What is Cognitive Behavioral Therapy?
Cognitive Behavioral Therapy (or CBT) is an evidence-based, goal-oriented psychotherapy treatment that takes a practical approach to problem-solving. The goal of CBT is to challenge and change patterns of thinking that are unhelpful or maladaptive to your life. The idea is that you can change the way you feel by changing the way you think about or perceive different situations.
The work of CBT focuses on identifying unhelpful cognitive distortions that may be contributing to problems in your life. The role of the therapist is to help you identify these cognitive distortions, challenge, and reframe them into healthier and more adaptive ways of thinking. Doing so improves emotional regulation and the ability to develop helpful coping strategies.
CBT is highly effective in treating many different types of mental health issues, including anxiety.
If you would describe yourself as a “negative thinker”, CBT could be very effective for you. When implemented consistently, many clients report starting to feel better in a relatively short amount of time compared to some other types of psychotherapy treatments. CBT allows you to take control over your thinking, and in turn your feelings and behavior. Who doesn’t want that?!
Situation —> Negative Automatic Thought —> Feeling —> Behavior
Same Situation —> New Reframed Thought —> New Feeling —> New Behavior
Let's Use A Concrete Example
You open your work laptop and notice a string of emails about an issue with a customer account you’re on. You also see an unexpected 1:1 meeting with your supervisor has been scheduled. You say to yourself:
“Oh no this is awful! I know I probably did something wrong. My supervisor is probably upset with me or maybe I’m getting fired. I never do anything right and I’m always messing up. I’m so stupid”.
There are a few cognitive distortions present here:
- You are jumping to conclusions about making a mistake and assuming your supervisor’s intent for scheduling this meeting, without having any actual facts. You’re assuming you know what your supervisor is thinking and feeling. In all reality, we don’t ever really know for sure what anyone is thinking or feeling unless they tell us directly. You aren’t a mind reader. The meeting could be about something else. Or maybe your supervisor notices the issue and is trying to help you sort out the problem but has no plans of firing anyone.
- “I never do anything right” and “I’m always messing up” are distortions because you are overgeneralizing. Is it really true that you NEVER do anything right? Is it true that you are ALWAYS messing up? I think not. You probably do a lot of things right. At the very least your work is mostly acceptable as evidenced by you are not on a performance review plan or fired. And you probably make some mistakes from time to time like we all do, which is normal because you’re human.
- “I’m so stupid” is a distortion because you are labeling yourself. Labeling is irrational because you are not the same as what you do. Even if you did make a major mistake you are still not stupid. Intelligent people can say foolish things and make mistakes. This is normal and does not change your inherent value as a human being.
Let's Use Another Example
You finish your long work day and think to yourself:
“Ugh, I still have to return this Amazon item and I should go to the gym after work too.” You notice feeling a sense of dread.
“Should” statements (similarly “have to” and “need to” have the same general effect) tend to increase stress and anxiety by providing an arbitrary expectation for yourself or others and creating an unnecessary sense of urgency. If you don’t meet said expectation then you feel bad about yourself, like you’ve failed. If others don’t meet your expectations you may feel frustrated with them.
Let’s work through this. First of all, who said you “have to” do anything?
Do you really “have to” return the Amazon item today? What would happen if you don’t? Maybe you do need to return it today if the return window is closing today. Or maybe you have a few more days to deal with this and could schedule this task for a day you have less responsibilities.
You could say to yourself: “I would like to get that return done by the end of the week so it can be off my mind for the weekend. I’ll schedule that task for Thursday when I have less going on”.
Many things in life are important but few things are urgent. It’s important to distinguish between the two.
Who said you “should” go to the gym? Should is an expectation that you created. You “want” to go to the gym because it’s in line with a health goal you have. We could even reframe that to: “I’d like to be able to make it to the gym tonight because it will feel good to workout my body”. This states a goal or intention you have for the day but is not going to leave you feeling like you’ve failed if you don’t make it.
How would you feel if you repeated these reframed thoughts to yourself instead? Less overwhelmed? Less dread? Maybe even looking forward to the gym now?
Common Types of Cognitive Distortions
All or Nothing Thinking
Overgeneralization
“Should” Statements
Emotional Reasoning
Jumping to Conclusions
Fallacy of Fairness
Filtering
Magnifying
Minimizing
What Does CBT Therapy Look Like?
Step 1: Awareness
You can’t change what you don’t acknowledge.
This is where having a therapist is helpful. Many people are not really even aware of how many negative or unhelpful thoughts are running through their brains on any given day, and how these thoughts are impacting their mood and behavior. I will help you identify these thoughts by pointing them out and bringing them to your attention.
As a CBT therapist, I am laser-focused at picking up on distortions.
Step 2: Homework
I may ask you to track your thoughts with a thought log between sessions. A thought log is helpful so that we have material to process at the next appointment. We will frequently be referring to our cognitive distortion chart to help you make connections about your thinking patterns. Maybe you’re a “black-and-white thinker” who has a hard time viewing situations in shades of gray. Or maybe you’re an “overgeneralizer”, using words like “always” or “never” frequently in your thinking. This is good to know because we can now use that information to start reframing.
Step 3: Challenge & Reframe
This does NOT mean we are going to take a “positive spin” on everything, invalidate your pain, or try to view the world like it’s all rainbows and unicorns.
That’s not realistic and that won’t work. We are simply going to be challenging distortions and looking for new ways to view situations that serve you better. Ideally, your new reframed thoughts should contribute to less feelings of anxiety, depression, stress, frustration, etc. If the thought isn’t serving you, it has to go.
Step 4: Practice, Practice, Practice
As with any new skill, you will need to practice consistently in order to make it stick. We are not born knowing how to think positively or rationally, so don’t beat yourself up if this is difficult. We have to learn.
If your parents were negative thinkers or often used cognitive distortions in their thinking it’s likely you learned to also. It takes some time to rework your thoughts and get comfortable with new ways of thinking. Over the years I’ve developed many tips and tricks for troubleshooting if you get stuck.
Contact me today so we can get started with CBT Therapy!