What is Cognitive Behavioral Therapy (CBT)?

Cognitive Behavioral Therapy (CBT) is a type of talk therapy that helps individuals identify and challenge negative or irrational thoughts or beliefs. By changing the way we think, we can change the way we behave and ultimately how we feel. Therefore, Cognitive Behavioral Therapy teaches us new and more realistic ways of thinking to manifest a more realistic, positive, and productive mind space.
 

The Cognitive Behavioral Model rests on the premise that our feelings are very difficult to change without also changing our thoughts and behaviors. In fact, the way we think about ourselves and the world strongly influences the decisions we make, how we behave, and ultimately how we feel. Each of us views the world through a unique lens that can become clouded by our negative emotions and irrational thoughts.

Here’s an example: 

Imagine you have a very important exam coming up and your thought/belief is “I’m going to fail.” Because of this thought, you start to worry so much and feel so uncomfortable that you decide not to study. In this example, the thought led to a negative feeling which then led to a behavior that wasn’t productive. 

Thoughts are the words that run through our minds each day. Thoughts are the things we tell ourselves abut what’s going on around us. Thoughts come and go. Some thoughts carry more weight than others based on the amount of importance we place on them.
 
Feelings come and go just like thoughts. Feelings are not “good” or “bad”. They might be uncomfortable and distressing but they are not bad. We might feel happy, angry, anxious, insecure, vulnerable, sad, remorseful, irritable, excited, and rejected all in the same day. 
 
Behaviors are the things we do (the actions we take). Thoughts and feelings have a big influence on how we act. When we are happy we are more likely to behave nicely. When angry, we are more likely to behave meanly. 

The point of CBT is to identify which thoughts are causing problematic feelings or behaviors and then challenging the validity of those thoughts. To do this, we must first identify those “automatic thoughts.”

Automatic Thoughts

Automatic thoughts are thoughts that “pop up” in response to a situation or event. Many times we don’t even recognize them. They happen automatically. Automatic thoughts stem from core beliefs about ourselves and the world. 

For example, if our core belief is “I’m unlikeable” then we might automatically assume that others don’t like us even if there is little evidence to support that belief. 

Let’s look into the lives of Dave and Sally to better understand automatic thoughts.
 

One can see how automatic thoughts might influence how we feel…

The core belief “I’m unlikeable” will drive the types of thoughts Sally has in various situations. Because Sally doesn’t believe she is likeable, she might automatically think Dave doesn’t like her when he is a few minutes late. This might make her feel discouraged, anxious, rejected, and insecure.

It is important to realize that automatic thoughts are beyond our control. We cannot control which thoughts pop up. We can, however, control how much significance we assign to our thoughts. This takes practice. Automatic thoughts are like the branches of a tree and the core belief they come from is the trunk. Let’s look into core beliefs in a little more detail.
 

Core Beliefs

Core beliefs are the central beliefs we have about ourselves, others, and the world around us.  This means people with different core beliefs might be in the same situation, but think, feel, and behave very differently. Even if a core belief is inaccurate, it still shapes how we interact and relate with ourselves and others.

Harmful core beliefs lead to negative thoughts, feelings, and behaviors. CBT aims to identify and challenge harmful core beliefs.

Cognitive Distortions

Cognitive distortions are the thoughts we have that aren’t entirely true. They represent the ways in which our lenses can become clouded or “distorted.” All of us know how negative thoughts can influence how we feel. We all experience cognitive distortions in our every day lives to varying degrees. Some of us experience them more than others and sometimes they can be so severe they end up hurting us emotionally. As you read through these ten cognitive distortions, circle three that you experience the most.
 

Below are examples of cognitive distortions and how we might correct those distortions. 

Overgeneralization

Making broad interpretations about something from a single event or occurrence. 

Example: “I didn’t perform well on my math test. I suck at math.”

