You’ve probably heard about CBT. It’s the recommended evidence-based treatment for anxiety and depression, but also for chronic pain and a host of other mental health / emotional ailments. Here’s a quick summary of what CBT is and how you can use it:
What is CBT?
CBT was developed by Aaron Beck, a psychiatrist, back in the late 1960s. Some see it as a counter, along with the behaviorism of B.F. Skinner, to the prevalent and heavy influence of psychodynamic / Freudian approaches to mental health at the time that focused on unraveling the past and doing long-term therapy.
What Beck focused on is thoughts — the notion that how you think affects how you feel. If you can change your thoughts, you can come to change your emotions. Over the years others have focused more on behaviors — while you can’t directly control what you feel (you can’t right now make yourself happy) you can learn to control your thoughts — what you say to yourself — and you absolutely can control your behaviors. Change either thoughts and behaviors and/or both, you can change how you feel.
How is CBT different than other therapeutic approaches?
What makes it different from psychodynamic, insight-oriented, past-oriented approaches is a focus on the present: What are you thinking about right now? What were you thinking when you started to feel anxious before your exam? What do you do when you start to feel angry? The goal is understanding what happens in your brain and your body when emotions start to overwhelm you. Unlike other approaches the source is not in your past but what happens in the present, in your brain.
What to expect in therapy
While a CBT-oriented therapist may ask you about your childhood and past to better understand the environment you grew up in — such as if there may be a family history of mental health problems — the focus in sessions is on understanding what is happening inside you when emotional problems arise and helping you do the same. This is about increasing your own awareness of how you think, what you do when you are stressed, anxious, depressed, in pain. What topics does your brain focus on? Can you tell that you are going down some rabbit-hole of worry? How do you talk to yourself when you’re feeling depressed and feel that you can’t get out of bed? What do you do when your partner says something that hurts your feelings?
Awareness is the front door to change, and by being aware of your reactions, you now can begin to change them — both the thoughts and the behaviors. That being said, the change is not immediate: If you do change your thoughts and/or behaviors, you should expect that your feelings will stay the same for a while — that you will feel guilty if you didn’t volunteer for that committee at church even though you said to yourself that you really don’t have the time; that you will feel anxious that you didn’t get all the laundry done on the weekend like you usually do; that if you force yourself out of bed, you will likely still feel depressed.
This is because emotions lag behind thoughts and behaviors. You need to repeat creating these new thoughts and behaviors many times before you create new circuits in your brain. You also need to deliberately pat yourself on the back, in spite of how you feel, for breaking old thought and behavioral patterns.
How to apply this on your own
While a CBT-oriented therapist can help you increase your awareness and learn these skills, as well help you stay accountable for applying them, you can do this on your own. There are plenty of workbooks that you can use to help you develop this way of approaching your specific problems — depression, anxiety, pain. But even without them, you can learn to apply these skills in your everyday life. Here are some suggestions:
If you start to get overwhelmed by emotions or pain
Ask yourself: What is going on? What am I right now anxious, depressed about? Why is my pain suddenly flaring up? See if you can figure out where your thoughts are going, what self-talk is taking over. Often it is about some disasterization — that someone will be really angry, that my boss will fire me, that my pain will never go away, that I need to find the right answer to my worry in order to feel better?
Is there a real problem that I need to fix?
There is rational anxiety — real problems, real pain, depression from feeling trapped in your job — and irrational forms. You haven’t heard back from your partner about the kids’ pick-up schedule — rational. My back hurts because I probably over-stretched it when doing my exercises — rational. I’m depressed because I hate my job, but at my age I realize that I probably can’t find anything that will pay as well.
If there is a real problem, you want to take action: Now send a text or email or call to your partner about the pick-up schedule; take the Advil for your back and skip your exercises tomorrow; go ahead and go online to see what might be actually out there in terms of possible jobs, or set up a meeting with your supervisor to talk about ways of improving your everyday job tasks.
The key here is decisive action. Don’t dither by waiting till you hear from your partner, by going online and looking endlessly about other reasons your pain my be flaring up, by crafting the perfect email to your supervisor about your job, or talking yourself out of looking for a job.
If your problem is irrational
If you can’t pin down a specific problem and/or you can’t find a specific cause, or if they are clearly irrational — you’re worried that you’ll get sick because you touched the doorknob at work, that you’ll get run out of the church because you didn’t volunteer for that committee, that you’ll wind up in a wheelchair because of your back pain — this is about calming yourself down.
Here you can try journaling, writing out what irrational thoughts are going through your mind, and then engaging your rational mind and writing what is rational — that you likely not get sick, run out of the church, not wind up in a wheelchair. And if you don't want to write, deliberately talk to yourself in the same way. You can also reduce your emotional stress by doing some exercise, deep breathing, engaging in some mindful activity like cooking, by distracting yourself by playing a video game. Again, the key is action with the focus on calming yourself down, rather than allowing yourself to go the rabbit-hole of trying to find the perfect answer to your problem or disasterizing.
You can begin to practice these skills whenever those troubling thoughts and emotions begin to flood you. The content — your current worry of the hour — isn’t important. What is important, and the lifelong skills are you trying to learn are the skills of managing your own mind?
CBT is about you learning to control your brain rather than your brain controlling you. It’s about you learning to run your life.
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