Cognitive Behavioral Therapy

Cognitive Behavioral Therapy

The Basics

Introduction

Cognitive Behavioral Therapy (CBT) is a type of talk therapy whereby the therapist works with the client or patient to identify and revise negative and irrational thought patterns and/or behaviors in an effort to change the client’s feelings. By learning new and more realistic ways of thinking, clients begin creating a more realistic, positive, and productive mind space. 

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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 are influenced by core beliefs about ourselves and the world. If our core belief is “I’m unlikeable” then we might automatically believe 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.

Because she has this core belief, she might automatically interpret Dave’s tardiness to mean he doesn’t like her.  She might become anxious and upset based upon an irrational thought. 

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.

Core Beliefs

Core beliefs are the central beliefs we have about ourselves, others, and the world around us.  These beliefs act like a lens through which we experience life. 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 see the world.

 

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. 

 

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

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 really just means observing without judgement. This can be a great alternative to our tendency to immediately evaluate, judge, and critique them.

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.

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Recommended Books:

  1. The Mindfulness Workbook for OCD by Jon Hershfield
  2. Brain Lock by Jeffrey Schwartz MD
  3. Mind Over Mood by Dennis Greenberger