Cognitive Behavioral Therapy: Learning how our thoughts, emotions, and behaviors influence each other

Cognitive Behavioral Therapy: Learning how our thoughts, emotions, and behaviors influence each other

Anna Been, M.A., Clinical Coordinator

Often viewed as the therapeutic “gold standard,” cognitive behavioral therapy (or CBT as it’s commonly called) is an effective intervention for various psychological disorders. Research has demonstrated CBT’s effectiveness in treating conditions including depression, anxiety, addiction & substance use, insomnia, bulimia, anger & aggression, and general stress. While every therapist has a unique style and way of interacting with their clients, CBT practitioners follow the same theoretical principles and may pull from similar interventions when treating clients.

What’s the Basic Idea?

At its core, CBT focuses on the basic idea that the way we think, the way we feel, and the way we act are all influenced by one another. When we feel trapped in a certain mindset or can’t seem to escape certain emotions or behavior patterns, CBT therapists delve into the ways our thoughts, emotions, and behaviors interact and get us stuck in those ruts. Here’s an example: Imagine you see a post on social media of two of your friends spending time with one another. As is often the case, your brain may take you for a ride: “Why wasn’t I invited?.. My friends must not want to hang out with me… maybe I did something to make them angry… I’m not a good friend… I don’t have any friends… nobody likes me...  I’m going to die alone!”

This catastrophizing thought spiral can lead to some uncomfortable emotions that may include anxiety, worry, sadness, anger, fear, or frustration (to name a few!). When we experience those feelings, we may then unintentionally play into and reinforce our negative thoughts, for example, by avoiding reaching out to our friends to make plans, or worrying about what we say when in their presence. We then feel trapped in a cycle of unhelpful thoughts, emotions, and behaviors. CBT therapists utilize the CBT triangle (see below) to show clients how changing their behaviors and challenging their thoughts can help them escape from, and eventually prevent, this cycle.

 

What actually goes on in a session?

CBT is often structured as a short-term therapeutic treatment. As opposed to therapy that may progress over several years, clients who work with CBT therapists often attend somewhere between 6 and 20 sessions. While some types of therapies focus on the past, CBT is present-focused. You may still talk about things that happened in your past, but the sessions will focus more on how those past events impact your present self. Its present-orientation also invols problem-solving and learning actionable skills (like those listed below) that clients can use to challenge unhelpful thinking and behaviors. CBT therapists should also assign “homework” outside of sessions, where clients  get a chance to practice their newly learned skills.

While working with a CBT therapist, you may practice and utilize strategies to help you become more aware of the interconnectedness of your thoughts, emotions, and behaviors. You may use some of the following strategies to do so:

 

  • Cognitive Restructuring involves identifying thought patterns (sometimes called cognitive distortions) that lead to negative moods and unhelpful behaviors, and then coming up with more helpful ways of thinking. To use the earlier example, if you repeatedly fall into the trap of worrying about why your friends are hanging out without you, you may practice catching yourself in this thought spiral, identifying the thought that is troubling you, and challenging it with a different thought. This new thought might be something like, “I have spent one-on-one time with friends before, and it didn’t mean that I didn’t care about my other friends.” Don’t worry if this feels challenging-- cognitive restructuring takes practice!

  • Exposures are a way of interacting with whatever brings you anxiety or fear in an effort to confront and overcome those emotions. Exposures may be “graded” in nature, meaning they can increase in levels of difficulty as you do more of them. For example, if you experience anxiety in social situations, exposures may involve tasks like sending texts or emails or  attending an event where you may have to interact with a group of strangers. 

  • Mindfulness is the act of focusing your attention on the present moment and noticing and accepting the thoughts and feelings that show up, rather than judging or worrying about them. Mindfulness also takes a lot of practice! Check out this video that guides you through noticing your thoughts rather than latching onto them. The goal of mindfulness is not to get rid of thoughts, but rather to notice and exist with them. Mindfulness may also include focusing on your breathing, paying attention to your senses (i.e. what can you smell, see, hear, touch, and taste), or focusing on the sensations in your body when you do yoga or another physical activity.

  • Behavioral Activation involves decreasing our avoidance of and increasing our involvement in activities we value. Part of behavioral activation can also involve becoming aware of how our thoughts, emotions, and behaviors are linked. For example, folks who struggle with depression or low mood may tend to lie in bed, which often contributes to thoughts about hopelessness and emotions of sadness. In this example, behavioral activation would involve recognizing that link, and getting out of bed and doing something we care about, even if our thoughts and feelings may initially be keeping us from doing so.

  • Skills Training may involve learning and practicing certain skills through education, modeling, and role-playing. Skills training can include topics such as social skills, communication, and assertiveness. For someone who struggles to voice their opinions in social situations, skills training may include a mock scenario in which the client will have to practice this assertive behavior with the therapist role-playing a potential peer or co-worker.

CBT guides clients through identifying a conflict, restructuring their thoughts around the issue, and then developing skills to help challenge their reactions to that conflict. Because we, as humans, all experience thoughts and emotions, CBT can be widely applicable in day-to-day life, regardless of whether or not you have a mental health diagnosis.

About Anna Been

Anna Been received her Master’s degree in mental health counseling and behavioral medicine from Boston University. She currently works at Worcester Polytechnic Institute as a clinician in their Student Development and Counseling Center and so has first-hand experience as a clinician in a college counseling center and the demand on college counseling resources. Prior to WPI, Anna worked for 4 years at McLean Hospital’s Obsessive Compulsive Disorder Institute as a clinical residence counselor.

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