Cognitive Behavioral Therapy simplified

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Cognitive behavioral therapy (CBT) is based on the idea that emotions affect behaviors and thoughts, thoughts affect emotions and behaviors, and behaviors affect emotions and thoughts. To resolve a problem, CBT therapists generally try and promote a change in behavior and thinking patterns with the goals of increasing positive emotions.

CBT is a relatively linear and pragmatic model that is less concerned with catharsis and more concerned with tangible solutions. Therefore the therapist tends to be more active and might spend less time simply listening or gathering information than in other approaches.

  • In short the therapy is used to change problematic behaviors and thinking patterns as apposed to fostering insight, empathy based recovery, self-awareness, or meaning etc.

 

In CBT a client will engage in exercises designed to foster positive change. The therapist will confront the client in an effort to assist the client in challenging and changing behaviors and thoughts that perpetuate the problem.

CBT tends to be a more directive form of therapy. The therapist will lead the client on a journey towards identifying disruptive thoughts and behaviors. The therapist will collaborate with the clients so as to come up with differing ways of behaving and thinking. The client is then instructed to make the agreed upon changes.

CBT is often compared to the medical model as it has the goal of isolating and removing a problem. Like the Medical model CBT is rooted in modernism which is a theory of existence which maintains that objectivity (or facts) exist.

CBT instructs the clients to monitor their thought processes and to record all of their negative cognitions.

  • These negative cognition will be investigated in therapy to check their validity.
  • By bringing a person’s thoughts into their conscious awareness a therapist can then assist a client in making subtle alterations to those thoughts/beliefs.

 

Cognitive Example: “I am a horrible soccer player” this is a somewhat useless thought/belief that will likely bread hopelessness. It is hard to identify how this thought stands to benefit the client.

  • There is probably an underlying belief which suggests, “I should be good at soccer and I should feel inadequate about myself given my current level of play… poor performance should be accented with self criticism and self pity.”

 

The client could make two changes in this instance, one change is more on the surface and the other is more foundational.

Foundational belief change: If a client can monitor their “shoulds” so that they are able to hold that their “should based belief systems” are the root of their suffering. The new belief would be “I am accepting of the emotions I experience… cognitive based ‘shoulds’ do not dictate my emotional reactions.”

Surface level: “I am learning to become a better soccer player.” this thought allows for the possibility for change and is not inherently self critical. By changing this thought a person would likely have a different emotional disposition while playing soccer.

Cognitive distortions are beliefs that a person has that are ‘incorrect’. These ‘incorrect’ beliefs tend to be overgeneralizations. Example: “I am an inherently unlovable person” or “If I lose then I am a failure,” or “I should not bother trying as I am not good enough.”

Clients will work with their therapist to change these unhelpful beliefs.

The behavioral component of CBT essentially assigns behaviors that will very likely impact the solution either directly or indirectly.

  • Examples: if a person has a motivation problem related to exercise they could be asked to walk around the block every day for a week.

 

  • If a person is procrastinating looking for a job they could be asked to make one phone call or to write one cover letter etc.

 

Successive approximations – a client is asked to engage in behaviors that will likely lead to the desired solution. For example, if the goal is to clean the kitchen the first behavior would be to buy dish soap. If the goal is to get into shape then a ½ mile walk could be the first suggested behavior.

Systematic desensitization – this is a behavioral method most commonly used with phobias. The idea is to start small… if you have a fear of snakes; first try watching a program about harmless snakes on television… then perhaps you could visit a zoo and look at the reptiles from a distance etc. Start small is the basic message.

There are so many different theories and intervention strategies involved in CBT, but the basic message is:

 ‘Change behaviors and cognitions = change affect or fix problem.’

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