Part 1: Introduction to Cognitive Behavioral Therapy
Can Cognitive Behavioral Therapy Help Me?
If you’ve found this online workbook, it’s likely that you’ve been struggling with some kind of a challenge. Whether an emotional problem like generalized anxiety, a behavioral problem such as avoidance of important responsibilities, or a cognitive problem, like distorted or self-limiting thinking, cognitive behavioral therapy may be the answer you’ve been looking for.
Cognitive behavioral therapy, or CBT for short, is a treatment that helps people build skills to effectively handle the challenges that life throws at them. Overwhelming research over the past two decades has shown CBT to be the most effective therapy for a whole host of problems: anxiety, depression, OCD, anger, phobias, eating disorders, substance abuse, assertiveness, shame, avoidance, procrastination, and relationship problems, just to name a few. Because CBT teaches people to solve their own problems by learning and practicing new skills, CBT helps people stay well long after treatment is complete.
What is Cognitive Behavioral Therapy?
Cognitive behavioral therapy is a short-term, skill-based psychotherapy treatment that helps people learn to assert more influence over their thoughts, behaviors, and feelings to effectively solve life’s challenges. To appreciate how CBT works, it will be helpful to understand the core components of the CBT model:
1. Situations themselves are generally not problematic. It is our reactions to situations that cause problems. This may seem counter-intuitive because when something goes wrong, we usually point to the thing in our environment that started it all. But in most situations, it’s the way we handle the challenge that dictates whether/to what degree the situation becomes a problem.
Take the example of not getting the job you wanted. For some people, this could serve as a devastating blow in their careers, causing them to avoid putting themselves out there again and instead just settle for the jobs they have. For others, it may feel temporarily disappointing, but they’re able to use that disappointment to assess what (if anything) went wrong and bolster their training and experience to make themselves more marketable next time. It’s not the situation, but the reaction that really counts.
2. Thoughts play an outsize role in how we experience the world and how we feel. Similar to the component discussed above, life events alone don’t dictate our experience of the world; the thoughts we have about life events are what shape our experience. Technically, thoughts mediate the relationships between situations, moods, and behavior. This means when something doesn’t go our way, it’s the way we think about the situation that determines whether it’s a permanent setback or merely a challenge to be solved.
For instance, when we wave to someone we know on the street and they don’t wave back, our habitual way of making sense of things takes over. If we’re prone to self-defeating thoughts, we might think, “They’re ignoring me because they don’t like me. They don’t want anything to do with someone like me.” This line of thinking might lead us to avoid the person and eventually lose contact with them, resulting in a kind of self-fulfilling prophecy. If we’re in the habit of having thoughts grounded in our actual experience, we might think, “They probably didn’t see me,” and not have even a second thought about the event.
3. Our behavior also affects how we think and feel. It’s not just that when we have certain thoughts, we act a certain way. The converse is true, too; when we act a certain way, our behavior affects how we think about situations.
An example is avoiding situations we don’t look forward to, for instance, avoiding talking to strangers at parties. When we avoid socializing because we’re uncomfortable, our thoughts tend to fill in the blanks of our experience about what socializing is like. We might have thoughts that “talking to strangers is too uncomfortable,” “I’m no good at talking to people,” “I won’t have anything to say,” or “They won’t like me if they get to know me.” The problem is, if we continue to avoid socializing, we aren’t really giving ourselves the opportunity to collect evidence to the contrary, so our self-defeating thoughts are reinforced. We end up believing them even more and engage in even more avoidance. (Learn about CBT for social anxiety).
4. Our thoughts, feelings, and behavior are constantly influencing each other. These components are interrelated. A change in one changes the others as well. Not only do thoughts shape moods, but moods can shape thoughts. When we feel a strong emotion for whatever reason, our thoughts tend to fall in line with that emotion.
Take, for example, drinking a double-shot of espresso on your day off. You might have been looking forward to all the things you were going to do today, but consuming too much caffeine can trigger physiological anxiety, and you may notice your thoughts take a more fretful tone. The more anxious we feel, the more likely we are to avoid things we otherwise wouldn’t, and pretty soon the day is ruined. All of these components are constantly influencing one another.
5. Changing thoughts, behavior, or feelings results in changes in the other components. The good news is we can use this system to our advantage. If we’ve been feeling depressed, small changes in thoughts/behavior can set off a chain reaction to feeling better. The more we tweak thoughts and behavior, the more we wrestle back influence over our mood. This is what we teach people to do in CBT: make small changes in thoughts and behavior to effect big changes in feelings.
Understanding this model of emotions can help you think about problems differently and can illuminate new ways of making positive changes in your life. All of the exercises in this online CBT workbook are designed to teach you these underlying mechanics of your mind so you can feel better and achieve your goals.
How to Use This Online CBT Workbook
This online workbook is organized to help you learn and practice the skills that are foundational to CBT so you can apply them to whatever problems come your way. It’s organized in such a way that most people will find it easiest to start at the beginning, slowly and repeatedly applying the exercises in each module, and only moving to the next module once they feel they have mastered the previous one.
Most research on CBT has studied people who use the self-help homework you’ll find in this textbook while working with a qualified CBT therapist. But you don’t necessarily need to be in therapy for the skills here to work. We encourage you to practice the skills here, and implement them in your life, and if you run into trouble, you can contact one of the referral sources at the end of this chapter to work with a professional.
Will CBT Work For Me?
Our CBT clients ask us this question a lot in the beginning of therapy. The truth is, a lot of factors influence how effective CBT is for different people, but the one that matters most is the level of effort you put into practicing the skills. Like any new skill, it may feel difficult at first, and if you don’t practice regularly, it might always seem difficult. The intention of cognitive behavioral therapy is to help you rehearse the skills so often that you don’t need to think about skills when a challenge arises. You just do what needs to be done spontaneously. With this in mind, it’s important to be diligent about completing the exercises as many times as you need to gain mastery of the techniques.
Other factors that predict whether people succeed in CBT are how ingrained the problem is and how severe the problem is. If you have been struggling with depression for a decade, it will take more time and effort to treat than if you have felt depressed for only a month. Similarly, if your depression has you not getting out of bed for a week at a time, rather than just feeling a little down most days, you’ll probably need more help.
Although many people can benefit from using the self-help techniques in this workbook on their own, if you think you may have a psychiatric disorder, it’s highly likely that you’ll benefit most from working with a cognitive behavioral therapist. Much of the positive research focused on CBT has examined people who are completing CBT exercises at home while working with a trained CBT therapist. If you’ve been suffering for a long while or your symptoms feel very intense, you owe it to yourself to consider pursuing CBT therapy with an experienced CBT therapist. No workbook can compare to working with a trained mental health professional.
To find a CBT therapist near you, you can explore the links below:
Cognitive Behavioral Therapy Treatment Center
Treatment Plans and Interventions for Depression and Anxiety Disorders, Second Edition. The Guilford Press: New York. – Leahy, R.L., Holland, S.J.F., McGinn, L.K. (2011).