Cognitive Behavior Therapy 101

Written by Asal Azizi, Psy.D.

As a therapist who provides Cognitive Behavior Therapy, I often meet with new clients who have heard a thing or two about CBT work, but have never experienced it. As a new client, you may be intimidated by the idea of undergoing CBT or believe it is the answer to all your problems. This brief summary is intended to give you a basic understanding of CBT so you can determine whether or not it is the right type of therapy for you.

What is CBT

When using CBT, your therapist will help you in identifying the thoughts, emotions and behaviors you experience before, during or following stressful and problematic situations. If, for example, you tend to have worrying thoughts when driving, (“I will probably get in a car accident”) then you may likely feel tense, jittery and nervous when in a car and subsequently end up with a bad outcome or end result (i.e. – drive erratically).  Similarly, negative beliefs or self-talk (“I’m not good enough for that job”) can result in pessimistic or hopeless feelings and unhelpful behaviors (i.e. – not applying for the job or skip the interview altogether).

The major components of CBT include:

• Identify automatic thoughts: these are the spontaneous and habitual thinking patterns we have been engaging in for as long as we can remember and are influenced by our upbringing and early life experiences.
• Recognize cognitive distortions: some examples of these include all-or-nothing thinking (“I must be perfect in the interview or else I will fail at getting the job”); overgeneralizing (“He didn’t call me last night; no one will ever want to date me”); catastrophizing (“If I get on the freeway I will probably have a panic attack”); and labeling (“I’m so stupid”).
• Look for evidence and challenge your thoughts: (“How do I know this thought is true?”, “What happened the last time I thought/felt this way?”, “What’s the worst that can happen?”, “What would I tell my friend if they were experiencing this?”)
• Restructure negative thoughts: think about or write down alternative thoughts or self-statements that are realistic, helpful and positive (“At my last interview I was anxious but I ended up getting the job I have now.”, “He may not be interested in me, but I will meet someone else who is.” “I am a safe driver.”, “I made a simple mistake, it could happen to anyone.”).
• Homework and goal setting: each week in between your sessions is an opportunity to work on changing your faulty thoughts and behaviors through the use of record logs to monitor and change patterns, practice relaxation techniques, try out new and healthy coping behaviors, etc.

What is it used for

CBT is evidence-based, meaning many researchers and studies have found it to be an effective form of treatment for mood and anxiety disorders. It is also commonly known that this form of therapy can be helpful for individuals experiencing self-esteem issues, relationship difficulties, and other psychological concerns.  It is a change-oriented, meaning that you and your therapist will be working together to identify the patterns in your life that need to be modified in order for you to experience improvement in mood and behaviors and develop a new set of healthy coping skills.

What to expect in sessions

Most CBT sessions have a common set of elements:

• Review of the past week and any “homework” goals met or unmet
• Mood check
• Setting an agenda for the present session
• Identifying, evaluating and modifying any thinking, feeling and behaving patterns that are problematic or contributing to mood or anxiety symptoms
• Setting a new set of goals or homework for in between sessions

The extent to which you may stick to this structure depends on the therapist you are working with and your particular needs. For example, if you just experienced a major crisis, traumatic event or the loss of a loved one since your last session, you may need to take a break from the CBT structure and use your therapy time as an opportunity to process, debrief and gain emotional support and validation. It is important to keep in mind that if you are seeking therapy for general support and do not feel a need to change anything, then CBT may not be an ideal match for your current needs.

To summarize, I often tell clients that CBT is not rocket science and you only need to be an expert on yourself in order to use it. However, it can be hard to do alone or when you are not sure where to start. Working with a knowledgeable, non-judgmental and caring therapist can help you identify and implement the appropriate and individualized CBT techniques that are best for you.

Image: ^CiViLoN^ on flickr and reproduced under Creative Commons 2.0