Cognitive Behaviour Therapy in Sport: A review of two books

Stuart Carrington
St Mary’s University, Twickenham, UK

The ‘canon’ of psychological techniques employed by applied sport psychologists (e.g., imagery, self-talk, goal setting; Anderson, 2000) are couched in cognitive behavioural therapy (CBT). The premise of CBT is that thoughts and actions are inexplicably linked, with behaviours being influenced by (and revealing) an individual’s core values and beliefs. The aim of self-talk, for instance, is to promote adaptive behaviours by disputing unhelpful thoughts. As such, it is prudent for those interested in both the theory and application of sport psychology to familiarise themselves with CBT, not just because of the approach’s influence on applied practice but also due to its other qualities. In particular, perspectives found under the CBT umbrella offer flexibility to the practitioner regarding strategies used, a necessity as people are eclectic and, therefore, methods used to help them should reflect this eclecticism. Additionally, the CBT practitioner’s focus on the ‘here-and-now’, in contrast to the attention paid by psychoanalysts on the origins of emotional and behavioural disturbance, is preferential to sportspeople who operate in a time-constrained environment. Therefore, the recent publications of Cognitive Behaviour Therapy in Sport and Performance and Applying Cognitive Behavioural Therapeutic Approaches in Sport are valuable resources in understanding more about this perspective of psychology. In this review, both books will be discussed independently, as well as identifying how and where they complement one another.

Cognitive Behaviour Therapy in Sport and Performance provides the reader with a comprehensive guide in how to apply CBT in sport and exercise settings. This guide begins with a review of the theoretical assumptions of CBT, namely that our thoughts, feelings and behaviours are interdependent. From a theoretical perspective, therefore, modification of negative automatic thoughts is encouraged to promote helpful behaviours, a strategy that literature supports as more advantageous than the suppression of undesired cognitions and emotions (Cutili, 2014; Wang et al., 2021). To complement the introduction on theoretical background, the book does an excellent job of providing the reader with guidance around the humanistic and constructivist approach the CBT practitioner adopts. In short, practitioners should aim to assist the individual in how to become their own therapist via strategies couched in empathetic and authentic behaviours.

Building on these foundations is perhaps the greatest feature of this book, a detailed and chronological guide to CBT in practice. This section begins with how to construct sessions with clients, from agenda setting to needs analysis using appropriate measures. For a qualified rational-emotive behaviour therapist, this was valuable as the systematic approach to CBT (application only when the individual experiences a ‘problem’ is not recommended) should be reflected in the sessions. The structure provided in the book consequently arms the practitioner with a template for best practice that is enriched by valuable considerations throughout. For example, the reminder that the intensity of the emotions experienced by the individual is of great importance, as is the formulation of the thoughts and resultant behaviours a client is experiencing. Throughout, the book provides reflection points (sometimes prompting the reader to consider topics covered, sometimes requesting the reader applies some of the theory or intervention strategies themselves) to buttress learning, as well as sharing case studies to demonstrate how practice may look in reality. This feature is especially helpful in the section that covers interventions. For example, when discussing progressive muscular relaxation as a behavioural intervention, the book walks through how best to apply this approach. While not unique (this has been done previously, e.g., Cox, 1999) it demonstrates the comprehensive nature of the book, meaning that the reader feels well prepared to apply theory to practice.

What readers may wish to acknowledge, before or after reading, however, is that CBT is not monolithic. Rather, it is a term used to describe several approaches, each with its own benefits and assumptions (theoretical, practical and philosophical).

This feeling of competency is reinforced by the identification of issues the practitioner may experience in CBT application. For instance, when setting homework, the book guides the reader into what needs to be acknowledged to enhance efficacy. This criticality is demonstrated further in the chapter on troubleshooting and the transition to client self-help. What readers may wish to acknowledge, before or after reading, however, is that CBT is not monolithic. Rather, it is a term used to describe several approaches, each with its own benefits and assumptions (theoretical, practical and philosophical). While there are indeed similarities, namely that our behaviours are derived from our thoughts, the need to distinguish between different approaches to CBT is outlined in a recent paper by Young and Turner (2023). To surmise, evidence-based practitioners are guided by accuracy and precision. Grouping different approaches is inaccurate, contributing to flawed assessment, practice and understanding. It is only through understanding the subtle differences that distinguish approaches within the CBT family that best practice can be informed. Hence, to benefit the guidance found within Cognitive Behaviour Therapy in Sport and Performance, it is recommended that those interested in CBT and its utility in sport and exercise setting also read Applying Cognitive Behavioural Therapeutic Approaches in Sport.

