By Tom Gettelman, PhD
Cognitive Behavioral Therapy (CBT) was developed by Dr. Aaron T. Beck in the 1960’s and is one of the most beneficial models of psychotherapy in use today. Decades of empirical research has demonstrated that CBT is highly effective in treating most psychiatric illnesses. As described eloquently in a quote attributed to Buddha, “We are what we think. All that we are arises with our thoughts. With our thoughts we make the world.”
The CBT triangle (see image) is based around the core principal of CBT: a person’s thoughts, feelings and behaviors are all impacted by one another. A specific thought can trigger an emotion which then can lead to a behavior. For instance, the thought “something bad might happen” can cause someone to feel anxious (emotion) which can lead to the avoidance (behavior). When someone regularly experiences the negative thought “something bad might happen” and then consistently avoids situations that make them feel anxious, the more control anxiety has over how they live their life. The goal of CBT is to restructure the negative thought to produce healthier emotions and behaviors.
Write Down Your Thoughts
When doing CBT, therapists use a variety of concrete exercises to help clients identify negative patterns of thinking. A common exercise is having a client write down the automatic thoughts that they have related to a specific situation and then have them write down new or different thoughts that make sense to the situation but aren’t likely to lead to the same troubling emotions. For example, the client reports that they made a mistake at work. Their automatic thoughts are, “I’m probably going to be fired. I always mess up. I’m no good at this job.” These thoughts connect to feelings of sadness, worry, and shame. The client is then asked to provide evidence to support that thought and then evidence against that thought. After reviewing the evidence, the client is asked to come up with different thoughts relevant to this situation and write them down, “I messed up but mistakes happen. Everyone makes mistakes sometimes. I’m going to work through this like I did before. When I made a mistake before, I wasn’t fired so I’ll be okay now.” These new thoughts are likely to connect to feelings like hopefulness and self-confidence.
Challenge Your Thoughts
Another useful exercise asks clients to challenge their thoughts. For example, a client with high anxiety is asked to “Describe a common situation that triggers your anxiety. Now imagine that you are faced with the anxiety-producing situation you just described. Describe the worst outcome, the best outcome, and the likely outcome. Now imagine the worst outcome comes true. Would it still matter 1 week from now, 1 month from now, 1 year from now? Finally, using your own ‘worst outcome’ and ‘likely outcome’, describe your irrational thought(s) and then describe your rational thought(s).” Completing exercises like these help clients take more control of their automatic thoughts and begins to help them learn how to experience the same situation from a different perspective, breaking the thought, feeling, behavior cycle that caused the difficulty.
At HopeWay, the principles of CBT are part of all of the various therapies we offer. Elements of CBT are used during art therapy, during music therapy (lyrics are, after all, simply thoughts), and even in our learning kitchen. CBT takes practice and most clients do not experience the benefits overnight. Sometimes clients are working to change an automatic thought that they have had for their whole life! However, with a lot of practice and hard work the benefits can be life changing.
It is wise to remember that every person experiences the world, themselves, and others via the language of their thoughts. Consider this for a moment. It is a very powerful realization. Accepting this truth empowers us to use principles of CBT to struggle, yet succeed, heal and recover. After all, what is healing but a shift in perspective?
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Dr. Tom Gettelman is Chief Clinical Officer and Director of Admissions at HopeWay, an accredited nonprofit residential and day mental health treatment center for adults located in Charlotte, N.C. and serving clients from our region and from across the nation. To learn more, visit www.hopeway.org