What does cognitive behavioral therapy consist of? What are its aims? How does it go about fulfilling them? What has been your experience with it?
If I understand correctly, there are two sections to it, the cognitive and the behavioral one. How are they different?
I’ve read that CBT exposure therapy may not be effective for anxiety disorders. What do they use then?
Your post is a bit like asking what does the law consist of - it’s not so easy to answer in a brief post; however, some guidelines:
CBT blends cognitive and behavioural therapies - it teaches patients to work on controlling self defeating thoughts, as well as behaving in self positive ways.
For instance, a person with depression may never get out of bed and leave the house because they tell themselves they’ll hate it and they suck and no one will be nice to them even if they do.
CBT helps mitigate the self-defeating thinking, but also mandates that the person actually get up and have a shower and go out and get a newspaper or something.
So, it focuses on the thinking, as well as the doing.
Exposure Therapy is excellent for treating phobias, seriously - it’s the gold standard. Is that what you’re asking about?
My very limited experience with it involves writing things out. It starts out with identifying a bad emotion, then wring down both the good and bad reasons for feeling that way, then deciding if thinking that way is beneficial. It’s basically trying to out-logic an emotion.
It can be beneficial at times, but sometimes an emotion is far outside of the realm of logic and impervious to it.
As Alice says, its a twofer.
The Cognative - which as TDN says can be a little like “out logicking” an emotion. Its both teaching yourself affirmations as well as teaching yourself to think things through and realize that the chance the “worst thing” will happen is really small - and the “worst thing” is probably not that bad.
The Behavioral. i.e. regardless of whether you talk yourself into feeling good about getting out of bed, you GET OUT OF BED. This means that even if you haven’t talked yourself out of “if I get out of bed, I’ll forget to put on my pants and everyone will laugh at me” - you GET OUT OF BED, and discover that you don’t forget your pants.
Behavioral can be things like eating well - even when you don’t want to - going to bed at a decent hour - even when you don’t want to - getting exercise - even if you don’t want to. The idea being that a lot people get into a “feel bad, act bad” loop where - you know, you feel like shit if you don’t sleep, don’t eat well, and haven’t seen the sun for three weeks. But when you feel like shit, you might not want to sleep, eat anything but junk, or go outside.
The idea behind CBT is that you are what you think. Your feelings are a direct result of your thoughts, and if you can learn to recognize and guide your thoughts, you can overcome some very negative patterns of thinking that lead to bad emotional and behavioral outcomes.
The goal is to increase your awareness of what thoughts you’re having, whether those thoughts are useful or harmful, and how to reinforce the former and redirect the latter.
I’m not remotely an expert, but I’ve never heard of it not being useful for anxiety disorders. I would consider it ideal for anxiety problems, from my perspective.
I’ve used CBT before and it’s worked, but I sometimes question its usefulness. Lately I’ve been exploring the idea not out-logicking an emotion, but fully feeling and accepting it. The idea is that emotions need to be processed and transformed, otherwise they show up as illness later.
The two ideas seem very contradictory, but the interesting theing they have in common is that they both require increased awareness. Some combination of the two is probably very powerful.
@tdn: I think the balance is seeing and feeling the emotion fully - a part of you remains detached enough to be aware of (and/or track) what’s going on with your feelings, another part is accepting and experiencing the feeling.
That sounds about right. It’s possible to fully feel an emotion while at the same time recognizing patterns of faulty thinking. And of course physically doing the right thing, such as getting out of bed.
Feeling Good is a classic introduction to some basic CBT techniques.
CBT is not always about out-logicing emotions. I think it’s more about out-logicing repetitive habitual negative emotions, and getting enough perspective from your authentic emotions that you can process them and move on rather than being stuck in a repeating cycle.
That’s a much better explanation, thanks.
I wanted to post a list of forms faulty thinking, and the best I could come up with is this. Scroll down about 1/4 of the way for a numbered list. Interestingly, it looks like it’s lifted directly from Feeling Good.
TDN, one of my counselors suggested something called Acceptance and Commitment Therapy when I expressed distrust of CBT, and it sounds a lot like what you describe - accepting a feeling but recognizing it and “committing” to work through it.
It turned out that I found the books on ACT really wishy-washy and preferred using the CBT methods, but it was helpful to know the former existed.
Interesting. What did you find wishy-washy about it? (What I’m talking about is probably not quite the same thing – I don’t think it even has a name.)
A good short example is something I learned in CBT; using the word “should” or “should have” in your internal thoughts isn’t always good, because it sets the world up in binary terms- success or failure.
The idea is that if you think something like “I **should **be making 100,000 dollars a year.”, then if you aren’t making 100k, then you failed. There’s not much room in that way of thinking for “I make 90k; I’m still doing damn good.” or for “I may only make 75k, but I just got a 25% raise to get here”, which is also a great thing.
Or even just “I’d like to make 100k per year” is still good- it doesn’t have the all-or-nothing negative feel of “I should be making 100k per year.”
(it’s on the list that tdn linked, BTW)
That’s a real short-form version of the things that CBT trains you to identify and change.
No, to me I don’t see a contradiction. You can certainly acknowledge that you’re feeling an emotion and that emotion is real, while still understanding that it’s created inside yourself.
So, you can say “Wow, I am really jealous of Ms. G---------” and explore that emotion, while still saying “I wonder exactly what is making me feel this so strongly” or “Funny how I never feel superior to her about <this thing> and <the other thing> where it’s objectively clear that I do better.”
Good one, bump.
The way I used it was to first become aware of a negative emotion. Then I would trace it back to a particular event. Then I would pick it apart and describe what it was, exactly, that created the emotion. I should have done this (should), he was thinking that (mind reading), I’ll never get the other thing (black and white thinking, future predicting), etc. Then I would ask myself if those were reasonable reactions to the event.
Here’s the thing – sometimes the reactions are reasonable! Usually they are not, but the point is to get at the truth of the matter. Maybe so-and-so really was being a jerk and I have a right to be mad! And maybe not.
In the beginning I did this very consciously and wrote it all out on paper, and really took my time. The ultimate goal was to be able to do it in real time. The paper thing was just to get practice thinking in those terms.
Quercus, excellent point. Another thing is to not only acknowledge the emotion, but to genuinely feel it. It’s kind of like getting a cold. Sometimes you just have to lay on the couch and feel miserable. Let it process.
I also think that you’re conflating two things here - as far as I know, exposure therapy is a separate thing from CBT. I’ve been a volunteer leader of an anxiety disorder support group for a couple of years now; I would recommend CBT to anyone - you don’t need excessive anxiety or depression to benefit from thinking more clearly and telling yourself fewer distorted stories. I’m more mixed about exposure therapy; I think it can be really useful, but I think it can be hard on someone trying to get rid of a phobia, and if you’re at a point where it’s taking all you’ve got to just get out of bed every day, that might be a bit much at the moment.
I think the CBT version of exposure is to stick your foot in the water and see that it really didn’t hurt you, and move on from that success to trying something a little harder. Exposure therapy would be jumping in the deep end of the pool and seeing that you didn’t die from it.
I did a lot of this when I was really working on my anxiety disorder, too - it is nothing short of fascinating to see where emotions are coming from. They can come from such small, silly things, and end up in such a strong emotion. I agree with you, too, that just sitting with your emotions and not trying to change them or fix them or deny them is also really powerful and useful. I would usually do this while meditating - ask myself why I was feeling down or angry or whatever. When I figured out what was really bothering me, I’d usually burst out crying - yup, that’s it!
Nor labelling or judging them.