Understanding CBT: A Beginner's Guide to Cognitive Behavioral Therapy
Written By: Heather Rolland, LCSW and Dr. Beata Lewis
Cognitive behavioral therapy (CBT) is a widely used therapeutic approach. The basic idea, in layperson’s terms, is that thoughts influence emotions, and then emotions impact behavior. This idea isn’t new – Shakespeare refers to it when Hamlet is bantering with his pals, Rosenkrans and Guildenstern. When Hamlet refers to Denmark as a prison, his friends (who are there to cheer him up) argue with him. His response is pure CBT: “Why, then, 'tis none to you; for there is nothing either good or bad, but thinking makes it so.” In a similar vein, during the first world war, a journalist misattributed the following CBT-enriched quote to Abraham Lincoln: “folks are usually about as happy as they make up their minds to be.”
However, CBT is much more than simply the power of positive thinking. This approach to therapy has been used for decades and has been well studied. CBT is effective, sometimes even more effective than other modalities. Explaining and demonstrating what CBT looks like in a therapy context is a bit beyond the scope of one blog post, but we can take a closer look at one piece of this work by exploring what have been called “thinking errors” or cognitive distortions.
Cognitive distortions are thoughts that support an inaccurate (and often painful) world view. For example, if deep down you doubt you are worthy of love, or believe that you are “too much,” then the cognitive distortions you use will skew reality to support that world view. Thinking this way can become a habit, and habits can be so hard to break.
Most of us slip into using at least a few of these distortions some of the time; they are beyond common. The good news is that we can make distortion-free thinking a habit, once we learn how. Here’s a sampling from the catalog of cognitive distortions (in no particular order):
All or nothing (or black and white) thinking. If you find yourself using the words “always” or “never” be on the lookout for this distortion. Situations are interpreted through polar extremes: either I am perfect (I get the highest grade possible, receive the promotion, date the prom queen) or I am a total failure. No shades of gray, no middle ground.
Catastrophizing. All or nothing thinking often leads to catastrophizing. This is when you accelerate from 0 to 60 in negative outcomes based on minimal facts. A single error at work becomes the foundation of losing your apartment or your partner leaving you.
Labeling. You could also call this “name calling” – it’s when you label yourself (or someone else) based on a single action. For example, you send an email with a typo in it and then tell yourself you’re stupid.
Emotional reasoning. Letting feelings stand in for facts. For example, if I feel worried about my partner’s health, then she must have cancer.
Magical thinking. Superstitions fall into this category. Bargaining is also a type of magical thinking: if I finish all my paperwork by 3 pm, I’ll get a raise.
Shoulds. Deciding what other people should or should not do is a recipe for feeling distressed, resentful, or self-righteous. Same goes for shoulding on yourself.
Discounting the positive. A particularly painful flavor of all or nothing thinking, discounting the positive is exactly what it sounds like: cherry picking evidence to prove to yourself that everything is terrible, wrong, bad, stupid or ugly.
Personalizing. The snowstorm, the flat tire, the bad grade on an essay – personalizing is when you believe that a bad thing that happened was due to some person or force that’s out to get you. Personalizing can lead to wondering “why me?”
Many of these are intertwined with each other – for example, all or nothing thinking often blends with labeling, and in this case leads to mind reading: “The teacher never calls on me because I’m stupid. She knows I’ll say something stupid.”
Becoming aware of how we tend to rely on these self-deprecating ways of thinking is the first step. Once you notice how often your thinking fits into one or more of the above categories, you can start to catch yourself.
Then what? You can change both what you think and how you think. For some people, it helps to pause as you board a familiar train of thought, and just step back and remind yourself of the pattern. For example, if thinking about your ex-husband always leads to feeling like a failure and weeping, the next time you start to daydream about your ex, ask yourself “Do I want to feel bad and start crying? Because based on past experience, I know that if I keep thinking about Phil, I will feel terrible and cry.”
Another helpful approach to confronting these types of thoughts is to substitute them with other, less distorted thoughts. For example, if you tend to use all or nothing thinking frequently, start challenging yourself to scale situations, either from 1 to 10, or use percentages. Instead of declaring yourself a complete failure, you can assess a situation and note what went well, or what you did right, as well as what went wrong. The overall score might be closer to a 5 than a 0. Seeing parts, shades of gray, or nuance in situations can help decrease the intensity and lead to feeling more balanced.
It is also possible to substitute thoughts entirely. Notice what you’re thinking about, and then make a choice: do I want to think about this right now? Ask yourself how you will feel in 5 minutes if you continue to rehearse this particular scene, and then choose. Sometimes thinking about a distressing situation is unavoidable and potentially helpful, but usually there is a limit beyond which you’re just spinning your wheels, digging yourself more deeply into upset feelings. In these cases, try using a timer. Set a timer for a reasonable amount of time – 10-15 minutes should be plenty – and go ahead and think freely about the upsetting scenario. When your timer chimes, choose something completely different to think about, something pleasant or relaxing. If thought substitution feels too challenging at first, use music, comedy reels, breathing exercises, or a sensory experience (try putting an ice cube in your hands or mouth, for example) as a transition.
Believing that when your brain tries to take you for a ride, you are in the driver’s seat, not a helpless passenger, takes time and practice. Start small and easy, thinking about specific colors or flavors and then changing them a couple of times as an exercise. This can help create the habit of directing your thoughts. If you struggle and backslide, don’t panic: these moments are opportunities to practice new ways of thinking, new scripts to use. Instead of telling yourself “that didn’t work” you can notice how well you did for 30 seconds.
CBT is much more than simply replacing cognitive distortions with positivity, toxic or otherwise. To learn more about becoming aware of the relationship between thoughts and feelings, and how to use CBT as one of your coping strategies, email us at info@mindbody7.com.
Mind Body Seven clinicians offer treatment in Brooklyn and via teletherapy for adolescents and adults. If have not worked with us and want to get started please contact us here, so we can set you up with the clinicians that best suit your individual needs. If you are an existing patient get in touch with us here to set up your next appointment.
