What is CBT?
Disclaimer: I am not a professional, the following information has been gathered from my own
experience as a CBT patient and my own research.
Cognitive Behavioural Therapy (CBT) aims to make sense of problems by breaking them down into smaller and more manageable parts.
It is considered a helpful treatment for depression, anxiety, Obsessive Compulsive Disorder (OCD) and panic disorder. CBT breaks problems down into 5 areas and is based on the idea that these areas are interconnected.
1. Situations
2. Thoughts
3. Emotions
4. Physical Feelings
5. Actions
For example, CBT is based around the idea that our thoughts dictate how we feel, both emotionally and physically, and so we can change how we feel by changing how we think.
You feel anxious when you enter a crowded room, you start sweating, your breathing quickens and
you feel like your heart is beating out of your chest, you may even have a panic attack. But it isn’t
the crowd that is making you feel that way, not really. It’s how you are thinking about the crowd and
situation that generated that reaction. Your mind perceives the crowd to be some sort of threat.
Maybe you think that the people in the crowd are dangerous. Maybe you think that they will hate
you or think you’re weird or fat or ugly or stupid. Thinking this way makes you feel a certain way.
“The problem is not the problem. The problem is your attitude about the problem”
- Captain Jack Sparrow
I know a lot of people think differently but I personally do not believe that we control our thoughts but we can choose to challenge them.
Your first thought is a reflex which has evolved from what you have repeatedly been exposed to; criticism, comparison, negative self-talk. You need to keep challenging your immediate thoughts to reach a healthy way of thinking.
The way you think about this situation results in you feeling worried, hurt and paranoid. But how do you know this? How do you know that they hate you? Maybe they just didn’t see you.
Thinking something doesn’t make it true and CBT wants us to remind ourselves of this by challenging our thought process. Ask yourself how you know what you think is true. Is it fact or fiction? Is it knowledge grown from logic or an assumption bred from insecurity and anxiety? Which one should you trust?
How do you know that someone will think you are stupid? How do you know that someone thinks you are ugly? How do you know that you would fail if your tried to do something new?
Take your problematic and damaging thinking and challenge it by asking yourself why you think that is true and then challenge it further by asking why it would matter if it was.
Maybe they do think that you are stupid, why does that matter? Really ask yourself why you should care what someone else thinks about you. It’s not a reflection of your true self, so does it really matter?
“What you think of yourself is much more important than what others think of you”
-Lucius Annaeus Seneca
Maybe the crowd are all killers ready to attack you, but is that likely? What are the chances of this really happening?
You may want to say that it is likely, your anxiety wants you to think that but CBT wants to change your thinking so that you challenge your unhealthy, anxiety-driven thinking with a healthier, logic-driven thinking.
In terms of anxiety, safety behaviours are things we do to help us cope with anxiety when we feel
threatened. Maybe you speak quickly so that you can get out of the social situation sooner. Maybe
you drink alcohol before the social situation to help you feel less anxious. Or maybe you avoid the
situation completely.
These behaviours offer temporary relief but causes long term damage because they reinforce your belief that the situation is dangerous. This is why continuous use of such behaviours have been linked to chronic anxiety disorders.
The problem with using safety behaviours is that if the situation goes well you will attribute the success to these coping behaviours. You will never know if you can actually handle the situation. You will never know if the situation is actually as bad as you thought.
I have social anxiety disorder, also known as social phobia. I am terrified of social situations. And when you are terrified of something you tend to avoid it. You’re afraid of spiders? You probably won’t lift a spider. You’re afraid of enclosed spaces? You probably won’t go in an enclosed space.
I’m afraid of socialising so for a long time I avoided people. I didn’t go out with friends. I didn’t go to school. I didn’t leave my house. But you can’t avoid people forever, not if you want to live a somewhat fulfilling life.
For example, I eventually needed to go to class. But going to class didn’t make my anxiety go away. I sat in my tutorial group with panic surging through me. My chest was in agony. My heart was pounding. My breathing was getting faster. I felt like I was going to throw up or hyperventilate or faint, and these have happened many times in social situations.
So, what did I do to receive some temporary relief? I kept my head down, avoided eye contact and I didn’t talk. But then when the tutor directly asked me a question I found that I couldn’t talk, even though my silence made my anxiety even worse. I literally couldn’t speak.
