“We can’t solve problems by using the same kind of thinking we used when we created them.”
–Albert Einstein
Identify unwanted emotions and behaviours: This is our starting point. Excessive sadness, worrying, fear, anxiety, panic, anger, loss of interest/motivation, loss of enjoyment, replaying past traumas…these are the types of unwanted symptoms that may be interfering with your life. These symptoms often lead to maladaptive behaviours such as avoidance or withdrawal.
Identify distorted thoughts: The foundation of CBT treatment is that our emotions are determined by our thoughts—that is, by our core beliefs, biases, perceptions, assumptions, expectations or interpretations, and our emotions then drive our behaviours (e.g., anxiety typically drives avoidant behaviours).
These thoughts act like a lens through which we see the world, others and ourselves.
Sometimes these are conscious thoughts, and other times they are so deeply embedded that they are subconscious, meaning that we may need to dig a little deeper in session to understand exactly what they are and how they impact us from day to day.
Often our thoughts and beliefs serve us well. However, sometimes we fall into patterns of thinking that can distort our perceptions and cause a chain reaction of distressing emotions and unhelpful coping behaviours.
In summary, the premise of CBT is that problematic emotions are the result of problematic thoughts—that is, thoughts that are distorted, irrational, dysfunctional or maladaptive, and problematic behaviours—that is, avoidance, withdrawal or aggression, are the result of problematic emotions.
Examples of negative thoughts:
Self-criticisms: “I’m never good enough” or “Everything is too much of an effort” or “People will always judge me poorly.”
Catastrophizing: Assuming that the worst outcome will occur. For example: You develop a sore throat and immediately panic, assuming it must be COVID-19.
Personalization: Taking full blame for a situation that in reality involved multiple factors. For example: You lose your job or your relationship ends, and you’re convinced it was entirely your fault when in fact there were many contributing factors, which may have had nothing to do with you.
All or Nothing Thinking: Also known as “black and white” thinking. For example: If you’ve always been a high performer at school or work but suddenly you make an error or encounter a setback, and now you conclude that you’re stupid or a failure. This can also be considered labeling, which is when instead of describing your error you attach a negative label to yourself; one that is highly emotionally loaded (e.g., I’m a loser).
Emotional Reasoning: Believing that feelings are facts. In other words, when you are feeling anxious or scared, and you conclude that there is a real danger or threat and therefore you are not safe. For example, feeling anxious in a social situation is used as evidence that one is being negatively judged. Similarly, feeling anxious when a loved one is late to arrive home must mean they’ve been in an accident. Finally, feeling anxious before speaking up or being assertive, and concluding there’s going to be negative consequences, thus you decide to say nothing.
Understanding the vicious cycle: When our negative thoughts are automatically accepted as facts, the problematic emotions and behaviours they create can actually reinforce each other over time.
For example, a person who assumes others will negatively judge them may avoid social situations due to the perceived threat and high anxiety. This avoidance will cause the anxiety to diminish or not exist, which confirms to the person (wrongly) that socializing is threatening and that avoidance is the safe solution. When that person inevitably encounters a social interaction, their anxiety may spike, which again reinforces their beliefs that socializing is dangerous and that avoidance is the answer.
By breaking down your symptoms into their component parts—the negative emotion, the thought(s) behind it, and the resulting behaviour—patients are better able to understand how these components are powerfully linked.
The work begins: CBT is a very practical treatment that will help you break the cycle of distorted patterns of thinking, emotional over reactions and maladaptive coping behaviours. During therapy you will learn to recognize when these negative thoughts enter your mind, the situations that trigger them, and how they influence your mood, which in turn determines your behaviours. Therapy may involve evaluating evidence for and against these thoughts, and replacing those thoughts that do not align with reality.
The goal of CBT is to reconstruct your problematic thought patterns by replacing the thoughts we identify as distorted with thoughts that are more realistic, rational and evidence-based.
The process of CBT therapy will help you learn healthier, more appropriate ways to process and react to stressful or triggering situations in your life. Ultimately, CBT will help you think more accurately and thus have more control over your emotions and behaviours.
More specific CBT therapies: There are many scientifically proven protocols that fall under the CBT umbrella. These techniques will be selected and utilized by your therapist in a way that is most consistent with your treatment needs. Some of these protocols include cognitive restructuring, cognitive exposure, interoceptive exposure, behavioural activation, exposure and response prevention, acceptance and commitment therapy, assertiveness training, trauma-focused therapy, problem solving therapy, mindfulness skills, dialectical behavioural therapy, motivational interviewing and habit reversal training.
