Cognitive Behavioral Therapy (CBT) explores the interactions or relationships between a person’s thoughts, feelings, and behaviors.  Sounds simple enough, right?  But in fact, this type of therapy is more complex than it appears at first glance.  The combination of an invested client, an insightful and skilled therapist and CBT can help improve many mental illnesses.  CBT has been found effective in treating mental health illnesses including depression, anxiety, substance use disorders, eating disorders, schizophrenia, personality disorders, and bipolar disorder, and can be used when working with individuals, couples, groups, and families.  Generally speaking, CBT is structured therapy using a goal-oriented approach, with the objective of creating awareness about unhealthy patterns of thinking.  It is important to recognize and change these harmful thoughts because often they lead to destructive behaviors and beliefs.  But by using CBT to form more healthy and realistic ways of thinking results in more realistic and healthier behaviors and beliefs and this can benefit many aspects of one’s life.

So how can you get the most out of CBT (and therapy in general)?

­+ Make sure your therapist is a good match for you:  Check a therapist’s qualifications, education and certification/licensing.  Additionally, make sure your therapist helps facilitate a safe and non-judgmental environment for you to explore yourself and your needs.  Not every therapist is good for every client.  If you do not feel safe, heard and respected, it will be difficult to do the necessary work.  You owe it to yourself.  If you are looking for a therapist with a specialty in CBT, be sure to ask about the therapist’s training and knowledge in the area.

+ Actively participate:  No matter how good a therapist is, he/she will never be able to “fix” your problems.  Therapists are available to help facilitate change.  They provide their expertise and training to help the client gain more insight and understanding into his/her life.  The client’s responsibilities include coming to therapy consistently, actively participating, being honest­, and doing homework.  CBT often asks clients to practice skills outside of the therapy room.

+ Be an advocate:  Nobody knows you better than yourself.  Be honest with your therapist about what techniques are helpful and what techniques are not as helpful.  Therapists will adjust their techniques and therapeutic methods based on what they are seeing, but also what feedback you are giving them.  CBT has many different techniques, and chances are not all will be equally helpful.  Experienced CBT therapists can help you find the best tools to fill your own “toolbox”!

+ Be realistic and give yourself a break:  Change takes time.  Be patient with yourself and your therapy process.  Change is usually difficult and slow, but a wonderful thing.  Allow yourself to make mistakes as you seek improvement, and have realistic expectations of how quickly change will happen.   Although CBT is generally a limited number of sessions, it is very difficult for any therapist to predict just how many sessions will be needed.  However, you and your therapist should consistently check in about progress towards your goal.

Once you have found a good match with a therapist, he or she may choose to use CBT in helping improve your mental well-being.  To illustrate how CBT is applied, let’s walk through an example.

A client, “Bob”, an adult male, is seeking psychotherapy services to help lessen his depressive symptoms and specifically improve his low self-esteem following the separation from a partner.  Here are some key therapeutic CBT steps in bold, followed by how they apply to Bob’s particular situation.

Identifying an aspect of you or your life you would like to change (i.e., a goal).

+ Using our example, Bob, would like to improve his self-esteem and lessen depressive symptoms.  He’s hoping to feel more confident and happy with his life.

Once the goal is decided, Bob’s therapist will help explore the thoughts, behaviors, feelings and beliefs associated with this aspect.

+ Bob is feeling hurt post separation from his partner.  He is feeling down, unmotivated, and isolated.  He used to love walking and attending social gatherings on the weekend, but finds he doesn’t want to do the things he used to enjoy.

Exploring client’s “self-talk” – what thoughts and feelings come to mind about this issue?  How do you interpret certain events, interactions with certain people, etc?

+ Bob doesn’t want to see any of the friends that were mutual between him and his ex-partner.  He worries they will judge him and wonder what is wrong with him if his ex didn’t want to stay with him.

Identify negative and inaccurate thoughts.

+ Bob’s therapist encourages him to explore his feelings, while listening to statements like: “I am unlovable and worthless.  Nobody wants to be with me.  I can’t do this.”

Challenge these negative and inaccurate thoughts

+ Bob’s therapist encourages him to challenge these thoughts, getting him to ask questions like: ‘Do I really not have any worth?  Am I unlovable?  What am I unable to handle?’

Form new appropriate and accurate thoughts.

+ Over time, the exploration of Bob’s thoughts and feelings allows him to see that: ‘Every person has worth.  I have worth.  I am a smart and caring individual.  I am lovable.  I can handle this.  It might be challenging, but I can handle anything.’

As these thoughts and behaviors are explored, your therapist might ask you to do some homework.  Continuing with our example, Bob’s therapist might encourage him to get back into exercising.  This discussion would seek out Bob’s comfort level for progressing, while the therapist explores Bob’s thoughts and behaviors about how he’s approaching the situation.  CBT allows for Bob and therapist to explore possible road blocks to achieving his goal, and find ways to break through.  Let’s say that they agree that Bob will start walking again for just 10 minutes twice a week.  This might be the goal for a week or two until it is revisited and a new goal is set – maybe 15 minutes four times a week or inviting a mutual friend to join him on his walk.

The therapist can explore Bob’s self-talk during this process and additionally may ask Bob to spend time writing his self-talk in a journal.  When Bob finds himself thinking negative or inaccurate thoughts, he can write them down and challenge or replace them with new motivating thoughts.  For example, Bob is getting ready to call his mutual friend on the phone and he freezes.  Thoughts of “I am unlovable”, “everybody hates me”, and “I can’t handle this” start to flood his mind.  Often these negative self thoughts creep into minds like a bad habit.  Through the use of CBT, a person can learn how to actively dispel these harmful perceptions and replace them with new appropriate reflections.  Instead Bob would replace those self-disparaging thoughts with newly formed positive self-reflections – “Everybody doesn’t hate me” “I can handle anything – I have already handled a lot, and it would be good for me to have fun in the company of friends”.

These steps may seem simple as you’re reading them, but can often feel overwhelming when we are faced with life’s challenges.  With the support of an experienced therapist, CBT can help individuals learn how to change harmful thoughts, behaviors, and beliefs into healthy and productive ones.

This topic was written by Liz Martinich, LCSW-C