I was mortified. I didn’t want this to happen again so I stopped leaving my room even more. I didn’t go to the kitchen and I skipped the next few tutorials.
With social anxiety, safety behaviours often draw attention to the user, which is exactly what they are trying to avoid and so in this case what I was doing to try and reduce my anxiety ended up increasing my anxiety instead.
Avoidance may get you out of a stressful situation but it, like other safety behaviours, can add to your anxiety in the long run.
If you miss three tutorials you fail the year. If you avoid class you miss the information and you can fail the exam. And if you fail you will need to go to meetings and so this adds even more social situations to give you anxiety.
I avoided the kitchen for so long that I fainted, naked, coming out of the shower in front of university staff and neighbours. Yep. That didn’t help with my social anxiety at all.
Exposure therapy in CBT aims to reduce the long-term anxiety through repetitive exposure to anxiety-provoking situations.
“All life is an experiment. The more experiments you make, the better”
- Ralph Waldo Emerson
Over time CBT aims to reduce the use of safety behaviours so that when you are exposed to a stressful situation and you realise it isn’t as bad as you thought you know that it’s not just because you kept your head down and stopped talking.
It’s because the disaster you were expecting wasn’t definite, it was mentally constructed.
That doesn’t mean that the fear isn’t real, it means that you need to expose yourself to it first in order to find out that you can do it and that the situation isn’t always as bad as you thought.
CBT is about changing how you think in order to change how you feel.
Exposure therapy is about feeling the fear, doing it anyway, realising that you are stronger than you think and realising that what you think isn’t always what is true.
CBT is about stopping negative thought cycles and replacing unhelpful ways of reacting to a situation with helpful alternatives.
It isn’t about positive thinking, it’s about learning to take a step back and recognise when we are being overly critical.
“The happiness of your life depends upon the quality of your thoughts”
- Marcus Aurelius
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Cognitive Behavioural Therapy (CBT) aims to make sense of problems by breaking them down into smaller and more manageable parts.
It is considered a helpful treatment for depression, anxiety, Obsessive Compulsive Disorder (OCD) and panic disorder. CBT breaks problems down into 5 areas and is based on the idea that these areas are interconnected.
1. Situations
2. Thoughts
3. Emotions
4. Physical Feelings
5. Actions
For example, CBT is based around the idea that our thoughts dictate how we feel, both emotionally and physically, and so we can change how we feel by changing how we think.
“The problem is not the problem. The problem is your attitude about the problem”
- Captain Jack Sparrow
I know a lot of people think differently but I personally do not believe that we control our thoughts but we can choose to challenge them.
Your first thought is a reflex which has evolved from what you have repeatedly been exposed to; criticism, comparison, negative self-talk. You need to keep challenging your immediate thoughts to reach a healthy way of thinking.
HOW DO YOU KNOW?
Someone you know passes you on the street, you smile but they don’t smile back. You think they hate you or that you must have done something to offend them.The way you think about this situation results in you feeling worried, hurt and paranoid. But how do you know this? How do you know that they hate you? Maybe they just didn’t see you.
Thinking something doesn’t make it true and CBT wants us to remind ourselves of this by challenging our thought process. Ask yourself how you know what you think is true. Is it fact or fiction? Is it knowledge grown from logic or an assumption bred from insecurity and anxiety? Which one should you trust?
How do you know that someone will think you are stupid? How do you know that someone thinks you are ugly? How do you know that you would fail if your tried to do something new?
WOULD IT REALLY BE SO BAD?
But I also think that we need to take it a step further. Why would it matter if that is what they thought? Would it really be so bad if you failed?Take your problematic and damaging thinking and challenge it by asking yourself why you think that is true and then challenge it further by asking why it would matter if it was.
Maybe they do think that you are stupid, why does that matter? Really ask yourself why you should care what someone else thinks about you. It’s not a reflection of your true self, so does it really matter?
“What you think of yourself is much more important than what others think of you”
-Lucius Annaeus Seneca
WHAT’S THE WORST THAT COULD HAPPEN?
Ask yourself, what’s the worst that could happen? Maybe you have a panic attack. I’m not saying that wouldn’t be awful, I know that they are but it’s not the end of the world. At least for me, the fear of having a panic attack has ruined my life much more than having them.IS IT REALISTIC?
