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How Does Cognitive Behavior Therapy Work?

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Cognitive behavioral therapy (CBT) is a therapeutic approach that is widely accepted as the gold standard in the field of psychotherapy. Not only is it the bbest-studiedform of psychotherapy with hundreds of research papers supporting it, but it is also the most commonly practiced. It combines cognitive therapy and behavioral therapy to deliver treatment tailored to individuals and their struggles. Cognitive behavioral therapy restructures thinking patterns that affect behavior. This is extremely effective since what we think, how we feel, and how we behave are all very closely woven together. Understanding the role that thoughts play in your life can help your recovery. The results of CBT include increased happiness, improvement in functioning, and remission of mental disorders.

How Does Cognitive Behavioral Therapy Work?

It isn’t unusual to feel skeptical about a therapy that sounds too good to be true. However, understanding how cognitive behavioral therapy came to be and how it works will help to demystify your doubt. You’ll realize that CBT is not just a one-time quick fix to your problems. CBT addresses both your perceptions (cognitive) and responses (behavioral). It teaches effective strategies for coping with hardships which is useful all throughout your life.

Principles Underlying Cognitive Behavioral Therapy

The first pioneers of cognitive behavioral therapy realized that existing psychological treatments for anxiety and depression focused too heavily on past events rather than current head space. In the 1960s, Aaron Beck, an American psychiatrist, theorized 2 principles that would come to be the basis for CBT:

  1. Negative thoughts, also known as cognitive distortions, cause and perpetuate emotional distress.
  2. In turn, these upset emotions fuel destructive behavior and lead to a vicious cycle of unhappy situations.

To break the cycle, one must learn to change their adverse thoughts; in time, their emotions and behavior will follow suit. This is what CBT is all about.

The Cognitive Component

Cognitive behavioral therapy takes advantage of the fact that your brain assigns meanings to things. These meanings are subjective and can be transformed. You may think a certain cloud looks like a rhinoceros while someone else sees a unicorn. With a little assistance you could start to see the cloud from their perspective. The same goes for how you interpret events in your life. The fluidity of meanings is not always obvious since you decided what you believe constitutes negative and positive outcomes at a very young age. However, CBT introduces you to new ways of thinking.

The Behavioral Component

In addition to cognitive rewiring, CBT also targets problematic behaviors. It’s likely that you continue maladaptive behavior because you receive some form of reward that reinforces it. For example, a person who is stressed out may return to alcohol or drug use because they have learned that those activities provide short-term stress relief or pleasure. Fortunately, you can unlearn bad routines and replace them with desirable behaviors. A therapist at APEX Recovery can aid you with creating a plan of action to break old habits and reinforce a healthy lifestyle. Through the combination of cognitive and behavioral components, CBT helps empower people. You may not have control over the events in the world, but you do have complete control over how you react and respond to these events. After therapy with APEX Recovery, you may be surprised to realize how truly strong and resilient you are.

The Process

It would be nice if all a therapist had to say was “change your negative thoughts” and all your problems were solved. But alas, cognitive behavioral therapy is not some miracle advice or magical incantation; it is a process. Your therapist may guide you along a slightly different journey depending on your needs, however, the general steps are:

  • Identify the problems
  • Brainstorm new strategies
  • Practice positive solutions

Identifying the Problems

During cognitive behavioral therapy, your therapist will ask you questions aimed at discovering what kinds of thinking patterns you have. You should work with a therapist you feel comfortable opening up to because the more honest you are, the better. This shouldn’t be an issue with the compassionate and understanding behavioral therapists at APEX Recovery. During this stage, you will uncover what kinds of automatic thoughts are constantly leading you back to negative emotions and reinforcing harmful behavior, what constitutes triggers for these thoughts, and establish goals for yourself.

Brainstorming New Strategies

The next step is to brainstorm new strategies for dealing with these faulty thoughts. The strategy most useful for you will depend on what you are personally struggling with. Here are few possible strategies that you may find helpful:

  • Visualizing your thinking patterns
  • Playing the script
  • Interoceptive exposure
  • Relaxation techniques

Visualize Your Thinking Patterns

Journaling and mood tracking can help you determine and reflect upon your unhelpful thinking habits. Then when you catch yourself having cognitive distortions you can challenge and restructure them.   For example, you could pass by someone you know and they may not acknowledge you. Your current inner dialogue may say something like: “They must not like me” or “Did I do something to anger them?” This would affect your future interactions with this person. However, a restructured dialogue may sound something like: “They must have a lot on their mind and didn’t notice me.” This is a benign example but can apply to more serious issues that will be described later on.

Playing the Script

A misconception of CBT is that you always have to spin negative thoughts into positive ones, but this is not true. One useful strategy is “playing the script” or “playing the tape.” This involves imagining a situation’s consequence, and the consequences of that consequence, and so on. In doing so, you may realize what your underlying fear is. Although it may seem scary, with the help of your therapist you can come to the conclusion that these fears are just that—fears not realities. You may not be able to avoid having these worries, but understanding where they come from can be comforting.

Interoceptive Exposure

With insight on what is at the core of your fears, you can practice interoceptive exposure. This involves slowly exposing yourself to what you are afraid of on your own terms. In the process, you can really focus on the sensations it elicits. You may start to recognize that while these fears can be uncomfortable, they are not as dangerous as you once perceived them as. Not only can you gradually become desensitized, you could also build your confidence and practice coping skills for controlling your panic. This is especially helpful for those wrestling with anxiety disorders.

