Let’s Talk About Cognitive Behavioral Therapy (CBT)

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By Cassandra Roos

When in the midst of any psychological distress or crisis and prolonged depression and anxiety, even with a doctor it can be difficult to figure out what kind of therapy will help. Your provider may discuss something called Cognitive Behavioral Therapy (CBT) as an option for you and if it sounds very confusing to you at first, you are not alone. I have found that even after undergoing CBT therapy for years, I constantly need to review it both independently and with a therapist. However, it is scientifically proven to be one of the best treatment methods for certain mood disorders and a skill you can use all your life. CBT is used in the treatment of depression, anxiety, bipolar disorder, personality disorders, substance abuse, schizophrenia and psychosis.

I like CBT because it is a structured, direct, and evidence-based approach to emotional stabilization rather than simply talking about one’s problems. It requires repetitive methods that will change thinking, writing thoughts down, and identifying the thought processes that lead to unwanted emotions and works gradually over time.

CBT aims to train your brain into thinking perhaps there is another way of looking at things. “Why can’t you find another way of looking at things” or “Just think positively, why are you so negative?!” are some of the last things that people suffering from a mental illness ever want to hear. A person needs specific tools in order to change their thinking. CBT involves active work, including homework, thought journals, and active collaboration and participation in your treatment. It allows you to take control of your symptoms and control your thoughts. The brain is a very powerful tool that you can learn to use in your favor.

To practice CBT a person has to identify and break down their thoughts one-by-one and challenge these distressing thoughts. An unhelpful, disturbing, or negative thought can lead to an uncomfortable reaction which then leads to a behavior that limits the person’s ability to actually change their reality. It looks something like this.

Event –> Thought –> Emotion –> Negative reinforcing behavior

The problem with this model is that the person rarely recognizes that a thought precedes the emotion they feel in reaction to a problem. The thought that occurs in reaction to the event is what leads to an emotional response.

If a thought itself can be identified then the emotions that follow can be altered. Most thoughts occur so quickly that the person does not notice them. These rapid racing thoughts are called “automatic thoughts” a term first coined by Aaron Beck who helped first develop Cognitive Behavioral Therapy methods. Automatic thoughts occur so quickly that the emotion appears disconnected from the prevailing thought. Almost all of these thoughts, particularly related to anxiety, are based around the notion that the thought and following emotion are in some way “unbearable” and “intolerable.”

Over time it is possible for CBT to change a person’s assumptions about the world, and this will help them better challenge their unwanted emotions. Cognitive Behavioral models challenge general negative thoughts that include automatic thoughts like: This is a disaster,  I can’t get through this,  I am a horrible person, This is a nightmare/catastrophe.

In order to catch an automatic thought, try to think: What event lead to an undesired emotional response? What thoughts may I have had/do I have in reaction to this event?

The automatic thought must be identified and challenged in writing. Try to write a possible thought that opposes the negative automatic you write down. The challenge thought works towards creating a new highway in the brain one can drive on to achieve a more desirable emotional reaction to events.

Here is an example of using CBT:

Tyra goes on an interview and thinks she did badly and her mind is racing with everything she did wrong. She goes to her car and starts crying and feels completely hopeless about her future. At this point, Tyra cannot reverse her emotional response she must challenge the automatic thought alone. She writes down her thoughts in her thought journal.

Event: Job interview
Emotion: sadness, anger, hopelessness, despair, frustration
Automatic NegativeThought: (Try to isolate one specific thought even though many may be racing through your mind. Usually it’s the most generalized version of thoughts that cause catastrophic thinking/emotional distress because they are unrealistic and vague so more easily proven “true” with distorted thinking.)

That went horribly so I will never get a job.

Challenge thought: (Write down the opposite of the negative thought)

Maybe it did not go as horribly as I thought and it is not the job for me anyway.

Having a bad interview does not make me a horrible person.

Maybe someday I will believe I can get a job.

I know I can get a job someday even if I can’t right now.

I am not defined by my ability to get a job because I have other good qualities.

Maybe there is a possibility the interview was not as bad as I thought it was.

I should ask people if I am stupid to see if this is really true.

The challenge thought can be as positive as you would like it to be or can handle it being. You don’t have to make a perfect or overly positive thought. Try to write something that at least attempts to challenge the intensity of the negative thought.

CBT is very confusing at first. It is confusing because it is hard to identify one’s own thoughts and it is hard to figure out how to challenge them. It is also difficult to accept that thoughts and emotions are two separate things. It is a good first step to write in a thought journal for two-three days. You will improve even if you do not actively notice it. Even if you just try it once, maybe the idea will come back to you someday when you feel clearer and more open to trying this kind of technique. It is a simple but sometimes difficult skill to master, but it works.

Below are some resources and articles to help you learn more about Cognitive Behavioral Therapy.

NAMI: Self-Help Options: (https://www.nami.org/Blogs/NAMI-Blog/November-2016/Discovering-New-Options-Self-Help-Cognitive-Behav)

NAMI: Interview with a CBT-Trained Clinician: https://www.nami.org/Blogs/NAMI-Blog/May-2012/Cognitive-Behavior-Therapy-and-Young-Adults-An-In

Why Does CBT Work? https://www.psychologytoday.com/blog/think-act-be/201501/why-does-cognitive-behavioral-therapy-work

Thought Journal Example:

Event:  
Emotions: Circle or add your own:    Anger        *     Sadness *     Frustration  *   Hopelessness *

Fear * Anxiety *    Disgust *   Shame *       Embarrassment       *   Grief     *   Guilt *   Hatred * (Self-hatred) * Loneliness * Paranoia *   Rage * Remorse     * Regret *   Suffering

________________   ________________ _________________   ___________________

Automatic NegativeThought (Try to isolate one or two specific thoughts to challenge even though many may be racing through your mind.)

 

Challenge thoughts (Write down the opposite of the negative thought)

 

 

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