And then ask yourself if your answer is realistic. Maybe the worst that could happen is that everyone in the crowd is allergic to the soap you just used and they all collapse as you approach them, but is that realistic?Maybe the crowd are all killers ready to attack you, but is that likely? What are the chances of this really happening?
You may want to say that it is likely, your anxiety wants you to think that but CBT wants to change your thinking so that you challenge your unhealthy, anxiety-driven thinking with a healthier, logic-driven thinking.
SAFETY BEHAVIOURS
These behaviours offer temporary relief but causes long term damage because they reinforce your belief that the situation is dangerous. This is why continuous use of such behaviours have been linked to chronic anxiety disorders.
The problem with using safety behaviours is that if the situation goes well you will attribute the success to these coping behaviours. You will never know if you can actually handle the situation. You will never know if the situation is actually as bad as you thought.
EXPOSURE THERAPY
In CBT, exposure therapy is thought to be particularly helpful when it comes to phobias, anxiety disorders and obsessive-compulsive disorder (OCD).I have social anxiety disorder, also known as social phobia. I am terrified of social situations. And when you are terrified of something you tend to avoid it. You’re afraid of spiders? You probably won’t lift a spider. You’re afraid of enclosed spaces? You probably won’t go in an enclosed space.
I’m afraid of socialising so for a long time I avoided people. I didn’t go out with friends. I didn’t go to school. I didn’t leave my house. But you can’t avoid people forever, not if you want to live a somewhat fulfilling life.
For example, I eventually needed to go to class. But going to class didn’t make my anxiety go away. I sat in my tutorial group with panic surging through me. My chest was in agony. My heart was pounding. My breathing was getting faster. I felt like I was going to throw up or hyperventilate or faint, and these have happened many times in social situations.
So, what did I do to receive some temporary relief? I kept my head down, avoided eye contact and I didn’t talk. But then when the tutor directly asked me a question I found that I couldn’t talk, even though my silence made my anxiety even worse. I literally couldn’t speak.
I was mortified. I didn’t want this to happen again so I stopped leaving my room even more. I didn’t go to the kitchen and I skipped the next few tutorials.
With social anxiety, safety behaviours often draw attention to the user, which is exactly what they are trying to avoid and so in this case what I was doing to try and reduce my anxiety ended up increasing my anxiety instead.
Avoidance may get you out of a stressful situation but it, like other safety behaviours, can add to your anxiety in the long run.
If you miss three tutorials you fail the year. If you avoid class you miss the information and you can fail the exam. And if you fail you will need to go to meetings and so this adds even more social situations to give you anxiety.
I avoided the kitchen for so long that I fainted, naked, coming out of the shower in front of university staff and neighbours. Yep. That didn’t help with my social anxiety at all.
Exposure therapy in CBT aims to reduce the long-term anxiety through repetitive exposure to anxiety-provoking situations.
“All life is an experiment. The more experiments you make, the better”
- Ralph Waldo Emerson
Over time CBT aims to reduce the use of safety behaviours so that when you are exposed to a stressful situation and you realise it isn’t as bad as you thought you know that it’s not just because you kept your head down and stopped talking.
It’s because the disaster you were expecting wasn’t definite, it was mentally constructed.
That doesn’t mean that the fear isn’t real, it means that you need to expose yourself to it first in order to find out that you can do it and that the situation isn’t always as bad as you thought.
CBT is about changing how you think in order to change how you feel.
Exposure therapy is about feeling the fear, doing it anyway, realising that you are stronger than you think and realising that what you think isn’t always what is true.
CBT is about stopping negative thought cycles and replacing unhelpful ways of reacting to a situation with helpful alternatives.
It isn’t about positive thinking, it’s about learning to take a step back and recognise when we are being overly critical.
“The happiness of your life depends upon the quality of your thoughts”
- Marcus Aurelius
If you like this you may also like:
Wow, thank you so much for explaining and summarizing the CBT treatment in such an eloquent way. I'll be sharing this for sure!
ReplyDeleteThank you so much! I'm glad you found it helpful :)
DeleteThis is such a good and informative summary of a really complicated subject. I love the quotes which you have included as well!
ReplyDeleteThank you so much! :)
Delete