Co-authored by Dr. Daniel Hoffman, PhD, ABPP.
If a patient is having a lot of fun during their therapy sessions, we don’t mean to pour cold water on the enjoyment: But the reality is the care is probably not that effective.
The truth is many therapists — and patients — would rather make behavioral health care a purely supportive, enjoyable experience. This is natural since the human instinct is to run toward pleasure and away from pain, distress, and discomfort.
Effective psychotherapy helps patients tolerate discomfort and better cope with stress. It’s also designed to place a patient or client in settings that trigger anxiety, anger, or sadness — so a trained therapist can work with the patient on solutions, in a warm, encouraging and compassionate manner.
None of this growth happens in a completely comfortable setting. That’s especially the case in cognitive behavioral therapy, or CBT. CBT has a long history of evidence showing that it helps reduce symptoms of many diagnoses, both in academic and community settings.
CBT is the gold standard of mental health care for people who frequently get stuck in the same negative emotional and thinking patterns, leading us to feel physically uncomfortable due to their mood. This also usually leads to struggling to act effectively in our daily responsibilities and relationships. The natural consequence of these patterns is increased distress and/or interference in our daily lives, perpetuating the cycle of negative moods and the linked thoughts, behaviors, and physical discomfort.
When we’re stuck like this, we often are either too aggressive, or avoid things we need to do. Either pattern keeps us from achieving our goals, causes distress and interference in our daily lives. When our emotions are at the level that they cause distress and/or significantly interfere with our lives, we may in fact have a mental health diagnosis.
In CBT, patients are guided to become our own therapists, to discover where rigid, negative thinking patterns and deeply held beliefs that are sabotaging the ability to live up to our values. These thinking patterns often lead to unpleasant emotions such as anger, sadness, or anxiety, which prevent us from acting in ways that are enjoyable and productive.
Emotions cannot be prevented — they’re a natural part of our experience. However, in CBT, we can learn to reduce or prevent overreacting to them. To cope with our emotions, a CBT therapist places a patient in settings that can trigger the negative feedback loop and works with them to find impactful solutions to break the habit.
CBT focuses on a patient’s cognitive, physiological, emotional, behavioral channels. Treatment is very flexible and is tailored based on where the patient’s primary concerns and stuck points exist. For example, people with panic attacks, or social anxiety/public speaking often need to spend more time confronting their fears about physiological bodily sensations and their consequences, such as rapid heartbeat (indicating bodily harm) or blushing (signaling potential criticism or embarrassment). At times, people get stuck in unhelpful thinking patterns, worrying about uncertain potential outcomes; this initially pulls for cognitive reframing or acceptance strategies.
Depression usually involves withdrawing from socializing, hobbies, and meaningful activities; for these people, therapy involves approach strategies to make time for enjoyable, valued activities, as well as assertiveness to get our needs met. It can also involve mood induction exercises, such as watching a comedy or doing exercise. With anxiety and related disorders, such as OCD, and PTSD, confronting our fears are key components, along with processing our emotions and thoughts afterward. In time, we learn to feel less threatened by confronting our triggers to emotional discomfort, to think differently about our emotions, to calm our bodies, and learn to act more assertively and effectively.
In any collaborative type of psychotherapy, problem solving can devolve into a more feel-good session if a therapist isn’t diligent. This can end up as a session which is only going to make us feel good in the moment but doesn’t help us cope with the stresses in the long term. Rather, let’s keep the focus on sustainable success, by using CBT's structure to challenge ourselves to learn effective skills to stop avoiding our challenges, and to have better long-lasting emotional health.
To find a therapist, visit the Psychology Today Therapy Directory.