It is the cornerstone of cognitive behavioral therapy, which emerged in the psychological scene in the 1960s and has garnered much praise ever since.
It may not be for everyone. Therapists often give “homework,” so it requires active client participation and it doesn’t address underlying issues like childhood trauma or systemic problems in the family. family.
But for those willing to work, cognitive behavioral therapy may be just what the doctor ordered. CBT has been shown in randomized clinical trials to alleviate depression, anxiety, obsessive thoughts, eating and sleeping disorders, substance abuse, post-traumatic stress disorder and more again.
What happens during the CBT era that can make a difference in so many conditions?
CNN spoke privately with two experts in the field: Jay Fournier, professor and director of the Mood and Anxiety Program at Ohio State University’s Center for Cognitive and Behavioral Brain Imaging; and Kristen Carpenter, a psychologist in women’s behavioral health at Ohio State University Wexner Medical Center.
These conversations have been gentle condensed and Edited for clarity.
CNN: In short, what is cognitive behavioral therapy?
Jay Fournier: It is a type of structured psychotherapy, much different from the type of therapy often depicted on TV or in movies. The focus is on trying to help people get well as quickly as possible by reducing their symptoms as quickly as possible.
CBT tends to focus more on the present than on the past and is often a short-term treatment. First few sessions with a cognitive behavioral therapist going home about your goals: What is bothering you and what would you like to change? We will then establish a treatment plan designed to address those goals over a set period of time.
My job as a cognitive behavioral therapist is to put myself out of the way. I’m trying to train someone to do all the things I know to do in their own life, so that when we stop seeing them they can continue doing it without my help.
CNN: In CBT, how do our thoughts affect our actions and emotions?
Fournier: Most people go through life thinking that the way they feel or the things they do is directly influenced by what has happened to them in their lives. One of the core elements of cognitive behavioral therapy is that there is an intervention step: How we interpret those situations. It is our interpretations of those events that lead us to feel certain things and behave in certain ways.
One of the first things we ask people to do is just pay attention to what they think. If you notice a change in your mood, try asking yourself, “What was on my mind right before I felt worse?”
The goal is not to think happy thoughts because happy thoughts are happy. The aim is to help people think more carefully and accurately about their circumstances, especially those who tend to think more negatively when things get tougher.
Let’s use the example of someone calling your name. You might think, “That person saw right through me, they’re absolutely right, that’s just what I am.” And you probably feel pretty bad about yourself. Or you might think, “Wow, that person is such a nasty person. I really have to assess whether I want them in my life or not.”
CNN: Most of us are not clearly aware of thinking such negative thoughts, just bad feelings. How does CBT help people gain insight?
Carpenter Kristen: We do a lot of training around identifying automatic thoughts and the beliefs that underlie them. It starts with identifying self-talk – literally the things you say to yourself in a moment of distress.
For example, the thoughts we often see in people with depression often revolve around these beliefs: “I can’t love; I’m unworthy; the future is uncertain, and I can do a lot. little of that.”
For the anxious, those core beliefs tend to revolve around threat: “The world is scary; the world is threatening; I’m not equipped to face these challenges. ”
As therapists, we help you analyze your self-talk with a series of questions: “How true is that thought? What evidence do you have for and against that thought? It’s factual. Are there thinking errors that we can identify? And it’s not just people with a clinical diagnosis who make mistakes in thinking – we all do.
Some of those thoughts may be logical fallacies. Others are statements that we call “shoulds”: “I should be able to work full-time and also help my kids with their homework every night and have a rich social life and engaged, at the same time being well-read and participating in every event that ever happened and cooking healthy meals.”
We help the person begin to question some of those claims and gauge how realistic they are. Many of us hold ourselves to higher standards than we will hold others: “Why does every other mom on the block get the day off but you don’t?”
But it’s not about shifting negative thinking to a “rose-tinted glass” approach, because that doesn’t really help either. It is too far. What you want to do is move in the middle, towards a kind of self-compassionate mindset that is more realistic and free from assumptions that could be false.
At the end of the day, what we’re doing in CBT is helping to correct false, exaggerated beliefs, so that people learn the skills they need to overcome negative self-talk.
CNN: I understand that CBT often has homework. What kind of assignments do you give?
Fournier: Cognitive behavioral therapy involves homework, and much of the homework focuses attention in a new and different way on what you’re doing, how you feel, and what’s going on in your mind. Friend.
During therapy, we’ll have specific spreadsheets that we can hand out to people, and apps they can download to do the same thing. Ultimately, we want people to learn how to use these tools on their own. We see CBT as a partnership where we work together to bring about the changes in someone’s life they want to see.
One major tool we use is called automatic thought recording, where people keep track of what they’re doing, thinking, and feeling in the days between sessions. They’ll bring it back to the session, and we’ll look at it together and evaluate the thinking. What doesn’t make much sense? What are the alternatives to thinking or handling the situation?
We also asked people to monitor their stress and anxiety levels. And then we look for breaking points together: “When do you feel the most stressed? You are the least stressed? What are you doing and thinking?” And then that’s going to be the things that we’re going to start focusing on treating.
CNN: We talked a lot about the cognitive side of CBT. What about behavior?
Carpenter: CBT is predicted on the assumption that thoughts, behaviors, and emotions are tied together: “My thoughts affect my emotions, my emotions affect my behavior and all are all related.”
As a therapist, that gives me three avenues that I can use with individuals to help create change – through thoughts, feelings, and behaviors.
Take depression as an example. Depressed people withdraw from the world, no longer doing things they once found enjoyable and enjoyable. For those experiencing such challenges, we would encourage them to schedule positive activities, connect with friends and family, and strive to do things that bring them a sense of belonging. or a sense of accomplishment.
CNN: Could these behavioral changes apply to stress, such as the stress and anxiety that the pandemic has caused?
Fournier: When people struggle with anxiety, they tend to avoid the things they worry about. That’s pretty natural behaviour. But avoidance can affect their lives, can affect their goals, and they can ultimately make anxiety worse. And so, in their anxiety state, treatment is helping them gradually re-examine situations they used to avoid in the past.
For those experiencing high levels of stress, some of it may change in everyone’s life, but some of it may not, especially during a pandemic. Depending on the circumstances, we may encourage people to make the changes they can.
But even for those anxiety-inducing life moments that they can’t change, we can see how they’re going through those situations.
Sometimes bad things happen in life, and that’s just part of it. But sometimes people experience more depression or anxiety than the situation needs. We can help them look back at their thoughts and behaviors during those periods to see if there are ways to change those thoughts to reduce their stress.
While I’m no expert on post-traumatic stress disorder, CBT has been shown to be very helpful with symptoms. Of course, we cannot change the past; We cannot change what happened to that person. But what we can help them do is change their relationship with what happened to them, by changing the way they think about the traumatic experience. By doing so, we hope to make them less likely to experience life-threatening symptoms related to trauma.
CNN: How can one find a trained CBT advisor?
Persistence. Try a few therapists before you settle in. You want to find someone who is the best fit for you.
