Cognitive Behavior Therapy

I mentioned Cognitive Behavior Therapy (CBT) in my last post but didn’t elaborate. Some elaboration follows; I hope you find it useful and it answers your questions. Let’s get started with a brief dip into psychological theory.

From a psychological view, cognition is described as the mental action or process of gaining knowledge and understanding through thought, experience, and senses and from those, our actions arise. Simply defined, cognition is thinking. It comprises the procedures related to perception, knowledge, problem solving, judgment, language, and memory. Put another way, it’s about what we know.

As we go through life, we sometimes misread situations, fail to understand the point of another person, and take our skewed understandings and place them in our knowledge bank. At some point in our lives these understandings may haunt us. “Why am I not lovable? I’m terrible at xyz. Making friends is really difficult” and so on.

Goals of CBT Include:

• Encouraging self-awareness and emotional intelligence by enabling clients to “read” their emotions and distinguish between healthy and unhealthy feelings.
• Helping clients to understand how inaccurate perceptions and thoughts contribute to troublesome feelings that affect responses to situations.

Frequently such thoughts are automatic and self-defeating and explain why people feel unaccountably upset. A particular stimulus such as seeing an old school acquaintance across the street might lead to a wave of anxiety. Often people have no real idea why they feel like this and such thoughts and responses are often shown to be irrational when explored. They may have a story about the old acquaintance but how can they know it’s still true? How can they know the acquaintance even remembers or relates to their story? Was it ever true in the first place? Whatever the answers, they believe their reason for the anxiety from the picture they painted in the past. Sometimes memories of such events are unconscious and manifest in “similar” or “related” situations.

Here’s another example taken from my own notes from working with a businesswoman who described herself as “stressed”. Although anonymous, the following notes are edited and published with permission. Please understand that what I share here is a snippet of a lengthy process that had a successful outcome for the client.

SC: Let’s talk about connections between your thoughts and emotions. Can you share some recent examples of when you were frustrated with your business?

Client: Yes, I implemented a new policy for store staff. I imagined getting some queries about it because I always do. Rather than responding calmly, I became frustrated.

SC: Describe how were you feeling at that time?

Client: I felt stressed and annoyed because some staff didn’t understand the policy even though I had taken a lot of time to listen to them, think it through and write it.

SC: What went through your mind?

Client: Nobody appreciated my effort.

How could she know that nobody appreciated her effort? She didn’t ask if anybody did or did not. After getting her to identify that final thought, my role was to enable her to fill the mental gap and discover why the irrational thought contributed to her already high-levels of stress.

We discovered the answer in her past when she worked in a corporate career where she felt frequently challenged negatively. Tracking back through her timeline, we also identified related issues from early adolescence when her communication skills were questioned and challenged. Her default setting was that she was not a good communicator. We identified an irrational thought and recognized it for what it was.

The CBT role is to help the client recognize the irrationality of their beliefs by taking on the role of a sympathetic ally by asking a succession of questions to enable the client to see that their thoughts are self-defeating.

Here’s an example of a dialogue between a therapist (T) and a student (S) who is convinced that her grades aren’t good enough to be accepted by her ideal university.

T: Why do you think the university won’t accept you?

S: My grades are not good enough.

T: What was your average?

S: Good until the final semester in high school.

T: What was your grade average in general?

S: A’s and B’s.

T: Please be specific. How many of each?

S: Most were A’s but I got terrible grades last semester.

T: What were your grades?

S: Two A’s and two B’s.

T: So, your grade average is almost all A’s, why do you think you won’t get into your university of choice?

S: Competition is extremely high.

T: What are the expected average grades for admission?

S: Somebody said a B+ average.

T: Isn’t your average better than that?

S: Yes, it is.

CBT has a close affinity with Behavior Therapy

Fear-evoking thoughts are regarded as a form of behavior which are responded to with irrational beliefs that lead to unhelpful actions.

There are several approaches available to the CBT practitioner and regardless of approach, they will include:

• Pinpointing specific problems or issues in daily life.
• Enabling the client to become aware of unproductive thought patterns and how they influence their life.
• Identifying negative thinking and reshaping in a way that changes feelings toward those thoughts.
• Developing new behaviors and responses and putting them consistently into practice.

Cognitive Restructuring / Reframing

Here we take a detailed look at negative thought patterns. Often people over-generalize and place too much emphasis on minor details. The worst will always happen is assumed and, it often does because attention is on the negatives.

