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The Magic Behind CBT

CBT? What’s that? And what do you mean, magic?

Cognitive Behavioral Therapy (CBT) is one of the most evidence-based, well-researched psychotherapies out there. Honestly, if you search it, you will be bombarded with an insane number of results. Having so much information available on such a life-changing topic is actually a fantastic thing! However, it can be problematic for a consumer, as it might simply be too much. It may be overwhelming to figure out where to start or what you even want to know about it. That’s where this easy-to-digest piece on the basics behind CBT, what it is and how it works comes in.

What is Cognitive Behavioral Therapy?

CBT is a type of therapeutic intervention that focuses on thoughts, feelings, behaviors, and physiological sensations. Any time we experience a situation, we have thoughts and feelings associated with it. Then, we may also notice, or not, physiological sensations in response. Once our body very quickly processes these pieces of information, we react/respond (behavior). This sounds extremely simple because it really is. It is not a complicated process once we understand it, but that does not mean that if we are stuck in a maladaptive cycle that it is easy to get out of it. Let’s run through an example to give real-life context. We will use the same situation and go through it with two different “people” to show just how much a person’s internal CBT cycle plays a role, even when the situation is the exact same.

CBT Cycle in Action

The Situation
Someone is holding a dog in their arms. Picture a dog in someone’s arms; there are no obvious signs of aggression and the dog is small enough that it is possible for their owner to hold it.

Person A: Adaptive/Positive Experience
Person A sees this dog in the arms of its owner and has an automatic thought about it. This thought could be something like Oh, look at that cute dog, Isn’t that sweet, or even I hope that dog is okay. These thoughts will elicit some type of feeling, which could be happiness, joy, care, or others. Along with these more positive emotions, Person A probably wouldn’t notice anything physiological; however, they’d likely have calm muscles, a normal heart rate, regular breathing patterns, etc. Behaviorally, Person A may want to approach the dog/owner and ask to pet it or tell the owner they have a cute dog, but at the very least, they may have a slight smile (yes, that’s also a behavior). Because they left this situation in a positive mood and mindset (and potentially positive feedback from the dog or owner), they are likely to repeat this cycle the next time they encounter a similar situation. Not a problem; there’s nothing wrong with this cycle.

Person B: Maladaptive/Negative Experience
Person B sees the exact same situation and their initial thoughts might be What if they put the dog down?, Did it try to hurt someone and that’s why they picked it up?, or It doesn’t look friendly. Based on the nature of these thoughts, you can probably assume that they would likely have a different set of emotions. Person B likely experiences fear and anxiety. Based on this, they may notice physiological symptoms of an increased heart rate, sweating, muscle tension, upset stomach, etc. It is highly unlikely that Person B will respond with the same behaviors as Person A. Instead, they may try to quickly walk past the dog/owner, cross the street if that’s possible for them, or even turn around and escape entirely. When they leave this situation, they will no longer be experiencing fear or anxiety; instead, they will experience a sense of relief and safety. Because they experienced this relief, they will also be more inclined to repeat this cycle when they encounter a similar situation. This, however, can turn into a problematic response if this happens every time they see a dog.

What’s wrong with escaping an anxiety-provoking situation?
It is sometimes encouraged to escape certain anxiety-provoking situations. In fact, there are absolutely certain situations that escape is necessary for survival! However, when our need to escape less threatening situations starts interfering with our lives, it becomes problematic and we need to learn how to respond differently.

How does CBT help?

The whole idea behind CBT is learning how to respond differently, while challenging the negative thoughts along the way. When we do this, we start to learn that our thoughts are not always facts and may or may be true. We also begin to learn that those negative emotions and unpleasant physiological sensations we’re experiencing, don’t stay around forever! Once this is understood and learned, a person becomes much more empowered and can look at various unpleasant situations through a new lens. Not sure what I mean? Let’s get back to the example of Person B to show it more clearly.

Person B: Breaking the maladaptive/negative cycle
Person B will still see the dog and begin their initial thought process. In turn, they will experience the distressing emotions and physiological sensations. However, instead of running away or escaping, they respond differently and approach the situation. At this point, Person B makes a conscious decision to go toward the dog/owner. As they approach, their anxiety and fear may temporarily increase; however, if they stop to chat and/or even keep moving at a calm pace past the dog/owner, their anxiety will slowly begin to decrease. Now, this might not seem like a big deal at all, but it was actually a great educational moment. Instead of avoiding something they feared, Person B chose to actively approach it and they were able to learn a few things.

Their emotions ebb and flow and they can tolerate those changes
Their physiological symptoms ebb and flow as well
They can respond in a different way
Their thought was just that…a thought!

