CBT

Cognitive-Behavioral Therapy

DFW, Dallas, Richardson, Plano Texas

10 Ways CBT Can Help You

By Steve Reed, LPC, LMSW, LMFT

CBT-cognitive-behavioral-therapy

Jack suffers from panic attacks.  Sean worries about flying.  Susan has trouble controlling her irritability.  Deborah has been feeling depressed.  What do these people have in common?  Either their patterns of thinking or their patterns of behavior contribute to their distress.  Fortunately, there is a treatment that can help.  It is cognitive-behavioral therapy.

Cognitive-Behavioral Therapy (CBT)

CBT is a well researched set of interventions that can help you change unproductive patterns of thinking and behaving.  As those patterns change in a positive way, it can result in you feeling better, being happier and getting more of what you want from life.  Most people are not even aware of the impact of how they think or how their habituated patterns of behavior can either help them or hurt them.  CBT can help you to gain greater choice and control in route to transforming the quality of your life.

CBT has two major components.  There is cognitive therapy and there is also behavioral therapy.  Each plays an important therapeutic role.  They can work individually or together to help you along your journey to getting better.  Let’s take a look at each and some of the many ways they can help you.

Cognitive Therapy

Throughout the ages wise people have noticed a connection between how we think, how we feel and how we experience the world.  Here are a few notable observations:

  • “People are not disturbed by things but by their view of them.”  Epicetus
  • “The happiness of your life depends on the quality of your thoughts.”
    Marcus Aurelius
  • “As a man thinketh in his heart, so is he.”  The Bible
  • “We are what we think.  With our thoughts we make the world.”  The Buddha
  • “There is nothing neither bad nor good but thinking makes it so.”  Shakespeare
  • “Most people are about as happy as they decide to be.”  Abraham Lincoln

Our thoughts influence our emotions.  This in turn influences our behavior.  Here is a simple example that will illustrate this fact.

Event:  A man asks his wife to let him know when she will be home.

Thought (interpretation) Number 1“How sweet, he can’t wait for me to be back with him.”  This leads to an emotional feeling.

Feeling Number 1She feels happy and loving.  This leads to a behavior.

Behavior Number 1She hugs her husband and says, “I can’t wait to be back home to see you at 6:00 PM.”

Vs.

Thought (interpretation) Number 2 — “He’s trying to control me.”  Again, this leads to an emotion.  However, this time it is a very different one.

Feeling Number 2 — She feels angry.  This leads to a behavior.

Behavior Number 2 — She snaps at him saying, “I’ll be home when I get home!”

Notice that this is the same event.  However, depending on how one thinks about it or interprets it, the emotions and the resulting behavioral reaction that follows can be very different.

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Cognitive therapy can help us to correct dysfunctional, distorted, mistaken or negative thinking.  This can lead to feeling emotions that are more pleasant and help us to behave in more adaptive and constructive ways.  Here are five of the many ways cognitive therapy can help you.

Reduce anxiety.

If your cortex (thinking brain) imagines a scary story vividly, your emotional midbrain believes that it is real.  The emotional midbrain then activates the alarm center of your brain and this causes your body to go into the fight-or-flight reflex.  This results in all of the uncomfortable physical symptoms that you know as anxiety, nervousness, panic, etc.  When the mind takes us down a scary, dark alley then anxiety is sure to follow.

As a child, I liked to watch scary movies.  One night after watching “Invaders from Mars”, I awoke in the night and saw a shadowy monster in my room.  I shook in my bed trying to decide what to do.  Eventually, I found the courage to confront the monster by getting out of bed and turning on the light.  When I did, I discovered that the monster was only a chair with a shirt over the back.  In this example, my mind had played a trick on me.  A combination of shadows and a fertile imagination turned a chair into a looming threat.  Interestingly, as adults, too often we still allow thoughts to be the breeding ground for anxiety.

As an adult, I have learned that the objects of our anxiety do not come from Mars but from the mind.  Cognitive therapy helps you to learn how to change your scary mental movies and stories into ones that are more likely to be true, manageable and potentially more positive.

Manage anger. 

You have just seen how scary stories can cause the midbrain to go into an emotional state of fear, the “flight” side of the fight-or-flight reflex.  However, angry self-talk and stories of being wronged can trigger an emotional response of anger, the “fight” side of the fight-or-flight reflex.  By learning how to shift your thoughts and expectations, angry feelings can dissipate and you will likely behave in ways that are less hostile, more reasonable and more effective.

Lower inappropriate shame | Low self-esteem. 

