The Cognitive Behavioral Therapy Triad

What is Cognitive Behavioral Therapy (CBT)?

Introduction

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.

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” which are explained below.

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.

Imagine Sally and Dave go on a first date. Sally might have the core belief that she is unlikeable. When Dave shows up late to the date, Sally might automatically think “Dave doesn’t like me.”  She might become anxious and upset based upon a completely false belief (i.e., Dave was late because he was stuck in traffic).

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 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.

Below are examples of cognitive distortions and how we might correct those distortions through Cognitive Behavioral Therapy.

Common Cognitive Distortions 

(1) 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.”

(2) 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.”

(3) 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.”

(4) All or Nothing Thinking

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

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

(5) Personalization

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

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

(6) The “Shoulds”

The belief that things should be a certain way.

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

(7) 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.”

(8) Catastrophizing

Immediately assuming the worst case scenario in any situation.

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

(9) 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.”

(10) Mindreading

Assuming you know what others are thinking or feeling.

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

(11) Selective Abstraction

Drawing conclusions based on just one of many elements of a situation.

Example: “The lady at the front desk of the hotel wasn’t very nice. This whole trip is going to suck!”

(12) Arbitrary Inference

Drawing conclusions when there is little or no evidence to support it.

Example: “The nicest people in the world are _____”

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 Record

Final Comments

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:

  1. The Mindfulness Workbook for OCD by Jon Hershfield
  2. Mind Over Mood by Dennis Greenberger 
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