The dog didn’t get down, the owner didn’t “sick” the dog on Person B and everything turned out okay. This would not have been experienced had Person B resorted to avoiding the situation like they usually do. Instead, they are starting to put some cracks in the thought that this situation (and others like it) are threatening. If they continue to use an approach strategy as often as they can, they will soon learn that their fears about this type of situation may have been exaggerated compared to the actual threat of a situation.

That’s great, but what if something bad does happen?
I won’t go into significant detail here, but I’ll do a quick explanation and example. One could easily argue that driving in a car is dangerous and threatening, but most adults of driving age take that risk daily. However, if we end up in a car accident (as many of us have or will), why don’t we stop driving? After all, the danger was just proven to us and something bad did happen! Well, for a few reasons. One is that we have had many more times driving when we didn’t get into an accident, so we’re able to see that, although it’s possible, it does not mean it is highly probable. A second reason is that we may lose our job, social life, family, etc. if we allow this anxiety to prevent us from driving. Another reason is that we learned that, although it was unpleasant and uncomfortable, we tolerated it! We were able to handle the situation, problem-solve as necessary and move forward with the understanding that what happened was the exception and not the rule. So, if Person B experienced the dog getting down, barking at them, or even biting them, they would have learned that they can handle the situation, even if they didn’t like it. Scary things happening to us doesn’t have to be a bad thing. They are wonderful learning experiences, even when it’s hard to see that in the moment.

So, where’s the magic?
Well, that’s just it…there isn’t any. We don’t need any magic wands or smoke and mirrors; rather, we simply need to make an adjustment in our actions to make the magic happen! We are retraining our body and our brain by responding differently and approaching situations instead of avoiding them. This process alone begins building new pathways in your brain, getting you closer to taking control of your anxiety and fear. Even though it is a simple process, it can be difficult depending on the severity of the negative emotions and thoughts. It will take time, patience and practice, but with those things, CBT can do wonders for making significant life changes toward a happier lifestyle! My challenge to you is this: the next time you’re faced with a fear that you would usually avoid, try looking at it from a new perspective and approaching it instead of avoiding it. Maybe it’s a phone call you’ve procrastinated, or an assertive discussion you’ve been debating, or even looking at a bug outside. Whatever it is, see what happens if you approach it. Good luck!

When Reassurance Backfires

Does this look good? Read this for me, does it sound okay? Is it too harsh? I have this weird sensation in my leg, what do you think it is? Should I get it checked out? Did I do that okay? Was I awkward? If this sounds like you, let’s have a chat about what impact the reassurance you receive is actually having on you.

You probably assume that the reassurance you’re seeking from others is helpful in some way. It answers questions you’re unsure of, helps you feel more confident, decreases unpleasant emotions, and provides you with relief. But, how often does that confidence, certainty, and relief last? Not very long, most likely. And why did you feel like you needed it in the first place?

Getting stuck in this cycle of feeling like we need reassurance from others, causes us to lose trust in our decisions and ourselves. We, then, begin convincing ourselves that we need this reassurance from others to move forward. When we look at this from a cognitive-behavioral therapy (CBT) perspective, it’s easy to see how this could be problematic. We experience a situation; this situation leaves us with uncertainty about it or the outcome of it (thought component); we feel uncomfortable/distress about this uncertainty (feeling/emotional component); we seek reassurance from others (behavioral component). Then, once we seek reassurance and someone gives us the “answer,” our level of distress or discomfort decreases and we experience relief. This actually reinforces the idea that we need to seek reassurance from other people. That reassurance took away our distress and provided us with some degree of certainty. Because our need for reassurance has been strengthened, the next time we find ourselves in a similar situation (uncertain and uncomfortable), we are more likely to seek reassurance again. Thus, not allowing us to trust our own judgment and abilities to manage the situation, and encourages us to avoid any discomfort.

Let’s use an example: I’m writing an email to another professional. I’ve read it a few times, but I’m not sure if it sounds good enough or if I missed a small mistake. I’m nervous about sending it, so I ask someone to proofread it to make sure I didn’t make any typos and I communicated clearly and professionally. They agree and provide me with the reassurance that it sounds good and I can send it. I feel better because someone else checked my work and said it was okay. The next time I have to send a similar email, I’ll probably ask someone to check it for me. Why? Well, I’m beginning to convince myself that the only reason I didn’t have typos and it sounded good enough was because someone else looked it over. I also don’t think I can handle the discomfort/distress of sending it without getting it checked! What happens if I miss a typo? What will they think? What if it’s not professional? All of these questions are flying through my mind and I can easily fix it by asking someone else! So, why not?

