What is Cognitive-Behavioral Therapy (CBT)?
January 15, 2014
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Cognitive-behavioral therapy (also known as CBT) has been studied extensively and is considered one of the most effective forms of talk therapy for a variety of psychological difficulties, including depression, anxiety and anger management.

CBT examines the relationship between thoughts, feelings and behavior, with a particular emphasis on the role of cognition. For example, if one thinks something like “I am worthless,” then this thought can contribute to feelings of shame or sadness.  Alternatively, a thought like “I am a lovable and kind person,” of course, leads to a different set of emotions, likely more positive ones.

CBT helps individuals identify automatic and repetitive thoughts that contribute to emotional distress and negative behavior.  After this, the challenge is to examine these thoughts for validity and replace the irrational thoughts with more realistic appraisals of self and others.  In CBT theory, problematic thought processes are often referred to as “cognitive distortions.”

The other component of CBT looks at behavioral change. Changing what one thinks often leads to changes in behavior.  Alternatively, changing behavior can also lead to greater well-being. For example, with depression it’s common to experience a lack of motivation and decreased activity level. The feelings and internal thoughts (i.e., self-talk) associated with depression may tell one to stay home, sleep more, not participate in many activities, etc. This is a downward spiral where more inactivity then leads to greater depression. On the other hand, by choosing to increase one’s activity level, regardless of how one feels, one can increase their exposure to potentially pleasurable or meaningful experiences. New experiences like these can help improve mood.

Cognitive-behavioral strategies work well with mindfulness techniques because both philosophies emphasize how internal shifts in perspective can contribute to more positive mood and behavioral changes. Within this model, individuals have greater access to their inherent internal power in any situation, which is a contradiction to a more helpless, externally focused mentality. This isn’t to say that there aren’t difficult, external forces out there; of course, there are many. However, by shifting perspective and thinking more rationally, people not only feel better, but also are more empowered to act in useful ways to effect change in their lives and others.

The A-B-C-D Model

This is a classic model developed by one of CBT’s founders, Albert Ellis, PhD. The model, outlined below, can be used in a variety of circumstances to help one think and act more rationally.

A = Activating Event

This refers to the initial situation or “trigger.”

B = Belief System

Your interpretation of the situation; what you say to yourself about the event, and your beliefs and expectations of others.  The process of interpretation is at the heart of all cognitive therapy models, recognizing that it’s not stressful events alone that create problems, but it’s how we relate to those experiences.

C = Consequences

How you feel and what you do in response to your belief system (i.e., the emotional and behavioral consequences).

D = Dispute

The “dispute” stage encourages an examination of your beliefs and expectations. Are they unrealistic or irrational? If so, what may be an alternative, more rational appraisal of the situation? A more realistic interpretation is likely to lead to healthier emotional and behavioral consequences.

Here is a simple example to illustrate the A-B-C-D model:

A – Activating Event
You’re strolling down the street and someone you know walks right by you without saying hello.

B – Belief System
You think to yourself, “What did I do? He/she must be upset with me, or maybe they don’t like me anymore.”

C – Consequences
You start to worry and feel bad about yourself, then you get a little angry and decide to give this person the cold shoulder next time you see them.

D – Dispute
Then you catch yourself and say, “Wait, he/she probably didn’t see me; perhaps he/she was distracted by something difficult that happened earlier that day.” After you say this to yourself, you notice that you feel more relaxed, less worried, and more rational. You decide to approach this person next time you see them to inquire about how they’ve been doing.

For the model to work, awareness is the first step. The “B” part – one’s belief system – is very conditioned (i.e., our beliefs and expectations of others are shaped by past experiences). Therefore, the thoughts and self-talk that initially occurs in response to the trigger can be quite automatic, happening on a subconscious level.

The challenge is to pause, slow down and increase your level of awareness to identify the contents of A, B and C. With this awareness, you’re then more empowered to evaluate the situation rationally and alter your response (the “D”/dispute part) to something healthier, if the situation warrants this.

A great way to start experimenting with this model is to write down the contents of A-B-C on a piece of paper after you experience a challenging or difficult situation. Once you review A, B and C, fill in the D part (assuming that you didn’t already take this step). Writing the information down is better than trying to sort through it in your mind. Writing will heighten your awareness, bring more clarity and make a more lasting imprint on your memory bank. Practicing the ABCDs after the fact will eventually lead to implementing these changes in the moment, when you’re actually experiencing the problem.

About this Contributor: Kim Pratt, LCSW, is a passionate advocate of personal growth and healing.  She has been a licensed clinical social worker for the past 10 years, and in private practice as a therapist to adults of all ages since 2007.  Prior to her clinical career, she worked in the information technology sector in the SF Bay Area.  She is a proud spouse of 14+ years; co-parent to two beautiful non-human beings; a longtime practitioner of mindfulness meditation; and an aging jock. Her formal education was received at UC Berkeley (Masters in Social Work) and the University of Michigan (B.A. in Anthropology), where she also played varsity tennis (Go Blue!). 


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