Cognitive Behavioral Therapy

What is Cognitive Behavioral Therapy and What Makes it So Darn Effective?

If you have paid even a little bit of attention to the language of psychotherapy and personal improvement in recent days, chances are you have heard about Cognitive Behavioral Therapy (CBT) and how it has become the preferred method of treatment by many therapists and by insurance companies who pay for treatment. Its effectiveness for producing meaningful improvement in depression, anxiety, grief and the effects of trauma, anger, bipolar disorder and general stress reactions are widespread. A number of studies show CBT to produce better results than psychotropic medications such as Prozac and Paxil. While many of the concepts underlying CBT are relatively new and have evolved from the ideas of Aaron Beck many are a great deal older with Shakespeare doing a pretty good job of capturing the main concept in 12 short words,

”there is nothing either good or
bad, but thinking makes it so”
-Hamlet

It is not the outside world, not events, not circumstances, not “reality” or even brain chemistry that determines our emotional and mental well-being, it is rather the internalized narratives, the stories and meanings that we tell ourselves that determine how good, marginal or miserable our experience in the world will be. This is a surprisingly difficult concept for us to take on board and it is one that can simultaneously feel absolutely true and quite naive at the same time. I believe that it can help to think of the development of these skills or “good mental hygiene” as something that is not all or nothing, but rather something that exists on a continuum and one that we can get better and better at with practice and with commitment.

The main therapeutic power of CBT is that when administered skillfully, it can show us that much of our suffering is due to automatic, recurring, negative, and distorted thoughts which keep us stuck like glue in a state of anxiety, depression or other painful states. Below are the dirty dozen of the most common cognitive distortions:

• Mind Reading: You assume that you know what others are thinking about you and that it is generally negative
• Fortune-Telling: You predict a negative or catastrophic future for yourself
• Labeling: You assign global negative statements to yourself based on one adverse occurrence, “I’m a loser”
• Overgeneralizing: “I failed at this and I will fail at everything”
• Emotional Reasoning: You allow your feelings to explain reality. “I feel depressed, therefore I am a failure at my career”
• Catastrophizing: “I will never be able to stand a bad outcome. It will kill me”
• Blaming: “It is the fault of my parents or spouse or co-workers that I feel this way”
• Discounting the Positive: My successes are trivial compared to my shortcomings
• What If? “Sure things went well today…..but what if everything goes to hell tomorrow?”
• Dichotomous Thinking: Or “All or nothing thinking” You fail to see nuance or partial success in yourself or others. Everything is either all good or all bad
• Negative Filtering: Laser sharp focus on the negative and evidence of your deficiencies
• Inability to Disconfirm: Similar to all or nothing thinking, you find reason to reject any evidence that might contradict your negative thoughts about yourself.

The following diagram presented by the Aaron Beck Institute demonstrates the ABC’s of CBT. Quite simply, there is an activating event or thought (A) which leads immediately to an automatic negative thought (B) which results in painful or destructive feelings and/or behaviors (C)

Activating Event – the actual event and the client’s immediate interpretations of the event
Beliefs About the Event – this evaluation can be rational or irrational
Consequences – how you feel and what you do or other thoughts

In the charts above and below (from counselingresources.com) you can see how that when a negative event happens, one can interpret it positively or negatively. How one interprets it affects how one feels, thinks and behaves.

The curative power of effective CBT lies in its ability to create the powerful awareness that

First: “I am having an automatic negative thought,

Second: to be able to identify the type of negative thought…... eg. “I am using “What If” thinking,

Third: to realize that this thought is strongly contributing to me feeling badly”

Fourth: that this thinking is distorted and illogical

Fifth: that I can develop alternative thoughts which are more positive, more logical and more likely to lead to improved mood and life experience.

An important point to remember is that in spite of the demonstrated effectiveness of CBT, it will likely only work if there is a very strong rapport, trust and personal connection between therapist and client. The quality of the therapeutic relationship is likely still the most important single factor in determining how successful therapy will be.