Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy (CBT) was founded by Aaron Beck in the ’60s. Since then, the theory/therapy has been gaining popularity and use in the community and is now, by my best estimate, the most commonly used therapeutic treatment. I am one of many therapists that integrate this into my practice, notably for depression and anxiety related issues, but for much more.
Overview
The basic premise of CBT is that our thoughts affect our emotions, which in turn affects our behaviors. For any given Event in our life, we have an Automatic Thought (AT). This AT happens without warning, thought, or effort. This thought then causes us to have an associated Emotion. That subsequent emotion then can cause us to have a certain Behavior.
For example, let’s say I get cut off in traffic. The car swerves into my lane and I have to hit the brakes to avoid getting into an accident. This is the Event. A possible Automatic Thought that might go through my head is “That person could be drunk”. The subsequent Emotions I may have are anger, fear, disappointment, hesitancy, or all of the above. Typical resulting Behaviors would be to try to get away from them as quickly as possible, call the police, or get their license plate number.
Examples
These all following the following sequence: Event –> Automatic Thought (AT) –> Emotion –> Behavior
1. (Event) Cut-off in traffic –> (AT) “That person could be drunk” –> (Emotion) Fear –> (Behavior) Try to get away from them
However, someone else, given the exact same Event, may have the Automatic Thought of “Maybe they just didn’t see me”. The likely resulting Emotion would be fairly neutral, with perhaps some understanding, forgiveness, or mild trepidation. The Behavior would probably be to go about my day, or possibly change lanes to get a little further away from them.
2. (Event) Cut-off in traffic –> (AT) “Maybe they just didn’t see me” –> (Emotion) Neutral –> (Behavior) Go about my day
The Event, getting cut-off and having to hit your brakes to avoid an accident, didn’t change at all. However, the emotional and behavioral reactions were different.
Another example would be noticing someone is laughing and looking at you in public (Event). One thought could be “They’re laughing at me.” This seems like a very believable and plausible Automatic Thought. The Emotion associated is probably one of sadness, anger, decreased self-esteem, etc. The Behavior may be to walk away, start to cry, process this with a friend, and so on.
3. (Event) Laughing and looking at you –> (AT) “They’re laughing at me” –> (Emotion) Sadness –> (Behavior) Walk Away Sad
However, this same Event, I may have the Automatic Thought of “I wonder what was so funny? I bet their friend just told them a good joke” In this context, the Automatic Thought does not place any focus on me, but just a neutral event. The subsequent emotion would probably be inquisitiveness, or likely just neutral. The Behavior may be asking what was funny, or just ignoring it and going about my day. Once again, the Event was no different, but my thinking was.
4. (Event) Laughing and looking at you –>(AT) “I bet their friend told a good joke” –> (Emotion) Neutral –> (Behavior) Go about my day
With the thought from Scenario 3, that may ruin the rest of my day. I may get a little bit down about it, but go on. However, when a pattern comes up where this type of thinking happens daily (or numerous times per day), it can start to change their way we feel about ourselves, our Core Beliefs about ourselves, and how we interact with the world. This can occur throughout our lives, but often in childhood.
Where the therapeutic parts comes in is working on changing the way we think about things (our Automatic Thoughts), in order to change the subsequent emotions and behaviors. We have little control over the Events in our lives, but we have 100% control over how we react to them. If I’m thinking like Scenario 3, I want to think more like Scenario 4. I’ll be much happier, less stressed, and feel better about myself. Taking the more adaptive and happier thought, the Disputing Thought, and putting it into place of the Automatic Thought is when the healing begins.
This is obviously much easier said than done. It takes practice to become aware of our Automatic Thoughts and even more practice at recognizing when they come up and putting in a Disputing Thought instead. However, with work, time, and effort changes can really happen.
For one final scenario, let’s look at The Little Engine That Could.
Event: A big heavy load of railroad cars needs to get up a hill.
Big Engine’s Thoughts: I can’t; That’s too much for me to pull.
Emotion: Defeat, hesitance
Behavior: Doesn’t even try.
Event: A big heavy load of railroad cars needs to get up a hill.
Little Engine That Could’s Thoughts: I think I can, I think I can, I think I can.
Emotion: Ambition, confidence, determined
Behavior: Gets the load over the hill.
Once again, the Event is the same, but the Thought, Emotion, and Behavior were the difference. This important life lesson, first shown to us in a children’s story, has tons of value for all of us.