What is cognitive behavior therapy?

Cognitive behavioral therapy, or CBT for short, is an action-oriented, practical approach to psychotherapy that is focused on helping you change maladaptive ways of thinking and behaving to help improve the way you feel. Clinical research trials have shown CBT to be effective in treating depression, anxiety, and a wide range of other psychological disorders.

During therapy you will learn effective skills that help you change the way you think, behave, and feel now, rather than focusing extensively on childhood experiences. You will learn how to problem-solve emotionally difficult situations and build a toolkit of coping skills you can use to improve the quality of your life.

The cognitive part of CBT is based on the idea that the way you think about problematic situations influences how you feel emotionally and how you cope with those situations. When you are distressed, you often do not think as clearly. Your thinking may become biased in characteristic ways that in CBT are sometimes called “cognitive distortions.” While they may at first appear logical, they often are not rational or reasonable.

Cognitive distortions include but are not limited to:

All-or-nothing thinking: Sometimes called black-and-white thinking or dichotomous thinking, you view things in extremes. Things are either perfect or awful, right or wrong, success or failure, and you fail to see that shades of grey in between. You may fail to give yourself or others credit as a result.

Overgeneralization: You take a single negative event and view is as part of a pattern of never-ending defeat.
“I knew he’d break up with me. Nobody likes me. I’ll always end up alone.”

Disqualifying the positive: You dismiss positive experiences, insisting they “don’t count”, giving more weight to the negative experiences that confirm you self-critical beliefs.
“Sure my boss said I did a good job, he’s probably surprised I didn’t screw it up like usual.”

Mind reading: You assume that someone is reacting negatively to you. You assume they are criticizing, dismissing, or judging you without any facts to back up that assumption. You react to your assumptions as though there were facts.
“I could see by the way she smiled at the end of the interview she thinks I completely unqualified for the position. She probably got a good laugh about it after I left.”

Catastrophizing: You exaggerate your mistakes or the likelihood of awful outcomes. You jump to an extreme, and usually negative, conclusion based on a minor event or a mistake you’ve made. You live in a world where the worst-case scenario seems likely and lurking around every corner.

Personalization: you blame yourself exclusively for some negative event, which in fact you were not primarily responsible for.
“My friend is quiet today, what did I do to offend him?”

Maladaptive focus: Maybe the thought you’re having IS true, but excessively focusing on one thought can be a form of self-criticism and can distract you from other important tasks, problem-solving, or trying new behaviors.

In general, biased ways of thinking can get in the way of your efforts to cope with difficult situations. Cognitive therapy provides guidance on how to change this thinking in order to help you deal more effectively with problems.

When you think more realistically,
you can cope more effectively with your problems,
and you feel better.

The behavioral part of CBT is based on the idea that the events in people’s lives and how they respond to such events influence how they feel.

For any number of reasons there may be a decrease in rewarding experiences in your life. For example, friends may move away, children may move out of the house, or a busy work schedule may keep you from engaging in sports, the arts, social activities or other rewarding experiences. Or there may be an increase in aversive events such as financial difficulties, the death of a loved one, the end of a relationship, or a stressful work environment. Or the prompting event may be a first panic attack, beliefs about vulnerability, or intrusive thoughts about contamination. We may be more susceptible to any of these based genetic predispositions and our interpersonal experiences growing up.

These experiences and predispositions can contribute to anxiety, depression, frustration, hopelessness, or anger. You may start to avoid these unpleasant thoughts or experiences or give up trying to find new sources of meaning or pleasure.

Avoidance can take many forms. You may avoid painful emotions or unpleasant thoughts through withdrawal, overeating, taking fewer chances socially, avoiding close relationships, engaging in compulsive rituals, gambling, or abusing drugs or alcohol. In the short term this avoidance provides some relief, but over time it leads to even fewer rewards, a worsening of mood, and additional consequences (e.g., addiction, weight gain, impaired work or personal relationships).

In CBT we identify the dysfunctional behaviors and avoidance that contribute to your problems and work together to:

  • Confront fears, reduce avoidance, and substitute more adaptive behaviors.

  • Forge new relationships, end unhealthy ones, and reconnect with old friends.

  • Learn to respond to difficult events by validating your pain (instead of chastising yourself) while still problem-solving solutions (in other words, focusing on improvement rather than putting yourself down).

  • Learn skills to help you tolerate periods of pain without engaging in destructive behaviors.

  • Build new sources of meaning based on based on your core values and the goals you set for yourself.

While the specifics behaviors we target will vary depending on what brings you to therapy, in most cases there will be a step-by-step method whereby you can start with more smaller, manageable changes initially and then build on those successes over the course of treatment.

When you confront your fears
and your behaviors match your goals and values,
you feel more effective and self-confident.

Finally, treatment also may involve mindfulness meditation and relaxation strategies to calm the mind and body so you can feel better and think more clearly.