An appreciation of the distinguishing features across CBT approaches is refined by progressing through chapters that provide a succinct but detailed account of varied perspectives. First, however, the pitfalls of assuming CBT is a singular approach is made explicit, a trend continued throughout the volume. This is an important feature of the book as Albert Ellis, founder of rational-emotive behaviour therapy (REBT), emphasised the need for efficiency in therapy. Therefore, competent practitioners are cognisant of the values found within different approaches. After all, if the only tool we have is a hammer, every problem looks like a nail. For example, the chapter on Acceptance and Commitment Therapy (ACT) emphasises the efficacy of this approach in group settings.

It is the increased awareness of these subtle, but pertinent, differences that is the main takeaway for the reader. For individuals that may not respond well to the theoretical approach of other CBTs, ACT adopts an anti-intellectual position with emphasis on analogy. For more clinical populations the psychoeducational goal of Compassion Focussed Therapy to help individuals accept that they are not responsible for what occurs in their own mind is contrary to the foundation of REBT that posits, while beliefs may be socialised, we are primarily responsible for our beliefs and actions. Similarly, REBT encourages the position that we cannot change beliefs, insisting that we can only weaken, refute and negate them, whereas Cognitive Therapy (CT) insists that we can only promote behaviour change by changing beliefs (Beck, 1991). That is not to say the book is immune from error regarding accuracy in language. For instance, at one point, it is suggested that CBT approaches are either directive (non-person centred) or non-directive (person centred). The terms are not mutually exclusive, with REBT a good example of an approach that is both purposeful and humanistic. This is a minor point though in a book that does an excellent job of identifying the subtleties found within the approaches discussed.

Consistent with the theme of ‘universal other acceptance’ found within REBT, that no one person is good or bad because the multitude of actions that they will perform in their life prohibits the accuracy of such a shorthand judgment, there is no point in comparison between these books. They simply have different qualities. While the need for clarity regarding terms used is important and is undoubtedly found in Applying Cognitive Behavioural Therapeutic Approaches in Sport,Cognitive Behaviour Therapy in Sport and Performance provides the applied practitioner with a ‘go-to’ template for session construction, execution and troubleshooting solutions when applying CBT approaches within sporting populations. For the applied sport psychologist, both would enrich their library and practice.

Copyright © Stuart Carrington 2023

References

Anderson, M. B. (2000). Doing Sport Psychology. Human Kinetics.

Beck, A. T. (1991). Cognitive therapy: A 30-year retrospective. American Psychologist, 31, 93-98.

Cox, R. (1999). Sport Psychology: Concepts and Applications (4^th Ed.). McGraw-Hill Education.

Cutili, D. (2014). Cognitive reappraisal and expressive suppression strategies role in the emotion regulation: An overview on their modulatory effects and neural correlates. Frontiers in Systems Neuroscience, 8, Article 175.

Wang, K., Goldenberg, A., Dorison, C. A., Miller, J. K., Uusberg, G., Lerner, J. S., Gross, J. J., Agesin, B. B., Bernardo, M., Campos, O., Eudave, L., Grzech, K., Ozery, D. H., Jackson, E., A., Garcia, E., Drexler, S. M., Jurković, A. P., Rana, K., Wilson, J. P., Antoniadi, M., … Moshontz, H. (2021). A multi-country test of brief reappraisal interventions on emotions during the COVID-19 pandemic. Nature Human Behaviour, 10.1038/s41562-021-01173-x. Advance online publication. https://doi.org/10.1038/s41562-021-01173-x

Young, P., & Turner, M. (2023). To (i)B or not to i(B), that is the question: On the differences between Ellis’ REBT and Beck’s CT. The Cognitive Behaviour Therapist, 16, doi:10.1017/S1754470X000090