What is CBT, or Cognitive Behavioral Therapy?

By Chris Kelley, PsyD

Imagine leaving your home to go grocery shopping. This is something you have done dozens, hundreds, maybe thousands of times before. It is practically muscle memory at this point. You check to see what you need to replenish in your kitchen, gather your belongings, walk through your front door and lock it behind you. No thinking required, brain on autopilot, maybe even distracted by music or a podcast playing from your phone. 

Now you are in front of your home, either walking toward your vehicle or toward your destination. Suddenly, a car speeds down the road you live on, jumping the curb and nearly collides with you! It misses, speeds away, and you are left standing there. 

What is the first thought you have? What about the second thought?

“That was close!”

“That person really could have hurt me.”

“This neighborhood is dangerous.”

“What an idiot! Who drives like that in a neighborhood?”

“I probably should not use headphones while walking around anymore.”

“Good thing I wore my lucky shirt today.”

“I am never shopping at night again.”

“I should buy a lottery ticket.”

How might the thought you have make you feel? Scared? Excited? Angry? Hopeless? You may even feel a combination of several emotions at the same time! What do you do next? Perhaps you shake yourself off, get in your car, go shopping, and forget anything happened. Perhaps you call your closest friend (“You’ll never believe what just happened!”). Perhaps you decide to avoid any additional risks, turn around, head back inside, spend the rest of the day watching television, and snack on whatever you happen to have left over from last week’s shopping. Whatever your experience of the above scenario might be, it can likely be looked at by identifying your thought process, how you felt in the moment, and what you wound up doing. By using this structure, you have successfully begun to look at your own experience through the lens of cognitive behavioral theory.

Generally speaking, cognitive behavioral theory views most human experience as a combination of situations, thoughts, emotions, and behaviors. Thoughts can be conceptualized as your inner dialog. Thoughts are what you tell yourself about yourself, others in your life, and the world around you. Some of the most powerful thoughts can even be images or scenarios. Next, emotions are generated or evoked by your thinking. It is important to keep in mind that this process is not necessarily unidirectional. Once an emotion is a part of your experience, you can often see the world through that emotional lens and your thoughts will start to sound a bit different. Last in the chain comes behavior. When in any situation, cognitive behavioral theory suggests the way you behave will be heavily influenced by your thinking and feeling.

This pattern of thinking, feeling, and doing is complicated and quick! You normally do not pay much attention to any of it because the process works automatically. However, sometimes your patterns of thinking, feeling, and doing just stop working the way you want them to. Sometimes your thinking becomes stuck, your feeling becomes painful, and your doing becomes harmful. When these patterns stop working in a helpful way, they can be called “maladaptive.” In other words, they not longer get you what you want. When this is the case, cognitive behavioral therapy can be a helpful way to intervene.

Cognitive behavioral therapy (CBT) is a therapeutic process that uses the above-described method of conceptualizing human experience. CBT is collaborative and transparent. When working with a CBT therapist, the patient is considered an expert on themselves, while the therapist frequently takes an investigative approach and helps the patient see their experience from many different perspectives. The CBT therapist is there to help the patient put words to their thinking, feeling, and doing, while also pointing out any patterns that emerge. Once unhelpful or maladaptive patterns are identified, intervention can be implemented. Intervention can take the form of many different activities both inside and outside of therapy. Examples of intervention include learning and practicing coping skills for stress, thought modification, and behavioral planning. These techniques help you implement change at any or all levels of your experience: situation, thought, emotion, or behavior. 

There are many additional aspects of CBT that can be worked on within a safe therapeutic relationship. Examples include, but are not limited to identification of core beliefs that influence thinking, identification and challenging of cognitive distortions, and exploration through open-ended questions. CBT is often goal-oriented, symptom-focused, and time-limited. However, therapy also often works best when you take your time exploring your life and organizing your own experience in a way that makes sense to you at a pace that feels comfortable. Regardless, CBT ideally ends with therapy becoming less frequent and less necessary for the identified problem. Through CBT, you ideally develop an increased understanding of yourself, identify areas you wish to change, learn skills for change, practice those skills in therapy and by yourself, and troubleshoot anything that does not work with your therapist. With enough practice, you can eventually implement the skills learned in therapy on your own and therapy can become obsolete. 

CBT with a therapist you trust can be exciting and the skills you eventually implement can be life-changing. Schedule a consultation with a therapist to see if CBT is an appropriate approach.

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