The role of the therapist is to enable the client to identify the negative thought patterns that are evident in particular situations. Once the client develops awareness, the therapist works to reframe negative into positive thinking habits.

For example: “I communicated my intentions poorly when I wrote that policy” can become “That wasn’t my best work, but I know I have the skills to do better next time”.

Guided Discovery

In the Therapist / Student example, through guided discovery, the therapist became familiar with the students’ point of view. Then asked questions designed to challenge the students’ beliefs and broaden their thinking.

The therapist asked for evidence that supported assumptions, as well as evidence that didn’t.

Guided discovery helps the client to see things from new perspectives, which have not been considered previously. This helps to select a more helpful path.

Exposure Therapy

This is helpful as a tool to confront fears and phobias. The therapist exposes the client to things that cause fear or anxiety, while giving assistance in small increments on how to cope with them mindfully.

Journaling and Thought Records

Writing is a wonderful way of connecting with our own thoughts. A therapist may ask you to record negative thoughts that occurred between sessions, as well as positive thoughts chosen instead. New thoughts and behaviors can also be tracked through recording to show a positive “how far I’ve come” timeline.

Activity Scheduling and Behavior Activation

I published a post a while back about Eating Frogs. Not in the actual sense of course. If there’s an activity that is typically avoided due to fear or anxiety, scheduling it on the calendar helps. Once the burden of decision is gone, most people are more likely to follow through and complete the activity.

Behavioral Experiments

If I do “X, Y, Z” something always goes wrong. Behavioral experiments are normally used for anxiety disorders involving catastrophic thinking. Such an experiment will ask the client who feels anxious about a particular activity to predict what will happen. This is followed up by discussing what actually happened and whether the prediction came true.

Starting with lower anxiety tasks, the goal is to see that catastrophic predictions are most often unlikely to come true.

Relaxation and Stress Reduction

I use simple mindfulness techniques and meditations to enable relaxation and some stress reduction.

• Deep Breathing Exercises
• Muscle Relaxation
• Imagery and Visualization
• Guided Meditation

These techniques are easy to learn, help lower stress and anxiety and enable clients to discover a sense of control.

Role Playing

Role play does not demand any acting competency and it can help clients work through different behaviors relating to potentially demanding situations in a safe and supported environment. Working through scenarios with role-play often reduces fear and can be used for:

• assertiveness training
• developing communication skills
• gaining familiarity and confidence in challenging situations
• improving problem solving abilities
• practicing social skills

Successive Approximation

Look at this as climbing a set of stairs one step at a time. Overwhelming tasks are broken down into small, achievable steps. Every step builds on the previous step and develops confidence in small increments.

Skills of Cognitive Behavior Therapists

The skills required by therapists or counselors using CBT techniques are beyond the scope of this article. However, as a basic guide, theoretical knowledge and its relationship to practical application is essential. Empathy and deep listening skills are necessary as is the ability to know oneself and our own strengths and challenges.

It does concern me that anybody can pick up a CBT course and offer their services, yet this is not always appropriate. It is not that the courses offered don’t make the mark, rather, the individuals enrolling often do not have the prerequisite skills that clients need. Many too operate in non-supervised settings and cross-profession supervision is essential and beneficial to all parties.

If you think support may be beneficial, please leave a message below (your message will not be published). If either of us consider that we do not have a potentially viable relationship, with your agreement, I will refer you to a professional who may be better suited to your needs.

Coaching and Tools That Help

Relating to these there are plenty of tools that can help with your Personal Growth and Development whether you feel challenged or just seek to advance the way you respond to your world and expand your success. Please leave your contact details in the comments and you will receive a prompt response. Alternatively, you can send an email. Please understand that your contact details will never be shared outside ExGro or published on this website. Confidentiality is always assured.

More Information

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Comments and Questions

Leave yours below. Your thoughts or questions may well ignite a positive spark in other readers thinking. You will always receive a prompt response to your questions and there is no such thing as a bad question; only the one that was never asked.

Namasté

I bow to the place in you that is love, light, and joy

Peace & Light

Steve Costello is a British Community & Youth Studies and Psychology honors graduate with over 30-years theoretical and practical experience coaching in the Personal Development public and private sectors. He founded ExGro in 2018 with business partner, clinical psychologist and friend, Leo Faerberg.