Cognitive behavioral therapy (CBT) in simple terms is learning about how your thoughts impact your emotions and behaviors. Let's define some of the words.
Thoughts - feelings - Behaviors
Thoughts live inside your brain. They can be referred to as "the voice inside your head" or your "inner dialogue." Emotions or feelings are the things that you feel; they are volatile and range in intensity. Emotions can be categorized as "comfortable" or "uncomfortable." Happy, sad, hungry, angry, irritated, excited, nervous, etc. are all feeling words. Behaviors are the things that you do such as eating, talking, walking, breathing, pooping, etc. They can also be called "actions." A situation is something that happens in life. It can be big or small, positive or negative.
Photo by Tim Hüfner via Unsplash
Now that we got the words down, why does this matter? You're probably thinking "why should I pay attention to how my thoughts, emotions, and behaviors are connected?" Well, for people who are tired of feeling trapped inside of their minds or are ready to make some serious changes in their lives, CBT is one way that can help. CBT focuses on the negative or intrusive thoughts that create negative thinking patterns. By increasing your awareness to what the voice inside of your head is telling you, you start to notice how those thoughts make you feel and then you actively choose how you want to respond to those feelings.
We find ourselves in situations all the time. It could be graduating from school, learning how to drive a car, arguing with another person, getting ready to go on a first date, experiencing the death of a loved one, etc. For some people, some situations are more challenging than others. One situation can elicit intense, uncomfortable feelings like anxiety, anger, or sadness and ruin their entire day. Using CBT, we can hopefully prevent a situation from ruining your entire day.
In my work with clients, I often refer to the CBT Triangle pictured below:
(yes I actually drew this for you)!
Together we identify a single situation using the triangle as a reference. First, we list out the immediate thoughts that come into my client's mind; their gut reactions. This part is hard, because humans have billions of thoughts come across our minds at any given point without even realizing it. My clients would probably tell me that this is the most annoying part because I am relentless at making sure they are as specific as possible. For example, with my school age clients, I usually give them an example like "What is your first thought when you hear you have a test?" The first thing they tell me will be something in the third person and not very specific. Then I say "No... what is your gut reaction?" And then on the 4th time I've repeated that same question, they'll say "ughhhhh I hate tests!." That's what I'm looking for when being really specific about thoughts.
Second, we move to feelings. I ask my clients, "how do these thoughts make you feel?" They usually tell me "bad." Again, that's where I ask for specific feeling words. When clients tell me "good", "great", or "bad" that doesn't really tell me how they're feeling. I almost always pull out a feelings chart (see an example below) for them to use because this is a skill that takes time to practice. Once they've listed their feelings (I typically ask for no more than 10 depending on their age), I ask them to rate each individual feeling on a scale from 1-10, 10 being the most intense. Not all of the feelings identified have to be uncomfortable. I do look for opportunities to identify comfortable feelings.
Third, we talk about the things they did in that situation. These behaviors can be helpful or harmful. Some of the most common behaviors I see my clients engage in are overthinking, talking to someone, arguing or fighting, drinking, isolating themselves, asking for help, playing on their phone, or overeating. A lot of times, I have to help my clients separate behaviors from feelings because they can be similar and confusing.
After completing the triangle, I ask my clients to reflect on it as a whole and we talk about it. But we've really only gotten to the halfway point because now we're going to work on creating a new triangle. My next move is to ask them what the impact of their thoughts are.
Are they helpful? Are they true? Are they logical?
Most of the time, my clients will say "no." We then identify "alternate" or "replacement" thoughts that they can say to themselves instead. The idea behind this is by changing their immediate thoughts, my clients will notice a decrease in the intensity of their uncomfortable feelings. I also normalize that not experiencing a decrease in the intensity of their feelings is ok too. It happens.
Lastly, we then tackle behaviors. We work together to find replacement behaviors. Repeat after me:
YOU CANNOT EXPECT A PERSON TO STOP ENGAGING IN A HARMFUL BEHAVIOR WITHOUT GIVING THEM A HELPFUL AND REALISTIC REPLACEMENT BEHAVIOR.
For example, if you harm yourself through cutting, I absolutely do not expect for you to just stop self-harming because I said so. I understand that when you're in that headspace of wanting to hurt yourself, it's extremely difficult to work through those urges and the intensity of those feelings without having something to do instead of cutting. So the behaviors I'm speaking about are usually positive coping skills that we have either worked on previously, talked about at some point, or ones that we just identified on the spot, but I aim to find things that they are already using as parts of their daily routines. Examples include: walking, exercising, mindfulness, cooking, reading, music, watching TV, or playing a game. This is important because it makes all of this feel less overwhelming when my clients find things that they don't have to learn. And it also increases the chances of them actually using them.
CBT works well for people struggling with:
-Depression
-Anxiety
-Eating disorders/body dysmorphia
-Behavioral disorders (i.e. ADHD, Conduct Disorder)
-Trauma related disorders (i.e. PTSD)
5 questions to utilize cbt in everyday life:
1. What is the voice inside my head telling me?
2. What am I feeling? How intense are my feelings on a scale from 1-10, 10 being the most?
3. What am I doing right now in this moment?
4. What can I tell myself instead?
5. What can I do to make myself feel better?
I hope this post was helpful in making your way to freedom from your mind. Thank you for reading.
Meet the Author: Jade Shapiro, LCSW-C
Jade Shapiro, LCSW-C works with individuals and families struggling with depression, anxiety, trauma, pre/post effects of terminal illness, behavioral & impulse challenges, and transinternational adoption. Jade is especially passionate about working with adolescents, young adults, LGBTQ+ individuals, and transinternational adoptees. Jade is also an advocate for pediatric oncology awareness, mental health awareness, and body positivity. Jade likes to spend her free time learning about nutrition & fitness focusing on sustainable approaches to create a healthier relationship with food and exercise (avoiding toxic diet culture), reading, listening to music, spending time in nature, and watching her favorite TV shows.