Relaxation Techniques

When you are overwhelmed by your problems, it’s easy to get flustered, forget what you’ve learned in therapy, and feel defeated. One of the reasons CBT is so effective is that incorporates methods that support you through these tough times. Examples of relaxation exercises are:

  • Breath focus: slow and deep breathing.
  • Body scan: imagining your breath being sent to a specific part of your body. This can release physical tension felt in your muscles and strengthen your mind-body connection.
  • Guided Imagery:  Envisioning scenes, experiences, or people that soothe your mind.

It’s important to note that relaxation techniques should not be used with the mindset that they will cure your problems. The goal of relaxing is to reduce mental and physical strain to show you that you can endure uncomfortable situations, not to eliminate all feelings of anxiety when having a panic attack. Relaxation can provide a calmer environment for you to engage in other strategies learned from CBT, and make your healing process easier to handle.

Practice Positive Solutions

The final step is to employ your new strategies outside of your therapy sessions. Be patient with yourself during this stage. You will likely try out a few strategies before finding ones that jibe with you. Your therapist may give you “homework” in between sessions to remind you to practice the solutions you brainstormed. It may not come easily at first and you’ll likely have to consciously remind yourself about what you learned in CBT. However, over time your detrimental habits will be replaced by beneficial ones and your positive perceptions will come more naturally. At each session, you can celebrate your mini milestones as you work your way towards recovery.  

What Does Cognitive Behavioral Therapy Treat?

The vague terms “negative thoughts” and “unhealthy behaviors” have been used because CBT can be applied to treat a wide variety of issues. But now you may be wondering: can your specific problem be addressed using CBT techniques? Technically, if there is any aspect of your life that you are unhappy with, CBT could be beneficial for teaching you ways to cope. However, most of the studies backing up the efficacy of CBT have been focused on individuals with specific clinical ailments. Research shows that CBT is highly effective for treating anxiety disorders and depression. It can also help manage substance use disorders like dependence on cannabis, nicotine, opioids, and alcohol. The following will cover what kind of CBT interventions you can expect for these specific struggles.

Cognitive Behavioral Therapy for Anxiety Disorders

Because CBT uncovers root causes for fears, it can be very useful in controlling anxieties. Relaxation, coping, and problem solving are just a few of the tools CBT provides to help you manage anxiety-inducing situations. If you suffer from any of the following, then CBT could be very beneficial for you:

  • Panic disorder
  • Phobias
  • Social anxiety
  • Generalized anxiety disorders

Cognitive Behavioral Therapy for Depression

The emphasis on cognitive therapy in CBT is very effective in mitigating depressive thoughts and irrational beliefs. It is so effective that the National Institute for Health and Care Excellence’s guidelines and American Psychological Association list CBT as a first-line treatment option for depression. A CBT approach to depression will teach you how to recognize and avoid these unhealthy thought processes:

  • Overgeneralizing
  • Blaming
  • All-or-nothing thinking
  • Rejecting the positives
  • Catastrophizing
  • Jumping to conclusions
  • Filtering

If you are struggling with depression, you may not realize how much of an effect these types of thinking have on your emotions and mood. CBT can help you challenge these cognitive distortions and may improve your condition.

Cognitive Behavioral Therapy for Addiction

If you are battling with addiction, there is a chance that at some point, you have told yourself one of these things:

  • I will just use this once
  • One drink won’t hurt me
  • It has been a bad day; I deserve to use
  • Why even try to stop?
  • I will always be an addict

Cognitive behavioral therapy can prepare you for responding to these dangerous thoughts. Your therapist may prompt you to reflect on the accuracy of these thoughts and fight back against them. When you encounter triggers, the behavioral component of CBT comes in handy. You could prepare a list of other non-drug activities you can engage in to deter you from substance use. For example, meditation and reaching out to your friends and family for social support can help you overcome a trigger in a safe way.

What Can You Gain From Cognitive Behavioral Therapy?

Cognitive behavioral therapy can give you the resources to manage your mental health problems that you previously believed were out of your control. It is thoroughly backed up by scientific research and is built on the basis of insightful treatments. Cognitive behavioral therapists at APEX Recovery will work with you to develop personalized approaches, set goals, keep you accountable, and motivate you during your healing. Different types of behavioral therapy can serve people with anxiety disorders, depression, post-traumatic stress disorder and addiction. In fact, most of life’s difficulties can be improved by gaining the awareness that your internal state influences your behavior and quality of life. You are not defined by a disorder, you have the power to overcome hardships, and you are not alone. Reach out to APEX Recovery to start cognitive behavioral therapy with a caring team dedicated to seeing you succeed. References:

  • David, D., Cristea, I., & Hofmann, S. G. (2018). Why Cognitive Behavioral Therapy Is the Current Gold Standard of Psychotherapy. Frontiers in psychiatry9, 4.
  • Beck, A. (1980). Cognitive therapy and the emotional disorders . New York: New American Library.
  • Craske, M. G., Rowe, M., Lewin, M., & Noriega-Dimitri, R. (1997). Interoceptive exposure versus breathing retraining within cognitive-behavioural therapy for panic disorder with agoraphobia1. British Journal of Clinical Psychology, 36(1), 85-99. doi:10.1111/j.2044-8260.1997.tb01233.x
  • Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive therapy and research36(5), 427-440.
  • McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive behavioral therapy for substance use disorders. The Psychiatric clinics of North America33(3), 511-25.
  • Kazantzis, N., Luong, H., Usatoff, A., Impala, T., Yew, R., & Hofmann, S. (2018). The Processes of Cognitive Behavioral Therapy: A Review of Meta-Analyses. Cognitive Therapy and Research42(4), 349–357. 
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