Cognitive Behavioral Therapy

What is Cognitive Behavioral Therapy (CBT)?

The American Psychological Association describes cognitive behavioral therapy (CBT) as an effective form of psychotherapy (counseling) for treating:

• Many mental health disorders

• Substance use and addiction

• Relationship problems

• Certain types of trauma

• Eating disorders

• Behavioral issues at home and in the classroom

CBT is unique because it has more scientific evidence to back up its effectiveness than any other type of therapy modality. Studies suggest that CBT is so effective, in fact, that medication can be avoided in some cases. How is CBT able to do this? Because it helps a person modify their thoughts and behaviors so that they can feel better and function more optimally.

Cognitive behavioral therapy as we know it today is an offshoot of two earlier therapies:

1. Rational Emotive Behavioral Therapy (REBT) in the 1950’s

2. Cognitive Therapy (CT) in the 1960’s

REBT Therapy

REBT was developed by Albert Ellis and proposed that our thoughts, feelings, and behaviors interact with one another to affect us in both positive and negative ways.

Negative thoughts, for example, can cause us to have negative feelings (such as depression or anxiety), which then affect our behavior.

To combat this, Ellis proposed that changing one’s thoughts using REBT could also change the way a person feels and acts. This helps to lower distress and negative symptoms that the person is experiencing.

CT Therapy

Cognitive Therapy (CT) was developed in the 1960’s by a psychiatrist named Dr. Aaron Beck. Dr. Beck’s therapy focused mainly on treating depression and the relationship between one’s negative cognitions (thoughts) and how they affect a person’s feelings and mood.

He believed that people have “automatic thoughts” that govern a person’s view of self, others, and the world. When these automatic thoughts are negative, they can also cloud a person’s view of how the future will play out.

Cognitive therapy treatment is aimed at helping a person identify and assess their negative automatic thoughts so that they can change them. This can help a person have a more positive perception of self, other people, and life in general.

Putting it all together: Today’s CBT is a melding of decades of evidence-based controlled studies using cognitive and behavioral techniques that have been shown to help a person overcome distressing symptoms and destructive behaviors.

People who go to a CBT therapist can experience relief from symptoms of depression, anxiety, fear, panic, OCD, addiction, relationship problems, and much more. Once a person has more positive thoughts about self, others, and the world, they will be better able to change their unhelpful behaviors and envision a more positive future.

Principles of Cognitive Behavioral Therapy

• Emotional issues stem from maladaptive thinking. Maladaptive thoughts are negative or unhelpful thoughts that tarnish one’s view of self, others, the world, and the future.

• Emotional issues can be partly caused by destructive behaviors we’ve seen in others (parents, for example) or by unhelpful coping behaviors that we have learned to use.

• Emotional issues can be greatly improved by learning better ways of thinking and coping with problems that we encounter.

If you change your thinking, you can change your life. That’s the basis of cognitive behavioral therapy. CBT is focused on helping you change the way you think about things, especially triggers in your life that cause you distress.

Some common triggers include personal relationships, work-related challenges, parent-child conflict, and unhealthy coping habits such as using alcohol or drugs to escape.

CBT is very solution-oriented, meaning that your therapist will help you identify the problem affecting you, pinpoint your thoughts about that problem, and then help you think about it differently. Coping skills are useful tools that your therapist will teach you to help you change the way you think about and react to common triggers in your life.

One of the major facets of CBT is to gain insight about why people act the way they do. For example, imagine that a woman at work passes by you in the hall and seems to be glaring at you. You feel a surge of adrenaline and anger rise inside as you conclude that she must have a personal vendetta against you. You decide to confront her the next time you see her.

With CBT, your therapist will help you identify:

• Why this interaction bothered you so much

• What thoughts you have about the woman’s look

• What other possibilities may exist for this person’s behavior

• The reality that their reaction had everything to do with them and nothing to do with you

Your CBT therapist can help you expand your thinking to accept other possibilities such as:

• This lady just got yelled at by her manager

• She may be going through a divorce

• She may be dealing with some other upsetting event that has nothing to do with you

By helping you reframe your negative thinking, there is now room to have different feelings and behaviors.

Types of CBT Techniques

One of the major ways that CBT is used is to help people overcome fear and anxiety. Exposure response & prevention therapy (ERPT) is a technique that introduces a person to their fear or anxiety trigger in very small amounts.

Over time, these exposures are increased in duration and intensity to help desensitize a person so they can confront it, cope with their feelings, and behave differently.

Using this technique has been successful in treating many different mental disorders such as obsessive-compulsive disorder. An important part of this therapy includes planning how you will respond in future triggering situations so that you are better prepared to handle them.

Similar to exposure and response prevention therapy is interoceptive exposure. This technique is often used to treat panic disorder and anxiety disorders. The therapist will plan to expose you to stimuli (a triggering bodily sensation such as fast heart rate) to reproduce your fearful or anxious response.

Once this response occurs, the therapist will help you:

• Identify what you believe about the sensation

• Encourage you to tolerate it

• Help you “sit with the feelings”

• Teach you to apply coping skills to bear with it

• Allow you to see your symptoms as upsetting, but not dreadful

In other words, through this exposure therapy process, you will learn that “this too shall pass” so that when triggering sensations happen outside of session, you’ll be better prepared to handle them well.