Learning how to manage these questions and uncertainties is a key skill to navigating so many areas of our lives! It’s important to move away from this need for immediate relief and figure out how we can handle some of these questions on our own. Sometimes, this means we don’t get an answer and have to sit in uncertainty and discomfort. The other thing that reassurance can “do for us” is teach us that we cannot handle making a mistake, sounding unprofessional, saying something harsh, etc. Simply put…that’s not true! We can cope with these situations, but constantly avoiding them via reassurance will not bolster our confidence, it does just the opposite! Think about all the uncertainties we sit with on a daily basis. We can’t be certain that our day will go as planned, if we’ll spill something on ourselves, if something happens that causes us to be late, if someone gets sick, if we get into an accident, if we get a distressing phone call, and so many more! If we’re able to sit with uncertainty for so much of our day, then why do we convince ourselves that we can’t manage in these other very specific situations? Also, when these more routine uncertainties and uncomfortable situations do arise, we move into problem-solving mode and figure out how to get things done and work through them. We cope with that unknown and as a result, we build confidence in ourselves.

I’m not discounting that there is a time and a place for reassurance. However, when it’s overused and a “go-to,” it becomes problematic. It’s not easy to change the way we typically respond to uncertainties that bother us, but it is absolutely possible. The end goals are to learn how to tolerate not knowing, cope with whatever happens, and learn how to trust ourselves again and those are all amazing outcomes. So, the next time you feel the need to seek reassurance, try to approach the situation on your own and see what happens!

Resolution Breakdown

2021 Here we are! We’ve been through quite a bit over the past year and there was a lot of hope that this year would be better, right?! Even on the heels of a much less eventful year, many of us use the New Year to set goals (either new or repeated) for ourselves. Setting those goals is usually easier than keeping them. But, why?

Have you already dropped your New Year resolutions? Are you back to eating all the food, drinking all the drinks, sleeping in instead of waking up early, and anything (everything) else you set yourself up for in 2021? Maybe you had amazing intentions for this year and you didn’t even get started! Guess what…that’s okay. You read that right, it’s okay! You might be wondering why it’s okay to drop the health/fitness/wellness/organization intentions when it isn’t even one month in to 2021. Well, the problem doesn’t come from dropping the goals or intentions, or “falling off the wagon” as so many say. The problem comes from watching that “wagon” you fell off drive away and leave you in the dust. Why did you watch it drive away? What stopped you from trying to get back on it? Are you going to wait for another one to come around so you can “get on” and start over?

You might say, “Well, how do I do that?!” Looking at our reaction to this can be really helpful in stopping this pattern and actually figuring out how to make changes, even if they’re small. Why do we set ourselves up for more disappointment and continue down the path of not making changes? Did we prioritize the wrong thing? Did we choose that goal for the wrong reason? Do we think it will be too hard? Not worth it? We won’t succeed? We won’t get the satisfaction from it we want? We could go on and on with so many more self-defeating thoughts that keep us from getting back on that wagon. Whatever the reason, it’s pretty common just to accept that we won’t be meeting those goals for the year and try again next year.

What if we stop accepting failure, figure out what small steps we can make to get to our goal, and get started on it today. We don’t need to wait until the next Monday for a “fresh week,” the next month, or the next year. The longer we stay in our current habits, the harder it will be to change them. With that knowledge, what would it hurt to try to break apart our large goal for the year and see how we can make progress toward that. In fact, wouldn’t it feel better to know you’re making steps toward something instead of just wishing you were?

It’s easy to get caught up in the distorted thought that if we don’t do it the way we want or intend, we didn’t succeed. However, looking at these goals or intentions as something that need to be completed to perfection is likely to make our efforts feel like a failure. Let’s be honest; if we’re looking for perfection, we’re setting ourselves up for disappointment. Instead, it’s important to pursue progress and look at every single step, no matter how large or small, as movement in the right direction. Maybe this means, you declutter one item a day, get up 15 minutes earlier to stretch, add an extra scoop of vegetables, or intentionally put your phone away for 5 minutes each day. You can always use those steps as motivation to keep going and increase the difficulty of the task.

Where to start? Anywhere! That’s the amazing part about approaching our goals from this perspective! Anything that progresses you toward the change you’re trying to achieve is in the right direction. There’s no right or wrong way to progress on personal goals. But, if these goals align with what you value in life, then working toward them is the accomplishment. Even noticing that there are things you’d like to better about yourself is an accomplishment. The steps don’t have to be large at all, they just need to be steps. Let’s use a quick example; most parents want their child to walk, but they don’t have the expectation that they will try the first time and never fall down; instead the expectation is that they get up and try again and take small steps first. If we are able to think this way about the goals we have for other people, why wouldn’t we afford ourselves the same opportunity? It’s time to make those changes and allow ourselves room to make movement instead of staying stuck in the same place. Let’s remember that we’re trying to build new habits, learn new skills and make internal changes. Successful long-term changes take time and errors. The challenge to you is to let yourself try in a way you might not give up on when you make a misstep. Challenge, accepted!

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