Understanding Cognitive Behavioral Therapy

“I’m not good enough.” “I always get bad grades on my tests. I must be dumb.” “Nobody cares about me.” Do any of these phrases sound familiar? These are called cognitive distortions which are exaggerated patterns of thought that are not based on facts and can lead you to view things more negatively than they really are. We all have negative thoughts that pop into our minds, but if you regularly resort to distorted thinking, your mental health can take a hit. Fortunately, cognitive behavioral therapy is one tool that can help us develop healthier thinking and behaviors.

What is Cognitive Behavioral Therapy?

Cognitive behavioral therapy (CBT) is a widely used and evidence-based therapeutic approach that focuses on the connection between our thoughts, emotions, and behaviors.

The purpose of cognitive behavioral therapy is to help individuals identify and change the destructive thought patterns that have a negative influence on their behavior and emotions. “We typically focus on shifting thoughts instead of emotions because asking someone to just ‘be happy’ is often ineffective,” says Daniel Sexton CASAC 2, Outpatient Program Manager at Chappaqua. “Our emotions are never wrong, but they may be misinformed by distorted thinking.”

CBT requires consistent, sometimes daily, practice for new, more desired thought patterns to take hold. This is because beneath our automatic thoughts exist concepts called core beliefs. These deep-rooted beliefs are usually formed during childhood and are refined throughout our lifetimes. They form the lens through which we view the world and can be adaptive or maladaptive depending on the situations we find ourselves in.

Common Cognitive Distortions

CBT is beneficial in treating anxiety, depression, PTSD, and addiction by exploring the negative thought patterns and behaviors that underlie these conditions. Some of the most frequent examples of cognitive distortions that therapists help to address are:

• Polarization: This distortion happens when we view things as black or white — all or nothing. For example, if an event doesn’t go perfectly as planned, it is seen as a total failure.
• Overgeneralization: A way of thinking where you apply one experience to all experiences, including those in the future. One scenario is if you tripped and fell during a race one time, you might think to yourself, “I always mess up my running races. I just suck at playing all sports.”
• Catastrophizing: Catastrophizing involves expecting the worst in every situation. For example, getting caught up in what-ifs and disasters, such as “If I fail this test, then I’ll never get into college and I’ll never have a good job.”
• Filtering: This distortion happens when you focus on the negative aspects of a situation and disregard all the positive ones. For instance, you completed most of your tasks for the day but overlooked one minor detail. Instead of being satisfied with your progress, you obsess over your mistake and see your entire day as a failure.

What Happens During a CBT Session?

The first aspect of cognitive behavioral therapy deals with “cognitive restructuring.” Here, you work with a trained therapist to identify any negative thought patterns and beliefs that could be contributing to your mental health issues. Together, you’ll analyze the truth behind these thoughts and beliefs, challenging and replacing them in a structured and supportive manner.

CBT in practice can look like discussing a recent distressing event with your therapist, then exploring the thoughts that automatically came to mind during this and addressing their validity. Sexton provides a scenario: I was walking down the street and I waved to a friend, but they didn’t wave back at me. I might automatically think “What a jerk!” or “They must not like me anymore.” Utilizing CBT, my therapist and I will challenge these thoughts and explore other possible reasons for my friend’s behavior. Maybe they just didn’t see me, or maybe they were in their own head and had a lot on their mind at the time. “Being willing to question and challenge my thinking could help me go from feeling sad or angry to content and understanding,” says Sexton.

The second part of CBT involves “behavioral activation” where you identify behaviors that might be contributing to your mental health issues or making them worse. With your therapist’s guidance, you embark on a journey to change these behaviors: you may start small and gradually embrace the bigger, more challenging ones.

What Techniques Are Used?

CBT involves the use of many varied techniques. Your therapist will work with you to find the ones that work best for you. Below are some of the most common techniques:

1. Guided discovery and questioning. By questioning the assumptions you have about yourself or your current situation, your therapist can help you learn to challenge these thoughts and consider different viewpoints.
2. Journaling. You might be asked to jot down negative beliefs that come up during the week and the positive ones you can replace them with.
3. Self-talk. Your therapist may ask what you tell yourself about a certain situation or experience and challenge you to replace critical self-talk with compassionate, constructive self-talk.
4. Thought recording. In this technique, you’ll record thoughts and feelings experienced during a specific situation, then come up with unbiased evidence supporting your negative belief and evidence against it. You’ll use this evidence to develop a more realistic thought.
5. Situation exposure. This involves listing situations or things that cause distress and slowly exposing yourself to these things until they lead to fewer negative feelings. Systematic desensitization is a similar technique where you’ll learn relaxation techniques to help you cope with your feelings in a difficult situation.

Homework is another important part of CBT, regardless of the techniques you use. Just as school assignments help you practice and develop the skills you learned in class, therapy assignments can help you become more familiar with the skills you’re learning.

How CBT Can Help Treat Addiction

CBT is a highly effective method for treating substance use disorders, focusing on underlying thought patterns and beliefs that contribute to addiction. The therapist helps the individual explore harmful behavioral patterns that can lead to alcoholism or drug abuse and teaches them healthier ones.

One of the shared struggles of many people in recovery is how to handle substance cravings. Using CBT, a therapist can work with the individual to identify triggers that lead to cravings and develop strategies to cope with them. This may look like challenging irrational thoughts related to using and practicing relaxation techniques to manage cravings effectively. Some in recovery also talk down to themselves and believe they are weak or incapable of change. CBT can help those folks reframe their thoughts and speak kindly to themselves.

Utilizing cognitive behavioral therapy to treat addiction shows significant success rates in clinical studies. An observation involving an alcohol-dependent patient group revealed an effectiveness rate of approximately 83 percent. When CBT is combined with other treatment approaches such as motivational interviewing, contingency management, medication-assisted treatment, or wellness practices, it can make for a more effective recovery.

Why You Should Try Cognitive Behavioral Therapy

Many people find CBT beneficial because it’s focused, goal-oriented, and applicable. You learn practical, hands-on strategies that you can apply in your day-to-day life both during and after the therapy. Sticking with CBT is not always easy, particularly in the initial stages when you are identifying problematic thoughts and behaviors. Remember, it’s okay to feel a little uncomfortable as this is a new experience, but completely natural. Over time, cognitive behavioral therapy can help you gain confidence and increase your sense of self-worth.