You can use cognitive behavioral therapy (CBT) anywhere and at any time.
CBT was created decades ago by Dr Aaron Beck. The Beck Institute defines it as a "structured, present-oriented psychotherapy directed toward solving current problems and teaching skills to modify dysfunctional thinking and behavior." In other words, changing your thoughts leads to changing your feelings and actions. CBT has been compared in many research studies with other types of therapy and usually comes out on top or as a "best practice" for helping to relieve symptoms from anxiety, panic, OCD, depression, eating disorders, and PTSD.
People you know may say many things to you when they see you suffering. They may intend to be helpful when they say such things as: Don't worry so much. Just push through. Be positive. Cheer up. While this may be a start, it is not that simple when you have an actual mental health disorder. A disorder is diagnosed only when symptoms impair your ability to function in daily life. For example, for someone with depression, just getting out of bed can be a major problem. For a person with panic disorder or agoraphobia, they may avoid leaving their house. For someone with trauma, they may cope by dissociating. These things can all affect one's ability to sleep, eat, have friends, get or keep a job, or stay physically healthy. A person with an untreated disorder doesn't have the same level of function that is typical of most people. Often, they cannot just "cheer up."
CBT offers tools. In fact, there are so many that some people find it overwhelming at first (hello, anxiety). But the great thing about CBT is that the tools are bite size - you can take one at a time, try it out for a little while, and integrate it into your life before you go on to the next bite. Following are some of the most common and universally helpful tools I use in therapy and encourage people to continue learning and practicing at home.
The Triangle: What I Think, What I Feel, What I Do. This is really just the main idea behind cognitive behavioral therapy. It says that what you think, what you feel, and what actions you take are all connected, just like the three sides of a triangle are connected. For example, if I think, "I'm a failure," I may feel sad, guilty, embarrassed, or self-loathing; because of those feelings, my actions seem limited to things like avoiding others, self-harming, or crying; and because I've been doing all those things, I feel even more embarrassed, guilty and sad. Now, I'm telling myself, "See? There's proof that you are a failure." It's a cycle that loops around and reinforces itself. Because we've made it so strong, we now see it as the only possible reality. But becoming aware of this cycle means that you're on your way to stepping a little bit off to the side. You're building . . .
Mindful Awareness of Thoughts. I always start here. It's really the only prerequisite to all the other tools, because without awareness of your individual thoughts, you will not be able to use CBT. I use the analogy of a fishtank: Imagine your brain is the tank and the fish and everything else in the tank are your thoughts. Building awareness of thoughts is like looking at your thinking process as if you were outside of it, looking in. First, this gives you the simple tool of knowing you are NOT your thoughts; you are the person thinking the thoughts. If you had a fishtank, you would not say, "Oh, those fish just appear and disappear. I can't do anything about it." You would know that you have some control over the tank because it is something that you have, not something that you are. When you have a disorder, you may be afraid to touch the fish. They may have gotten too big, too strange, or too scary. What you can do is observe them from the sidelines. Watch them come around when they get close to your side and stay in your spot, observing, until they swim back to the other side where you can't see them anymore. Just be aware. Don't identify with the fish. Just know that they represent the thoughts that you have right now. Take a breath, observe, and don't judge them. You'll come back to them later, once you've collected more information. Such as . . .
Thinking Traps, a.k.a. Cognitive Errors. This list is one of the most helpful tools to learn next, since it really helps bring more definite awareness to your thoughts. What you do is look at the different types and think about whether they have shown up in your life and how often. You may even recognize the thinking errors of close friends or family. Whatever helps you recognize and label them is fine. Check out Veronica Walsh's website for some amazing handouts and worksheets about this. I'll list the most common ones here:
Awfulizing - A simple "bad" experience will lead to a catastrophe: "I can't walk into class late - people will stare at me, I'll turn red, and I can't stand that, so I'll have to leave class, I'll never be able to go back, and then I'll fail and won't graduate!"
Mindreading - Assuming you know what others are thinking (when we simply cannot KNOW): "People think I'm stupid."
Fortune telling - Thinking you know the future (when we simply cannot KNOW): "My boyfriend is going to break up with me."
Emotional Reasoning: Using your feelings as proof for reality: "Because I feel like something bad is going to happen, something bad IS going to happen." (Again, we simply cannot know this.)
Filtering - Focusing on one bad thing and discounting other things that may be good: Saying "I always get bad grades," when you got one C, three A's and one B+.
Labeling - Calling yourself names or making a harsh judgment: "My girlfriend broke up with me - I must be a loser."
Overgeneralizing: Using words like always and never: "I'll never be happy." "Life is always unfair."
Black and White Thinking: Leaving no room for shades of gray, mistakes, or stages of learning/improving: "I skipped the first day of exercise class, so now I can't go because it's too late; I already failed."
Personalizing/Blaming - Thinking that what's happening has to be because of you, and only you: "It's my fault I was abused." As if who you are caused the abuse. (There are many factors in abuse, and none of them involve you as the reason for it.)
Shoulding - Rules about how we and others should behave: "They should know better." "I shouldn't feel this way."
"The Tyranny of the Shoulds." This phrase comes from an early psychologist named Karen Horney, and it is worth emphasizing as a thinking error because it is so strong and so common. We cannot get rid of shoulds completely. They represent an entire verb tense ("conditional" tense, as indicated by words like should, could, would, if, possibly, maybe, etc). But shoulds become "tyrannical" when we use them in our negative self-talk without questioning them: I shouldn't feel this way. I shouldn't have to deal with him. I should know better. I should just get over it. Shoulds may or may not be accurate - that is why we need to challenge them. I always tell people, while they are being mindfully aware of their thoughts, listen especially for the shoulds. Once you are aware of those, you can challenge them with . . .
Socratic Questioning. The idea technically derives from the Socratic method, a form of questioning that Socrates used to pursue thought in many directions, get to the truth of things, and uncover assumptions. While Socratic questioning can be pretty broad - and, I might add, really different from the conversation in Bill and Ted's Excellent Adventure pictured in the video above - there are some basic questions I use that are very helpful in getting you thinking more rationally, try out different perspectives, and come up with more accurate thoughts. To use Socratic questioning, you have to start by identifying a persistent negative thought. Common ones are: I'm a failure. Nobody likes me. I'll never get what I want. I'm stuck. People will always disappoint me. Money is evil.
To challenge these thoughts, some of the most common and helpful questions are:
What is the evidence for this thought?
What is the evidence against this thought?
Is there another way to look at it?
Am I thinking about this in black and white terms?
Am I basing this thought on fact, or on feelings?
What would I tell a friend who has this thought?
Am I making any assumptions? is this realistic?
Did I learn this thought or type of thinking from someone? If so, are they a reliable source of information?
Automatic Negative Thoughts (ANTS). Another tool of CBT is learning to identify ANTs (or NATs, depending on how you arrange the phrase).They are other thoughts, in addition to shoulds, that will lend themselves to Socratic questioning. They're the things we think out of habit, learned or picked up from others, or think we must believe in order to keep us humble, on our toes, or from making mistakes. Some examples may be more personal: I'm not as good as [another person/people]. Everyone thinks I'm stupid. My partner is going to break up with me. Or they may come from society as messages: "Money is the root of all evil," or, "Women are weak." Check out this website for a lot of resources on ANTs and a list of over fifty automatic thoughts, if you need more examples.
I hope this introduction to the main CBT concepts and tools has been helpful. Come back to this area (CBT Community) to see as it develops or as a refresher, and check out the Blog pages on this website for posts on many more tools (some of them CBT, some of them not) to help you on your journey in wellness. You're here, so you're already on your way!