I have clients referred to me for “CBT” – Cognitive Behavioral Therapy. What I’ve learned is that as popular (and effective) as CBT is in the therapy setting for addressing a broad range of mental health issues, ranging from general anxiety to PTSD, CBT is often misunderstood. What it looks like in action is often very different from some of the expectations people have.
Although CBT does come along with some specific and structured interventions, it is more often the case that CBT concepts and techniques are woven into the fabric of therapy – instead of relying on some specific type of protocol. Although Cognitive Behavioral Therapy is indeed conducive to structure (goal setting and measures of progress being key elements), it can also be subtle and more of an underpinning to the approach a therapist might take when working with clients.
CBT helps us become aware of our perceptions about ourselves, people, and the world – perception is our reality and how we view the world (and everything that happens to us) shapes how we experience our lives. How do two or more people experience the same thing, yet feel completely different about those things? The answer is that their perceptions and thoughts about what has happened are different from one another. CBT helps us understand how we think about things, why we think about things the way we do, and how our thinking impacts our feelings and behaviors.
CBT helps us understand that our thoughts are not always accurate – We all have lots of thoughts each day. Google how many thoughts the average person has each day, and you’ll find various sources suggest that we have on average more than 6000 thoughts per day. We don’t select our thoughts or choose when they come. Try “clearing your mind” for a minute and see if you can rid yourself of thoughts. You probably can’t. We have positive thoughts, negative thoughts, scary thoughts, and thoughts that lead to feeling anxious about the future. We live in stories and create narratives about things that have happened and that have not yet happened. A key component to CBT is recognizing that although thinking has given us an evolutionary advantage in terms of survival, our thoughts are not always true and that we shouldn’t believe everything we think.
CBT helps us become aware of and change our negative core beliefs – core beliefs are beliefs we have about who we are as a person. Who we think we are, what we think we are capable of, and how we feel about ourselves guide almost everything we do. How differently do you think someone who believes they are capable of success will act than someone who believes that they will fail at anything they try? CBT helps us get really clear on the kind of thinking that is getting in our way.
CBT helps us recognize and challenge distorted thinking. As humans, we are really great at jumping to conclusions, taking things personally, making excuses, justifying bad behaviors, overgeneralizing, seeing things in black/white terms, thinking that we can predict what others are thinking, and making things a bigger deal than they actually are (catastrophizing). CBT helps us identify our own thinking patterns that lead us to feeling bad and acting in unhealthy ways. When we can see these thinking patterns for what they are, we can then learn to reframe them in more helpful and healthy ways. Sometimes negative and distorted ways of thinking are habits that we have developed throughout our lives. With some practice and frequent reinforcement, habits can be changed.
CBT is not just about positive thinking – People often see CBT in oversimplified terms and think that the goal of CBT is to change negative thinking into positive thinking. Although CBT can certainly help people think more positively, it’s not about “sugar coating” or finding a way to turn anything negative into something positive. More often, it’s more about seeing things in more balanced, nuanced, and healthy ways.
CBT helps us challenge our assumptions – Oftentimes when working with a CBT therapist, you’ll work with your therapist to examine the evidence about your thoughts, beliefs, and feelings. You’ll put your thoughts on trial. You’ll explore your thoughts and feelings and then put them under some gentle scrutiny to discover how and when they might be misleading. This is where the unbiased, outside, and objective feedback from a therapist can be really helpful.
CBT helps us change our behaviors – When we think differently about the world, we feel differently. When we feel differently, we behave differently. CBT indirectly helps us to change the way we interact with the world. A good CBT therapist can also provide some effective behavioral strategies for getting better outcomes in the real world (whether at work, school, or in our personal relationships).