October 20, 2021 BY Dr. Christopher Cardoso, R. Psych

What Is Cognitive Behavioral Therapy (CBT)?

Cognitive Behavioral Therapy (CBT) is an evidence-based psychological intervention that was designed to improve emotional regulation and overall mental health. CBT is recommended as a first line of treatment in the majority of psychological disorders in both children and adults. It has been used to treat a range of mental health issues such as depression, anxiety, phobias, PTSD, sleep disorders, OCD, substance use disorders, bipolar disorder, psychosis and sexual disorders. CBT is a symptom-focused intervention designed to help individuals achieve specific goals. It focuses on alleviating mental health symptoms rather than answering existential questions, and it does not aim to clarify the values of people, nor does it help them manage deeper relationship or identity related questions. It is a practical and concrete approach that is specific and time limited. Through intervention, the client will learn or acquire the skills needed to resolve their own mental health symptoms. There are general CBT principles and techniques designed to work across all mental health issues that can help an individual to develop personal coping strategies. Cognitive behaviour therapy is a problem focused and action-oriented type of therapy that can help manage stressful life situations.

How does Cognitive Behavioral Therapy (CBT) work?

The premise of CBT is that there is a relationship between the things a person feels, the things that they think, and the things they do. These three ideas operate reciprocally. For example, when you feel good, you often think positively and act in ways that benefit you. The inverse can also happen. For example, if you are feeling sad, you tend to have negative thoughts, and you are less inclined to do things that make you feel better (or, similarly, you are more likely to do things that make you feel worse). This negative cycle can perpetuate itself. Specifically, It can create a spiral where negative feelings feed negative thoughts, which in turn feed negative actions, and so on.

When you are stuck in a negative spiral for days, weeks, or months, that spiral can lead to depression and anxiety, as well as other mental health issues. This happens unconsciously; people don’t spend a lot of time thinking about their thinking or about the choices that they make when they are spiralling. A lot of what people do in life is automatic. Once we build momentum with routines that hurt us, habits set in.

Habits are not things that we spend a lot of time thinking about. For example, when you get up in the morning you might have a shower, brush your teeth, put on a pot of coffee, and get dressed for work. You get up and do these things habitually and without a second thought. We can also develop harmful habits, which is the focus of CBT therapy.

Cognitive behaviour therapy helps you become aware of the distorted thinking that often accompanies unhelpful actions and negative feelings. Specifically, this mode of therapy enables people to examine challenging situations more accurately and respond in a more effective way. This kind of self-awareness, also called metacognition, is a key component of cognitive behaviour therapy. By becoming aware of inaccurate or unhelpful negative thinking, an individual can view challenging situations through a flexible lens and respond to the situation in a more productive or effective way, which can in turn make life less stressful, more controllable, and more predictable. This intervention can help break the negative spiral that feeds anxiety and depression, and these changes can lead to lasting positive improvements in many aspects of life.

Cognitive Behavioral Therapy (CBT) Techniques

The overall concept of CBT is to use cognitive and behavioural interventions to break a negative cycle of thinking, feeling, and doing. In practice, the first step in breaking the negative cycle is to identify what are called the ABCs of CBT. The ABCs are as follows:

A = Antecedents (things that may happen in our lives that trigger us, or a triggering event)

B = Behaviors (how we act in response to these triggers)

C = Consequences (what happens after we chose an action)

The antecedents in this model are the triggering events that happen in the environment. The behaviors in this model describe the actions that are taken in response to those triggers, and the consequences describe the outcome of what happens as a result of those actions.

An example of the ABCs of CBT is one that you might relate to. Your alarm clock goes off in the morning (Antecedent) and you hit the snooze button (Behavior), which makes you late for work (Consequence). This is a basic example of a small chain of events that can create more stress in your day. When you learn about CBT, you come to understand that mental health is often a result of lots of these small chains of events in life where the environment triggers a sequence of behaviors and consequences automatically. These small chains of events contribute negatively toward the day, and often leave you feeling overwhelmed or stressed.

People can begin to develop certain beliefs about themselves or the world that might not be true because they are formed on the foundation of a series of negative spirals. This is one of the principles of the cognitive interventions used in CBT. On the basis of a series of bad experiences, we automatically develop beliefs and ideas that are supported by our expectations. Our expectations may support confirmation biases or other psychological biases that might lead us generalize our negative experiences, which may color the past and the future. These confirmation biases may not supported by the evidence or the facts of the matter, however, their negative effect on our mental health is obvious and harmful. People often have blind spots in their thinking that is not supported by the evidence. By understanding psychological biases, you can learn to challenge them and begin to reverse or break the negative cycle.

Cognitive biases and unhelpful thinking happens between the As and the Bs of the ABCs of CBT (i.e. it happens between antecedents or triggers in the environment, and the actions we take in response to those triggers). And, it is important to know, a lot of our thinking happens unconsciously. Let’s take an example of misplacing your keys. When you are in a hurry and can’t find your keys, you might immediately react in a negative way by thinking things such as “This is just my luck and this always happens to me”. That thinking might happen automatically and without your conscious awareness, and it might make you feel frustrated and discouraged. That frustration and discouragement may deplete your patience and make you more likely to react poorly to other things that don’t go your way. There are cognitive and behavioural strategies that might help you think differently about the world and improve the way you handle stressful situations. Changes in thinking are important to create positive improvements in you life.

In addition to becoming more aware of your thoughts and finding new ways to see the world and yourself, behavioural interventions can be used to help reduce the triggers in the environment and create new habits in response to triggers that might lead to better outcomes.
For example, learning to use deep breathing as a relaxation technique when you are feeling frustrated may help you make better choices in response to stressful situations. Further, we can also find ways to reduce your exposure to triggers by becoming mindful of your ABCs and planning ahead.

Ultimately, by changing the way we think about things and creating new habits and routines, we are able to challenge our beliefs about the world and ourselves that contribute to negative patterns and negative spirals in our lives. Importantly, while a change in thinking is central to CBT, it isn’t just positive thinking. CBT also requires changes in behaviour, physical functioning and the environment. It is important to recognize that CBT will take practice; the beliefs that are central to the challenges that people face take time to develop. Some attitudes, beliefs and thoughts that people have developed in early childhood and have persisted into adult life. Change doesn’t happen instantaneously. However, with practice, new thoughts and habits can form, which can lead to more positive outcomes result in better mental health.

Cognitive Behavioral Therapy (CBT) Online

In addition to support from a mental health care provider there are many CBT resources available online and in print that might be helpful to you.

https://positivepsychology.com/cbt-cognitive-behavioral-therapy-techniques-worksheets

https://www.anxietycanada.com/resources/mindshift-cbt (The Mind Shift app available at no cost through the App Store)

https://foundrybc.ca/info-tools (free counseling services for youth 12-24 years)

http://anxietybc.com

https://bouncebackbc.ca (Free skill-building program designed to help adults and youth 15+ manage low mood, mild to moderate depression, anxiety, stress or worry. Delivered online or over the phone with a coach.)

http://worrywisekids.org (children and teenagers)

https://gozen.com online anxiety relief program (children and teenagers)

Cognitive Behavioral Therapy (CBT) Books

Feeling Good: The New Mood Therapy by David D. Burns, M.D.

Mind Over Mood: Change How You Feel by Changing the Way You Think by Dennis Greenberger, Phd and Christine A. Padesky, PhD (second edition)

Depression: A Teen’s Guide to Survive and Thrive by Jacqueline Toner and Claire Freeland

My Anxious Mind by Michael Tompkins and Katherine Martinez

Freeing Your Child From Anxiety by Tamar E. Chansky