Cognitive Behavioral Therapy is based on the idea that certain situations trigger false core beliefs
that negatively impact our thoughts, emotions, behavior, and physical reactions.
Once we learn how to identify what situations bring upon such destructive thoughts,
we can practice developing new interpretations that will then change our pattern of reaction.
The therapy is widely used to help people with phobias, depression, anxieties, or addictions.
To show how it works, let's look at Lily,
a teenage girl who hates going to school due to her fear of being judged and humiliated.
In her first session, the therapist tries to build trust and explains how CBT functions
since the better Lily understands the process, the more likely it is that the therapy is effective.
The therapist also illustrates how our brain, in specific situations, follows
a fixed path of reason — which gets stronger after years of having the same thought process.
Many of our destructive behaviors are based on false core beliefs — thoughts
that objectively don't make sense. We acquired these false beliefs when we
were too young to interpret others correctly. Throughout the therapy,
Lily will try to unlearn these false beliefs and create new mental pathways that will
replace the false beliefs she holds of herself with more realistic thoughts.
Once Lily understands the process, the counselor begins to ask questions
following the Socratic method, a form of argumentative conversation that
stimulates critical thinking to draw out false ideas and underlying assumptions.
“Would you like to tell me why you are here today?” Starts the therapist.
“Because I think I’m not normal,” Lily responds. Therapist1: You appear perfectly normal to me,
can you be more specific? Lily1: I think I’m afraid of people.
Therapist2: So, you are afraid of me? Lily2: No
Therapist3: Do you feel socially insecure? Lily3: I’m not sure what you mean.
Therapist4: Tell me how you feel about school. Lily4: I’m scared of going because they
think I’m stupid.
Throughout the interview, the counselor takes notes of Lily’s answers and identifies the
signs of social anxiety based on a false core belief - Lily believes she is stupid.
For homework, Lily should practice introspection. The goal: to find out which situations trigger her
negative thoughts. She gets a learning journal to keep record of all triggers
and other observations, such as self-talk or interpretations of particular events and people.
During the following week, Lily becomes more aware of her thoughts and the physical reactions they
trigger. By paying attention to her feelings, she identifies a specific pattern which occurs
every time during math class. The moment her teacher begins to ask questions her heart
starts racing and her palms get sweaty - she worries about having to answer the question,
about making a mistake, about looking dumb in front of all the others.
In her second session, Lily shares her observations and the therapist helps her
realize that her cognitive-behavioral patterns are false. First, her math grades are great,
so she should feel anything but stupid. Second, she explains that there are
always more interpretations to the same thing. What to her may look like her "stupid" face,
to others she may just look unhappy about having to answer. The reason she is afraid of what people
think is a form of social anxiety — a completely irrational cognitive behavioral response.[5.7]
As the sessions continue, the therapist suggests three practical strategies:
Through Journaling, Lily records her negative beliefs and reformulates them into positive
ones she can replace them with. Constructive Self-talk, helps her
to replace a critical voice with a positive one. And she starts exposure exercises, which means
Lilly deliberately puts herself in situations where she becomes the center of attention.
Along the way, the two set goals that are specific, measurable, achievable,
realistic, and time-based. SMART goals give her control over how she progresses
thus helping her to gain confidence in herself.
Over time and with a lot of practise, her brain builds new neural pathways that lead to different,
more neutral reactions to the same old triggers. And one day,
Lily may even enjoy the thrill of speaking in front of her class. Her interpretation
of the situation is more realistic and more aligned with those of the others.
CBT was initially developed in 1964 by Aaron Temkin Beck. Beck hypothesised that people's
feelings are determined by the way they interpret situations, rather than by the situations per se.
About depression he once said: “If our thinking is bogged down by distorted symbolic meanings,
illogical reasoning and erroneous interpretations, we become, in truth, blind and deaf”.
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