Cognitive Behavioral Therapy (CBT)

    Welcome, one and all! Ever wonder what therapists actually do? Why they ask the questions they ask, or what their "strategy" is? Well, you're in luck! ....sort of. There's a lot more to being a therapist than following a certain 'strategy'. In fact, most research suggests that the therapeutic relationship (feeling like you have someone who cares about you and wants the best for you) is more important than the actual 'therapeutic work', if you will. However, cognitive behavioral therapy (CBT) is pretty much a therapist's bread and butter. That is to say, it's what most therapists are trained in and what they use most frequently. Research has supported it as an effective treatment for a range of diagnoses including anxiety, depression, PTSD, Bipolar disorder, personality disorders, and the list goes on. 

Without further ado, I'd like to present my good friend, CBT:

The Concept:

    In essence, cognitive behavioral therapy says: we, as humans, are made up of thoughts (cognitions), behaviors (what we physically do and say), and emotions; they each affect the others; thoughts and behaviors are waaaay easier to directly change than emotions; and we develop patterns of thinking, behaving, and feeling. These patterns start when we're kids and happen subconsciously (outside of our active awareness). So, on the surface we have our present moment thoughts, feelings, and emotions. One layer deeper we have the patterns of thinking/feeling/behaving which develop over time. Even deeper than that, we have our core beliefs about ourselves, other people/ the world, and the future.

    You've heard of rose colored glasses? I've found that's a helpful way of thinking about core beliefs. Imagine wearing a pair of glasses, and someone took a sharpie and wrote "broken", "worthless", "alone", or "burden" on them. Every person and event is now seen through that changed perception of ourselves. You could be having a cup of coffee with your mom, and all you see is how you've taken time away from her being able to do what she really wants to do, or how you made her drive 45 minutes to meet you. Now you feel bad about yourself (like a burden) and can't enjoy the time with your mother, but she actually loves spending time with you and would be glad to drive twice that far just to see you. You can't see it like that though because you can only see things through the filter of "I'm a burden". We'll spend more time on core beliefs later - this is just a taste.

    

Why it matters:

    Alright, with me so far? CBT is helpful because it gives us the means to the end. We have the goal of changing the way we feel - I don't want to be sad, lonely, angry, scared etc. We have the goal of changing our thoughts - I want to love myself, I want to stop always criticizing myself, or being so negative all the time. We have the goal of changing our behaviors - I want to stop screaming at my kids, using drugs, or binge eating an entire packet of oreos (don't worry, I feel personally attacked too). All of these goals are great, but how do we get there? I'm so glad you asked! By changing our thoughts and behaviors. You can't change what you don't know. So, as always, the first step is awareness, what are the thoughts? What are the emotions? What's motivating the behavior? 

    For depression, research shows that starting with behavior change is the most helpful. You want the most bang for your buck, right? Start with something means a lot to you, that is realistic, and that will have a reward aka make you feel good. It's 3:45p and you haven't gotten out of bed all day because of lack of energy/motivation or just feel too sad and heavy? Maybe just get up brush your teeth and go back to bed. Sick of just going to work and sleeping day after day? Maybe listen to your favorite song or read an entertaining blog (wink, wink). Feeling really negative? There's lots of inspirational podcasts and TedTalks. The point is, doing something different will change the way you feel if you let it. 

  

  For anxiety, the research suggests starting with the thoughts is the most helpful. I had a professor in my master's program (actually in our CBT class) who said that anxiety is basically two things: overestimating the danger, and underestimating your ability to cope with it. Those words have stuck with me and I've shared them with almost every client who struggles with anxiety symptoms. Overestimating the danger means giving a person or situation more power than it deserves. Realistically, what is the harm? What is the likelihood that it will actually happen? With anxiety, usually our mind tells us that something is more dangerous than it really is, and because we aren't aware of that thought, we just go along with it and believe that we're really in a lot of danger. Underestimating your ability to cope means not having the confidence that you can handle a situation if it goes wrong. Let's say worst case scenario does happen, what would you do? Usually we have an answer for that. The trick is, we have to ask ourselves the question! 

A little self-pep talk never hurts either. "You're a strong, resilient person" or "You've been through way worse" or "You've got this!" or whatever floats your boat. If you're facing the right direction then all you have to do is keep walking.

Action Item: Thought Record

    First find a quiet, cozy spot where you feel safe and relaxed. Maybe grab a nice blanket or cup of tea. Take a moment to think of a situation where you had a strong emotional reaction - could be past or present. Take care not to pick one that is still overwhelming - this is just practice, and remember, you're doing it on your own and not with a therapist. 

Start with the event then identify the associated emotions as many as you'd like. Take some time to identify the automatic thoughts. This is where you should really spend the bulk of your time. If you're having trouble with this, try asking yourself this question: "what am I telling myself about this situation?". Next, you'll identify evidence that supports or contradicts the accuracy of the thought that you've selected. Taking both sides into account, create a balanced thought. Finally, you'll reassign values to all of the emotions you selected in column 2. 

Top Tips: 

1. Write down as many thoughts as you can
2. Identify the thought that you think is most responsible for the emotional reactions
3. Complete the rest of the chart based on that one thought
4. If you get to the end and your emotions didn't change  - go back and identify a different thought 

Questions to Consider:

• How aware am I of my thoughts?
• What was the hardest part of the activity? Why?
• What, if any, patterns came up in my thoughts?
• How could I use this to adjust future responses - emotional or behavioral?

As always, please feel free to leave any questions/comments/experiences in the comments section. 

Best wishes on your journey to self-fulfillment.

Namaste.