Cognitive Correction: “I didn’t perform well on my math test. I am upset with my performance on this test, but I can learn from my mistakes and improve my math skills for the next test.”

Magical Thinking

Believing that doing something or thinking something will influence unrelated situations. (Commonly seen in those with Obsessive Compulsive Disorder) 

Example: “If I don’t say this word four times then my family might be harmed.”

Cognitive Correction: “I feel worried about harming my family, but is there any factual evidence that my family would be harmed if I don’t say the word four times?”

Emotional Reasoning

Assuming that emotions reflect the way things actually are.  

Example: “I feel like a bad husband, therefore I must be a bad husband.”

Cognitive Correction: “Even though I feel like a bad husband because I forgot to pick up milk from the store, that does not mean I am a bad husband. Here are some reasons why I am not a bad husband…”

All or Nothing Thinking

Thinking in absolutes such as “always”, “never”, or “every”.

Example
: “I will never be good at basketball.”

Cognitive Correction: “Although I am not satisfied with how I played today, I can learn from my mistakes and improve in the future.”

Personalization

Believing you are responsible for things that are outside of your control.

Example
: “My wife is always upset. She would be fine if I did more to help her.”

Cognitive Correction: “My wife seems upset. I don’t want to see her upset, but I can’t control how she feels. The best I can do is support her in the ways I know how.”

The “Shoulds”

The belief that things should be a certain way.

Example
: “I should go to the gym today.”

Cognitive Correction: “I don’t really want to go to the gym today, but I know I will feel better if I do.”

Minimizing Positivity

When you recognize only the negative aspects of a situation and ignore or minimize the positives.

Example
: When you give a presentation and people compliment you and you immediately reply with “yea, but I think it went on too long and wasn’t interesting.”

Cognitive Correction: Give yourself permission to feel positive emotions. 

Catastrophizing

Immediately assuming the worst case scenario in any situation.

Example
: “My boyfriend didn’t call me last night. He is cheating on me.”

Cognitive Correction: “My boyfriend didn’t call me last night and I am worried. Even though I am worried he might be cheating on me, I know there are many other potential explanations.”

Entitlement Beliefs

Believing the rules for others shouldn’t apply to you.

Example
: “I don’t have to go to school and receive a degree in that because I already know the information.”

Cognitive Correction: “If I want to work in this industry, a degree is required. Therefore, I will have to go to school even though I know a lot about this topic.”

Mindreading

Assuming you know what others are thinking or feeling.

Example
: “He thinks I am stupid and worthless. I just know it.”

Cognitive Correction:
 Ask yourself, “What factual evidence do I have to support this?”

Acceptance

Acceptance of thoughts and moods means observing without judgement. This can be a great alternative to our tendency to immediately evaluate, judge, and critique them. By recognizing and accepting our thoughts for what they are, just thoughts, then we can avoid allowing the thoughts to drive our feelings. Again, this takes practice. Practice means first identifying thoughts and feelings as they arise followed by challenging and/or restructuring these thoughts in a more productive and realistic way. A thought record is the common tool used to practice CBT.

Thought Records

Although this barely scratches the surface of cognitive behavioral therapy (CBT), it gives you an idea of what it is and how we apply it. In summary, CBT is a type of therapy based upon the idea that our thoughts, behaviors, and feelings/emotions influence each other in complex ways. CBT is a time-limited, structured, and goal-directed therapy designed to help identify negative thinking patterns that contribute to troubling mood states. 

Recommended Books:

  • The Mindfulness Workbook for OCD by Jon Hershfield
  • Mind Over Mood by Dennis Greenberger 

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How did it go?

TASK 6: THE VOICES

  • What was your internal dialogue like?
  • What were the voices in your head saying?
  • Were they mean? Were they positive or negative?
  • Describe what you noticed.

TASK 5: THE SOUND

TASK 4: THE SIGHT AND SMELL

TASK 3: THE TASTE

TASK 2: THE TALK

TASK 1: THE WALK

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