt. That doctor thought I was dumb. Everyone at work must think I'm an idiot. Now I'll have back problems forever. They're probably better off without me anyway, because I'm weak and incompetent." |
| REACTIONS | |
|---|---|
| During his fortnight off work, Sam becomes very pessimistic about his chances of recovery. He sleeps in and watches TV all day long. Instead of getting better, his back pain worsens. | Sam misses appointments with his physiotherapist and GP. When his supervisor calls to check on his progress, Sam feels defensive and ends the conversation as quickly as possible. His supervisor tells the Case Manager about Sam's behaviour, and a claims' investigation is launched. Now Sam is convinced he's not wanted at work and has no motivation to stick to his treatment plan. |
According to the principles of CBT, Sam probably has a deeply held belief that he is inadequate, ineffective and incompetent. Usually, Sam masks this belief by being independent and never asking for help. However, when his back pain becomes acute and he has to seek treatment, all his feelings of incompetence come to the surface. He feels depressed and hopeless, and behaves in unhelpful ways, for example by missing his medical appointments.
In order to help Sam overcome his unhelpful reactions to this situation, a Cognitive Behavioural Therapist would encourage Sam to challenge his unhelpful thoughts and come up with some less threatening alternatives. For example, Sam might be asked to consider the ideas that “Everyone hurts themselves sometimes,” and “It’s smart to ask for help when you need it”.
The therapist would then assign Sam some homework, including a thought diary to question and modify unhelpful thoughts, and behavioural experiments, to test-drive his new, healthier thoughts and behaviours in the real world.
Eventually, as Sam engages in healthy behaviours and his new, healthy thoughts become habitual, the unhelpful beliefs which led to his depression and lack of motivation to rehabilitate will be eroded. Sam will realise that he is not incompetent. In fact, he can cope with all kinds of situations, including getting better after a workplace injury. As well as increasing his motivation to rehabilitate in the short term, Sam will have learnt techniques to help him through difficult situations in the future.
Origins of CBT
- CBT developed in the 1960s, largely through the work of Aaron Beck and Albert Ellis. Albert Ellis trained as a psychoanalyst, but became frustrated with that form of therapy because he felt it was inefficient and failed to provide clients with enough direction. CBT grew out of this frustration.
- CBT is also influenced by the thought of Stoic philosophers, who held that a person’s perceptions of their situation will impact how they feel. According to Epictetus, "Man is disturbed not by things, but by the views he takes of them." According to Rob Wilsson and Rhena Branch, CBT is based on the idea that “You feel the way you think”.
CBT resources online
The West Australian Centre for Clinical Interventions is an excellent online resource, as is MoodGym. However, for people with mental health issues, self help is no substitute for professional help and we recommend that you seek - or suggest - psychological assistance where appropriate.