When our own inner critic attacks us, makes us wrong and shames us through inappropriate or dysfunctional self-blame, then cognitive therapy can help also.  We can learn to catch and change our internal patterns of automatic negative thoughts.  We can curb the self-abusive thinking that lowers self-esteem.  We can increase our ability to see ourselves compassionately and objectively.  By changing our thinking, we can learn to treat ourselves better and improve our self-esteem.  This can also carry over into treating the ones we love and are the closest to in a better and more loving way.

Alleviate depression. 

When a person sees their situation as hopeless and thinks that they are helpless to impact their circumstances, then a natural consequence is that they feel depressed.  When emotional pain clouds our thinking, our perception can be distorted.  Things can seem worse and feel worse than they are.  But even when one’s circumstances are really bad, depressive thinking can prevent problem solving and inhibit our ability to ease distress.  Cognitive therapy has been shown to be as effective as antidepressants and to be longer lasting.  It can be like turning on a light in a dark room.  Everything can seem brighter.

Calm obsessive thinking. 

Many people experience intrusive, disturbing and recurring thoughts.  They don’t want to think these distressing thoughts.  However, they continue to re-experience them over and over again.  These are the type of thoughts that can haunt you and activate upsetting emotions.  This can lead to compulsive behaviors that contaminate the quality of life.  Cognitive therapy can help obsessive-compulsive disorder.  You can learn that you do not have to believe everything you think and that you are not your thoughts.  Through mindfulness-based cognitive therapy, you can learn to separate yourself from your thoughts and become an objective observer of them.  You can find peace of mind despite your mind and whatever background noise your thoughts create.

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Behavioral Therapy

Sometimes, actions speak louder than words.  When dealing with many types of distress, action may also be your antidote.  But there is a difference between random or reactive actions and effective actions that are strategic and therapeutic in nature.  An expert in behavioral therapy can help you to take the right steps that will culminate in relief from an array of distressing issues.  Here are five of the many ways behavioral therapy can help you.

Conquer a phobia.

Systematic Desensitization combined with other behavioral interventions can help to retrain the brain to associate comfort and relaxation with situations that have mistakenly been linked to distress.  An example would be the person who develops a phobia of driving over bridges or on freeways.  Often times, such fears emerge as a result of a bad experience that coincidentally happens while driving.  If a near miss accident happens on the freeway and the driver feels out-of-control and afraid of dying, then the midbrain can forge an association between freeways and the threat of disaster.  Once locked in the mind, the brain’s alarm system will set off the panic alarm even on a good freeway with low traffic.  This type of false alarm reflex can be desensitized with behavioral therapy.  This allows the phobia sufferer to return to comfort while driving.  There are, of course, many different types of phobias (flying, agoraphobia, insects, needle phobias, heights, etc.) but each can be treated to relieve distress.

Elevate your mood. 

A type of behavioral therapy known as “behavioral activation” has been shown to be as effective as antidepressants in helping people to elevate their mood.  For example, the simple behavioral activity of walking can be a powerful intervention to reduce stress and improve mental and physical health.  When done for the right duration, distance and in the right areas, walking has been shown as effective as antidepressants with no drug-like negative side-effects and it can provide many additional benefits.

Another type of behavioral activation involves learning how to develop or enhance one’s social support system.  There is a strong relationship between social support, positive people time, positive attention and nurturance with happiness.  We are all social creatures by nature.  Yet, often times, we do not have functional strategies for building or restocking a failing social support system.  No one functions at their best in social isolation.  If social isolation persists, depression can be a consequence.  Here is where behavioral therapy can help.

Improve problem solving.

Activities that facilitate patterns of bi-lateral eye movements have been shown to activate both hemispheres of the brain and to increase our ability to process information more effectively.  Many people will note that they get some of their best ideas when they are up pacing around a room.  This activity can get the eye movement going and the hemispheres firing.  In turn, this can help the brain to generate ideas, solutions and breakthroughs more easily.

Behavioral interventions can also help to reduce intense emotions.  This is especially important because as emotional intensity begins to increase, the emotional midbrain — the part that controls the fight-or-flight reflex — is activated.  As the emotional midbrain becomes more engaged the thinking part of the brain, the cortex, starts shutting down.  If the thinking brain is offline then we are not able to think clearly or solve problems very well.  Behavioral interventions can help to soothe the emotional midbrain and restore control to the cortex.

Behavioral interventions can also help to reduce intense emotions.  This is especially important because as emotional intensity begins to increase, the emotional midbrain — the part that controls the fight-or-flight reflex — is activated.  As the emotional midbrain becomes more engaged the thinking part of the brain, the cortex, starts shutting down.  If the thinking brain is offline then we are not able to think clearly or solve problems very well.  Behavioral interventions can help to soothe the emotional midbrain and restore control to the cortex.

Desensitize a traumatic memory. 