Other CBT techniques are used to help you distinguish reality from your thoughts about the situation. Using the example above of the glaring coworker, a CBT therapist will help you discern

1. The triggering event (the woman glared at you)

2. Your beliefs about it (she has a personal vendetta against you)

3. Your feelings or reactions that resulted (you got angry and planned to confront her)

This model is called the “ABC model” because it follows the:

• A = The activating event that triggered you (also called the antecedent)

• B = Your belief about the activating event

• C = The consequences of your thoughts/feelings about those beliefs

The ABC model helps you to identify faulty thinking, or cognitive distortions, that surround certain triggers in your life. By identifying and changing these thoughts, it can help you get along better with others, feel more self-assured, and experience less stress. This technique is very helpful for people with substance use issues that are triggered by activating events, people, or environments.

CBT Techniques Used Outside of Therapy

CBT often utilizes homework in between sessions to help clients gain greater insight into their thoughts, behaviors, and feelings (reactions). Some of the most popular types of homework assignments include:

• Journaling your thoughts, mood, and/or reactions

• Real life experiences to try (calling one hiring manager for a potential job)

• Telling a new story (rescripting) about an actual event or nightmare

• Practicing slow breathing to calm the nervous system

• Practicing mindfulness

• Identifying faulty thoughts and challenging them

• Progressive muscle relaxation from toes to head

• Grounding techniques to cope with panic, anxiety, and PTSD

• Imagining the worst scenario and how you would handle it

• Reframing and restructuring negative cognitions so they are more helpful

• Exposure & response prevention to develop resilience to triggering events

• Exposure to sensations that trigger panic (such as a fast heart rate) & responding using learned coping skills

• Worksheets or workbooks on specific conditions to help you better understand your symptoms

• Learning about your coping styles and how to improve your coping skills

Basic Irrational Assumptions that CBT Addresses

One of the founders of CBT, Albert Ellis, explained that people make assumptions about life that can dramatically affect their self-perception, ability to relate to others, and what to expect from circumstances. For example, an irrational assumption might be “men can’t be trusted” because a person experienced their own father abandoning them.

Therapists look for sweeping generalizations like this and “black or white” thinking to identify irrational assumptions and bring them to the client’s awareness. Statements that have the words “should,” “must,” “never,” and “always” are red flags that a person is using this kind of thinking.

Some basic irrational assumptions that CBT therapy can help with:

• Perfectionistic: “I have to be the best at everything or I’m no good.”

• Catastrophic: “Nothing ever works out like I want it to.”

• Victimization: “I can’t ever be happy because of what happened to me (or what someone did to me).”

• Learned helplessness: “ I can’t do anything on my own because I’m too weak to do it myself.”

• Stuck in the past: “I won’t ever be more than what has happened to me.”

• Idealistic: “If I don’t find the perfect solution, then this is going to be a total failure.”

A-B-C Method: Doing the ABC method on a piece of paper can alter irrational beliefs. Your therapist will have you fold a piece of paper into three vertical folds. This will create three vertical columns for you to place the A, B, and C of a situation. By brainstorming together, you and your therapist can expand your understanding of what is triggering your strong reactions.

In the left column on your paper, you’ll record what happened to prompt this. This is the “A,” or activating event, which is the situation that triggered your strong reaction.

In the center column of your paper, your therapist will ask you to write down the “B,” or beliefs, you have about the triggering event. For example, if your spouse said, “Forget it” and then walked away, you might write down that you believe that he or she either doesn’t care or is angry with you.

In the far right column, you’ll write down the “C,” or consequences, of your belief or thought. Consequences can also be described as your reaction to the situation. In the above example, you might write that you felt hurt, lonely, or angry.

Your therapist will help you connect the dots in understanding that your reaction was based on your interpretation (beliefs) of the event. This can help you change your view of the situation to make room for other possibilities.

CBT Treatment in Torrance at Pacific Pain & Wellness Group

Our therapy team has extensive experience treating adults with CBT for a variety of mental health challenges including anxiety, panic, PTSD, OCD, depression, phobias, eating disorders, and much more. CBT can be applied in therapy with individuals, couples, families, and groups.

We offer evidence-based CBT treatments in a compassionate and caring environment. Therapy is a delicate balance of art and science, and our therapists will create a safe and accepting environment for you where treatment is based on scientific data that effectively addresses your concerns.

Be your best self…starting today. CBT therapy is so effective that many clients can achieve their therapy goals in a shorter amount of time than with other therapy modalities.

At Pacific Pain & Wellness Group, we care about you as much as you do. Our goal is to help you feel better so you can live better. Call us today to schedule your first appointment at (310) 437-7399.

Sources:

https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral

https://beckinstitute.org/about-beck/team/our-history/history-of-cognitive-therapy/

https://www.simplypsychology.org/cognitive-therapy.html

https://www.healthline.com/health/abc-model

https://positivepsychology.com/cbt-cognitive-behavioral-therapy-techniques-worksheets/