Cognitive-Behavioral Therapy

What is Cognitive-Behavioral Therapy (CBT)?

CBT focuses on helping you understand the relationship among your thoughts, feelings, and behaviors and take effective action in order to make changes in the present.  You can identify and challenge irrational thoughts, and you can practice choosing more value-congruent, goal-oriented, mood-independent behaviors.  Both cognitive and behavioral strategies work to reduce psychological symptoms and emotional suffering.  CBT is comprised of a number of techniques, and your treatment will be tailored to your particular goals and the nature of your presenting problem.  No matter what techniques are used, CBT is goal-oriented, active, collaborative, and aims to reduce your symptoms and build a sense of self-efficacy and autonomy.  You define your values and goals and develop the ability to choose your actions no matter what automatic thoughts, feelings, or sensations your body and brain create for you. (The human brain can be quite creative!)

CBT Techniques

Exposure Response Prevention Therapy (ERP) involves facing uncomfortable thoughts, feelings, and situations.  As you progress from exposures that are easier to those that are more challenging, you conquer specific situations (i.e., you stop feeling bad during the feared situation), learn that the thing you are afraid does not occur, and come to realize that you can tolerate uncomfortable feelings.  This latter benefit of ERP is crucial for maintaining your progress after you complete therapy.  ERP is the foundation of treatment for anxiety disorders and obsessive-compulsive disorders.

Cognitive Therapy (CT), often used synonymously with “CBT,” involves identifying and disputing thoughts that are intertwined with the feelings and behaviors that you and your therapist have defined as problematic.  You examine the evidence for and against your upsetting thoughts (or the costs and benefits of endorsing these thoughts), practice generating more realistic thoughts, and experience the change in feeling that accompanies a shift in thinking.  CT often involves learning a list of common “cognitive distortions” and identifying these distortions in your own thoughts:

• All-or-nothing thinking
• Over-focusing on negative aspects of a situation
• Disqualifying positive aspects of a situation (“yeah, but…”)
• Jumping to conclusions about what someone is thinking
• Jumping to conclusions about what will happen in the future
• Viewing a situation as catastrophic when it is not
• Viewing one negative event as a never-ending pattern of defeat
• Blame yourself or others for your emotional reaction or for a situation that is more complex
• Labeling yourself or others rather than viewing behavior in context
• Believing a thought is accurate primarily because you feel that way
• Focusing on how you or others are not doing things the way you “should” (Thinking about things in terms of your experiences and preferences is a healthy alternative to viewing the world as organized by rules. This shift in thinking is also important for healthy communication.)

CT is an important component of treatment for depression, many anxiety disorders, and a wide range of other issues that present.

Behavioral Activation (BA) is a crucial component of any treatment for depression.  BA involves putting action before motivation, planning activities that give you the opportunity to experience pleasure and mastery, and participating in these activities with the support of your therapist.  This technique “jump starts” many people and helps them breakthrough the depressive prediction that “nothing” makes them feel good and that they will “never” get better.

Coming soon:  Rational-Emotive Therapy, Mindfulness, Effective Communication, and the complementary role of Validation