We all have bad experiences.  However, some experiences are so bad or so intense that the brain is impacted profoundly.  Truly painful or overwhelming events that are experienced at a high intensity level can become imprinted in the area of the midbrain that causes the fight-or-flight response.  When this happens, any small reminder of the event sets off the brain’s alarm.  This can result in physical changes such as rapid heart rate, perspiring, as well as adrenalin and endorphins being released.  This is what happens when your nervous system is being mobilized to run or fight.  Further more, people can often re-experience traumatic memories and high impact events in intrusive ways.  This can include nightmares and flashbacks.

More people suffer from traumas than even most experts realize.  This was evidenced by a research study conducted in a psychiatric hospital setting that found that between 29% and 69% of the patients (depending on ethnicity) had undiagnosed PTSD (post traumatic stress disorder).1  Amazingly, even the psychiatrists were not recognizing the problem.

If you suspect that you are being troubled by intense or traumatic memories then there are a few behavioral therapies that can help.  These helpful treatments can include prolonged exposure therapy, EMDR and an exciting new treatment known as REMAP.  Each employs the therapeutic elements of exposure, systematic desensitization and other physiological interventions that can reach and soothe the midbrain.  This can lead to retraining the midbrain to be calm in the presence of reminders of a traumatic memory and to no longer be bothered by the past upsetting experience.

Overcome panic attacks. 

A panic attack is an overwhelming experience that often propels the sufferer to the emergency room thinking that they are having a heart attach.  Symptoms can include a pounding heart, shaking, dizziness, a choking feeling, tightness in the chest or stomach, numbness, a fear of dying, and sweating.  This out of control feeling can be experienced abruptly and often people are unable to identify the cause.  Once you have experienced a panic attack, people become afraid of having another and any of the sensations noted above can become a trigger for more panic.  Panic attacks can be remarkably distressing and often interfere with day-to-day life.

Fortunately, the same types of behavioral intervention that are effective with traumatic memories are also effective with panic and anxiety attacks.  With effective therapy, the stress and anxiety responses that often trigger panic can be neutralized thus freeing you from the chronic fear of having another panic or anxiety attack.

Cognitive Therapy, Behavioral Therapy or Both?

If your thinking brain (cortex) is mainly responsible for your distress, then you will need the help of cognitive therapy.  If you emotional midbrain (limbic system) is at the root of your distress, then some form of behavioral therapy will serve you best.  However, for many people a combination of cognitive and behavioral therapies will be necessary.  An example of this might be when a trauma sufferer is triggered by a visual reminder of their traumatic event.  This can cause their midbrain to activate its alarm system (the part of the brain known as the amygdala) causing anxiety or panic.  In a way, the midbrain sparks the flames of fear.  However, the thinking brain can then come along and begin to create scary or catastrophic thoughts that will exacerbate the anxiety.  This is like pouring gasoline onto the flames of fear accelerating the emotional intensity.  In such a case, the traumatic memory imprint will need to be desensitized with behavioral therapy and the catastrophic thoughts will need to be challenged cognitively and replaced by thoughts that are better and more believable.

Through these well researched, evidence-based and innovative interventions, CBT can provide relief to a wide range of emotional suffering.  Studies have shown CBT to be effective for: depression, generalized anxiety disorder, social phobia, marital distress, childhood somatic disorders and chronic pain.2  It has also been shown to reduce relapse risk up to 50% in depression, panic disorder, social phobia and obsessive-compulsive disorder.3  CBT can offer the right help in just the right way when facilitated by an expert in both cognitive and behavioral therapies.   It may very well be that cognitive-behavioral therapy can help you.

To schedule an appointment with Steve to begin cognitive-behavioral therapy, call 972-997-9955 today. 

Steve Reed is available for an office appointment for your counseling and psychotherapy needs in the Dallas, Fort Worth, DFW metroplex, including Addison, Allen, Arlington, Bedford, Carrollton, Colleyville, Denton, Euless, Flower Mound, Frisco, Garland, Grand Prairie, Grapevine, Highland Park, Hurst, Irving, Keller, Lake Highlands, Lewisville, McKinney, Mesquite, Murphy, Plano, Richardson, Rockwall, Rowlett, and University Park. He provides therapy at his office in Richardson, TX.  He also offers phone appointments from anywhere in the world.

References:

  1. Al-Saffar, S., Borgå, P., Hällström, T.  (2002) Long-term consequences of unrecognized PTSD in general outpatient psychiatry.  Social Psychiatry Psychiatric Epidemiology, 37(12):580-585.
  2. Butler, A.C., Chapman, J.E., Forman, E.M., Beck, A.T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26, 17-31.
  3. Hollon, S.D., Stewart, M.O., Strunk, D. (2006). Enduring effects for cognitive behavior therapy in the treatment of depression and anxiety.  Annual Review of Clinical Psychology, 57, 285-315.
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