Dr. Elisheva Jakobov-Assouline
Cognitive Behavioral Therapy (CBT) was developed by Dr. Aaron Beck and is rooted in the idea that our thoughts, feelings, and behaviors are interconnected. CBT operates on the principle that negative/irrational/maladaptive/unhelpful thought patterns can contribute to emotional distress and unwanted behaviors. When an individual experiences negative thoughts about themselves or the world, they feel negative, causing them to engage in negative behaviors. This is a vicious cycle and continues unless you intervene to change the negative cycle from reoccurring. For example, if you think you are socially awkward and not a great conversationalist (thought: “I am weird and others don’t like me”), you may feel insecure and down. Because you feel insecure and down, you then decline a social invitation. Because of this, you then start to think how you constantly stay home alone and are a loser. The cycle just continues.
With CBT, the belief is that it is not the event itself that leads to a thought, feeling, and behavior. Rather, it is one’s interpretation of the event itself that leads to one’s feelings and behaviors. This explains why you can have two different people who experience the same event, however, each of them will react differently to the event. For example, let’s say Person A and Person B send a text to Person C (a close friend of both), and Person C does not respond to either. Person A may think to themselves “I must have wronged her if she is ignoring me. I wonder why she is upset at me,” which leads her to feel anxious and hurt. Contrary, person B may think “Person C must have a lot of things going on in her personal life. I wonder if she is okay” which leads her to feel concern for her friend. While person A may have personalized the lack of response from her friend, person B is able to understand her friend in a more neutral way, feeling less attacked. Again, the interpretation of the event is what impacts how each person will feel and react.
CBT therapists understand that individuals engage in different types of thinking including automatic thoughts, intermediate beliefs, and core beliefs. Automatic thoughts are thoughts that enter our minds and occur in response to a trigger, and are considered the most superficial level of cognition. They occur in all individuals regardless of a mental health disorder, happen quickly, and individuals are often not aware of them. Sometimes these automatic thoughts are accurate and other times they are not. There are different kinds of automatic thoughts. There are inaccurate thoughts that lead to distress or maladaptive behavior, accurate thoughts that are unhelpful, and thoughts that are part of a unhealthy thought process such as rumination.
To combat automatic thoughts, your therapist may utilize Socratic questioning in therapy. The therapist will ask you several questions regarding your automatic thoughts:
- What evidence exists that the automatic thought is true and not true?
- Is there a different explanation?
- What would be the worst case scenario?If the worst did in fact happen, how would I cope?What is the best case scenario?And what is most likely to occur?
- What happens when I believe the automatic thought?What could be the effect of changing my thinking?
- If my friend was struggling, what would I tell him/ her? (Now, take the advice for yourself)
In contrast to automatic thoughts, core beliefs are deeply rooted beliefs about ourselves, others, and the world that are usually unspoken, and are a result of our environments and life experiences. They are usually formed in early childhood, and can be helpful, unhelpful or neutral, and are typically rigid in nature. When core beliefs are unhelpful, they can lead to maladaptive behaviors. For example, a person may believe that humans are either good or bad, the world is a dangerous place, or that they are unlovable or perhaps they are very bright and ambitious.
In between automatic thoughts and core beliefs are what we call intermediate beliefs, which take on rules and assumptions. They are usually If-then type of statements. For example, “If I ask others for help, then they will view me as weak.”
Usually, the therapist will work with you targeting all three levels of cognition.
CBT is present oriented, goal oriented, and collaborative. In the first session, the
therapist will work with you to set goals that are specific, measurable, realistic, and achievable. Using an approach with a structured framework, the individual can monitor their progress along the way.
The therapist teaches the client about cognitive distortions, which are irrational thoughts that impact how you see the world, how you feel, and how you behave. All individuals engage in such thoughts from time to time. However, they become a problem if they are frequent and extreme. Cognitive distortions include the following types of thought patterns:
- All-or-nothing thinking: refers to thinking in absolutes such as “never” or “always.” For example, you may tell yourself, “I always fail on exams” or “I never say the right words at meetings.”
- Should statements: this refers to the belief that things should be a certain way. For example, “I should always be a perfect husband.”
- Emotional reasoning: this refers to the belief that if I feel something, it therefore must be true. For example, “I do not feel confident, therefore I am not confident, or I feel like a bad spouse, therefore I am a bad spouse.”
- Jumping to conclusions: this refers to interpreting the meaning of a situation without any real evidence. It involves mind reading and fortune telling. For example, “He didn’t invite me to his party. He probable thinks I am a loser.”
- Personalization: this refers to personalizing situations outside of your control. For example, if a parent blames themselves for their child’s bad grades or misbehavior.
- Labeling: this refers to identifying with your shortcomings. For example, you may say things like “I am so dumb” instead of “I simply made a mistake.”
- Magnification or minimization: this refers to the tendency to blow things out of proportion or to minimize the importance of something. For example, you magnify if you fail an exam and believe you are dumb, while you minimize the positive (“my other good grades don’t mean I am bright.”)
- Disqualifying the positive: this refers to the tendency of ignoring the positive aspects of a situation and only recognizing the negative ones. For example, your boss may give you constructive feedback on an evaluation but also many times compliments you. Rather than focusing on the compliments, you focus on the feedback. Or perhaps you do well on an exam and say it’s because of luck.
- Mental filter: this refers to the tendency to dwell on the negative aspects of a situation by filtering out the positive ones. For example, if you are a straight A student and receive an F on an assignment, you may focus on the F rather than on all your past achievements of receiving good grades.
By identifying your cognitive distortions, and challenging your irrational thoughts, you can change your emotional responses and develop healthier coping mechanisms. Research has shown that CBT is a strong and effective first line of treatment for many mental health problems. While in theory it seems simple, it can be difficult and requires commitment. If you or a loved one is struggling, feel free to reach out as we would love to be of assistance.
