Cognitive Behavioral Therapy

By Elaine Ryan
Cognitive Behavioral Therapy, or CBT helps you to change the way you think, feel and behave.

CBT is psycho-educational

This simply means that it teaches you how your thoughts, feelings and behaviors interact with each other.

Although we do not mean to, we often create our own distress through habitual ways of thinking.  Cognitive Behavioral Therapy helps us to understand this, and break it down.

For example, if you spend your day worrying about things, the chances are, you will start to feel this in your body.  You can read more about the effect this has on our body here.  You might feel nervous or on edge.  It may even prevent you from doing things.  If you stop and think about it for a moment, most of the things we worry about never happen.  In a way, we are unintentionally creating our own distress.

Take a moment and think if you do any of the following things.

If you have an argument with someone, do you think about it afterwards.  Do you imagine it in your head, having conversations with the person about what you would like to say?  Do you sometimes feel yourself getting angry because of the conversations you are having with yourself (and the other person) in your head?  We do not need to be in a real conversation with the person to feel something in our body, we are perfectly capable of upsetting ourselves with our thought processes!

When having a conversation with someone you do not know very well.  Do you find yourself thinking, “what will I say?” “I’m boring” “I’ve nothing to say” “What made me say that?”  It is very hard to pay attention to the conversation when inside our head we are second guessing what the other person is thinking about us.  This may make you feel uneasy, embarrassed, or uncomfortable with other people, thinking that they are judging you.

It is our “self talk” how we talk to ourselves in our head that can lead us into difficulty, as often we are misinterpreting what is actually happening.  CBT helps us to make sense of this by teaching us how our thoughts, feelings and behaviors and linked.  In other words, what we think, affects what we feel … and do.

The idea of Cognitive Behavioral Therapy is that you become your own therapist so to speak. You are taught the skills to provide you with a “toolkit” which with time and practice, changing the way you think and feel.

Much of the distress that we experience in our lives has more to do with how we interpret, or think about what is going on, as opposed to the situation itself. Try the quiz below to see how are thinking and feelings are related.

CBT comes from earlier forms of therapy:

• Cognitive Therapy, and
• Behavioral Therapy

Cognitive Therapy

Cognitive Therapy is one part of Cognitive Behavioral Therapy, that looks our thoughts (our cognitions.)

Cognitive Therapy focuses on our thought processes. Most of us will have noticed that our thought processes can change depending on how we feel at any given time, but when our mood changes significantly, our thought processes can be problematic. You can get into a habitual way of thinking that is no longer based on reality. Cognitive Therapy helps you identify and change these unhelpful thought processes into more helpful, reality based thinking.

Cognitive Therapy and Thinking Errors

According to Cognitive Therapy, depression and anxiety are maintained by what is known as negative automatic thoughts. The thought processes may be negative in that they have a negative impact on you and also they may not be correct.

• ” I always fail”
• “Nothing I do is ever good enough”
• “I will never be able to do it”
• “I can’t cope”
• “Other people seem to manage everything just fine. I’m hopeless”
• “Nothing ever works out for me”

These are typical negative automatic thoughts that can be addressed with Cognitive Therapy.

Cognitive Therapy helps you to identify the mistakes you might be making in your thinking.

Common Thinking Errors

• Mind Reading: You work on the assumption that you know what other people are thinking “He thinks I’m a loser” “She does not like me”
• What if?” You always ask (either out loud or in your head) What if something bad happens? What if it does not work out? What if…? and the answers given never seem satisfactory as you will always find another What if?
• Negative Filtering: You seem to focus almost exclusively on the negative and find it difficult to see (not necessarily a positive) but a more reality based side
• Fortune Telling: You see the future negatively. Something bad will happen. It will not work out

Cognitive Therapy notes that most problems have several different parts.

• The problem according to the person’s own interpretation
• How you are thinking about the problem
• How the problem makes you feel emotionally
• What you are going to do about the problem

For example, if someone had a Panic Attack in a large shopping mall, this could be broken down into the following parts:

• How the person interprets the problem:  I will not be able to cope.  I cannot go back to the shopping mall as I will have a panic attack.
• How they are thinking about the shopping mall:  It is somewhere that “causes” me to feel anxiety.
• How it makes them feel emotionally.  The thoughts about returning to the mall makes them feel anxious.
• What they do about the problem.  They stop going to the mall.

Cognitive Therapy helps you go from feeling overwhelmed, to being able to break it all down and think and feel differently about things. It is not positive thinking, rather it is reality based thinking. Often the way we think about things are down to habitual thoughts that we have about ourselves and our ability to cope, and often they are not correct.  In the example above, the person will be taught about their own interpretation of going to the shopping mall and how to think about it in a more helpful, balanced way.

Behavioral Therapy

Behavioral Therapy looks at how changing our behavior can lead to positive changes in how feel.  For example, each time a person fears that they may become anxious in a situation, they may start to avoid it.  This avoidance behavior helps in the short term, but does not help long term.  Consider someone who experienced anxiety in a large shopping mall.  They may fear that the anxiety may return if they go back to the mall.  This behavior becomes problematic as they may start to change their behavior without really realizing it.  For example, shopping somewhere smaller or somewhere that is further away from them.

In Behavior Modification, the person would be encouraged to start shopping in the large mall again, together with relaxation techniques.  With practice, the person will be able to shop normally again without experiencing or fearing anxiety.

Another example is to consider someone who is feeling depressed and has lost their sense of enjoyment in things they used to find pleasurable.  In Behavior Therapy, the person would be set certain activities for homework.  These homeworks would include exercise and things they previously enjoyed.  In changing their behavior, such as in starting to exercise, their mood should improve.  In returning to activities that they previously enjoyed, they have a chance to increase their mood.

If you would like to read more on CBT, Mayo Clinic’s guide to Cognitive Behavioral Therapy is worth reading
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