What is Cognitive Behavioural Therapy All About Anyway?
Written by Tara Tourloukis, BScN RN MPN
Have you ever heard the terms cognitive behavioural therapy, or CBT? You might hear about them a lot, but maybe you don’t know exactly what cognitive behavioural therapy (CBT) is, or how it can be helpful. Or maybe you think that CBT is only for people in therapy and how could it possibly be applicable for someone like you? CBT has many working parts, but here is a basic tip-of-the-iceberg run down of the theory itself, some common thinking traps and some ways to dismantle these thoughts.
Cognitive behavioural therapy has been around for decades and is a widely used tool in therapy and counselling. CBT can be done individually or in a group setting and can be incredibly helpful for both adults and children. It’s focused on the here and now, the problems or thinking traps that we fall into in our day-to-day life; it helps individuals look at how they interpret and evaluate what is happening around them and the effects these perceptions have on their emotional response/experience. Basically, CBT helps us realize that the way we feel is linked to the way we think about a situation and not simply to the nature of the situation itself. Wow, interesting. So, what we feel in response to a situation is determined not only by the situation itself, but the way we perceive, interpret or make meaning of the situation.
“So, what we feel in response to a situation is determined not only by the situation itself, but the way we perceive, interpret or make meaning of the situation”
Let’s try an example: You’re sitting in the living room, your kids are in the kitchen and you hear some banging in the kitchen. The way you respond to the noise will differ, based on what you think might be happening, or your immediate interpretation of the event. If you think it’s your 3 year old playing with the pots and pans that you left out, you may feel happy that they’re focusing on play. If you think it might be your puppy getting into something, you might feel frustrated and irritated and get up quickly to see what the mess is. If your teenager is cooking, you might feel some apprehension and worry about the state of your kitchen during their bake-a-thon and quietly peek around the corner.
The example didn’t change, but your response did, because your automatic thought changed based on your quick interpretation. This automatic thought had an impact on your emotion, which in turn had an impact on your behaviour. One of the core skills of CBT is the ability to notice and evaluate that automatic thought(s) during upsetting situations. One of the tricky things about those automatic thoughts, is that sometimes they’re distorted, or what you might hear referred to as a ‘thinking trap.’ Everyone has automatic thoughts, and from time to time everyone experiences a distorted thought or falls into a thinking trap. For some people, it’s harder to recognize these thoughts as distorted, which leads to negative impacts on their emotions and behaviour. Getting back to the noise in the kitchen example, until you actually get up to see what happened, you don’t really know what the noise was. Maybe it wasn’t the dog, but you’re already feeling frustrated with the dog and the mess he’s made. A main objective of CBT is to help individuals learn to see their thoughts as ideas that do not necessarily reflect reality. In other words, just because you think something, doesn’t always mean it is true. Thoughts aren’t facts. If you’re going to recognize a thinking trap, let’s take a look at a couple that may be familiar to you:
· All-or-nothing (black-and-white) thinking: When you see things as either black or white with no grey area in between (e.g., your daughter Sophie got her report card, and received all A’s and one B, and she thinks that because she didn’t get all A’s that she is a “failure”).
· Disqualifying the positive: When you discount positive experiences and continue to focus only on the negative (e.g., John is a great dad, and spends lots of time with his kids, playing outside, helping with homework, taking them swimming. He’s been getting more shifts at work recently, and has been away from home more than usual, leading him to conclude that he is a “lousy father”).
· Catastrophizing: When you think of the worst-case scenario (e.g., Alex awakes up in the morning and notices a small rash on his toddler. Instead of considering all the factors that could be contributing to the rash, he quickly concludes that his daughter has skin cancer and rushes to the doctor).
· Personalization: When you see certain events not going well and it’s a result of something about you or something you did (e.g., Jordan lost his hockey game, and thinks that it must only be because he wasn’t good enough as defense).
· Fortune Telling: Believing that you can predict the future. (e.g., Sandra couldn’t find a part time job last summer, so believes she definitely won’t be able to find one again this summer).
So, how can CBT help with these pesky thinking traps? By examining and recording thoughts during upsetting situations, individuals learn how what they think, can contribute to their emotional and behavioural responses. Soon after you have an upsetting situation, record the situation, your thought, and your emotion. Once you’ve recorded and examined your thought, there’s a couple ways you can try and change that distorted thought or disqualify the thinking trap.
· Examine the evidence: Look at the evidence to support and not support the thought. Be honest and objective. What are the facts of the situation; does it truly mean you’re a complete failure if you don’t have all A’s?
· Double Standard: How would you talk to your best friend if they were in your position? Would you tell your friend John that’s he’s a lousy father? Chances are, you would actually be quite empathetic and help to point out all his successes and strengths.
· Survey Technique: Conduct a survey to see if your thoughts are realistic. Ask yourself what others that you trust might think about the situation, and actually ask them! If you believe the rash could be skin cancer, ask your mother who’s had children of her own. Maybe she’ll suggest that you calmly call the doctors office.
· Reattribution: Instead of blaming yourself entirely for a problem, think about all the other factors that likely contributed to it. Ask yourself, "What caused this problem? What did I contribute and what did others contribute?" This might help Jordan to realize that there are 13 other players on the team that are all responsible for the plays, and not just him.
CBT can help to reduce the emotional distress from distorted thoughts and thinking traps, by helping you to identify those distortions. Once you’re able to see thoughts as ideas about what might be going on, rather than actual facts, this allows you the opportunity to step back from your thinking and consider other options from a different point of view. Although this was a quick and dirty description of the basic principles of CBT, working one-on-one with a therapist or counselor can be quite effective and helpful in moving you through more complex examples and ways to disqualify your thinking traps.
To learn more about CBT here are a couple links that might interest you:
Centre for Addiction and Mental Health: https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/cognitive-behavioural-therapy
The Mayo Clinic: https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610
Canadian Mental Health Association: https://bouncebackontario.ca/
**Disclaimer – the information in this article is for educational purposes only and is not meant to replace medical advice, therapy or mental health counseling. If you’re in distress, please call your local crisis line.
