Cognitive Behavioral Therapy (CBT) / Sameila Shrestha


Cognitive Behavioral Theory/Therapy (CBT) can be defined as the type of psychotherapeutic approach which chiefly deals with modifying irrational thoughts for better function or behaviors of an individual. As the name itself suggests, CBT monitors disrupted cognitions (thoughts), work on negative emotions for a better outcome, i.e., behavior. The history of CBT is indisputable; there are vivid contributions of the following founders with their theories for the birth and evolution of CBT. 

REBT (Rational Emotive Theory)
It was developed by Albert Ellis (1955). REBT focuses on resolving emotional and behavioral problems by changing irrational beliefs into rational. It works on the principle of "We feel what we think," meaning cognition governs emotions, feelings.

CT (Cognitive Theory)
Aaron Beck propounded CT. This theory claims that the individual misinterprets certain life situations, which leads to cognitive distortions or "logical errors."

CBT can be used synonymously or as a base for many other therapies. CBT can be referred as an umbrella concept that embraces many different forms of therapies such as- Cognitive Therapy, Problem-Solving Therapy, Dialectical Behavior Therapy, Meta-Cognitive Therapy, Rational-Emotive Behavior Therapy, Cognitive Processing Therapy, Mindfulness-Based Cognitive Therapy, Cognitive-Behavioral Analysis System of Psychotherapy & Schema-Focused Therapy. CBT works in two dimensions; Cognitive and Behavioral.

Cognitive techniques include-

Cognitive Restructuring
It assists in understanding unhappy feelings and moods and also challenges the sometimes-wrong "automatic beliefs" about the issue. It helps to reframe the unnecessary negative thinking with rational, positive thoughts for increasing the quality of your performance. For e.g., You failed an interview. There can be two ways you could possibly think. First, you could say I am a total failure or second, it did not turn out good this time, I will work hard and try next time. Cognitive restructuring assists you to think in a different rational way.

Thought record
It keeps the record of your triggering situations, feeling, automatic thoughts, thinking errors, your changed and positive thinking, behaviors, and finally, its outcome/behavior. For e.g., You have a presentation to senior-level staff (Triggering situation), your automatic thoughts/emotions might be nervousness or self-criticism. Instead of thinking, feeling that way, you may think I had my preparations well, there is a minimum chance of being a failure, or I can do it; I have aced it before as well. When you think in a later way, your emotions change, and this helps you to cope up with the situation in a calmer and more effective manner.

Journaling is a CBT exercise where you write about your perceptions, feelings, and emotions. By this, it helps to identify your negative, distorted thoughts and emotions and help you reflect on how rational and logical your automatic beliefs and emotions are. It is like writing yourself a letter with how and what you felt throughout the day and what went fine or wrong and your memories or future endeavors.

Behavioral Techniques include-

Behavioral Activation
Behavioral Activation (BA) is a specific CBT skill and can be a treatment all by itself, or can be used alongside other CBT skills such as cognitive restructuring. BA helps us understand how behaviors influence emotions, just like cognitive work, helps us understand the connection between thoughts and emotions. The following are some of the activities of BA.

  • Activity Scheduling
    It helps people engage in behaviors/actions rather than just thinking about it or worrying about it. It involves engaging in activities that increase pleasure, increase mastery, and increase approach (vs. avoidance) in people's routines.
  • Hierarchy
    It is done by ranking the list of activities from easiest to hardest. It makes sure that clients get active but also don't stress themselves out too much. By starting with some easy activities, motivation in people can be fostered that can eventually make it easier to tackle the harder activities.
  • Successive Approximation (Shaping)
    Successive approximation is a CBT exercise that helps people tackle huge goals by systematically breaking large tasks into smaller steps, or by doing a task similar to the goal, but less difficult people are able to gain mastery over the skills needed to achieve the larger goal. For e.g., You are assigned for a class presentation. You will break down your massive project into various steps and reward yourself with the completion of each step. Here,
    • First, research about one topic, after you are done, reward yourself with your favorite music, activities, food, or anything. then continue with other research
    • Next, make your' points to remember.'
    • Then, put necessary key points in your templates,
    • Choose your templates design,
    • Make your required side notes,
    • Finally, practice and you are done. Also, don't forget to give yourself a little mood-lifter after every step.

Reducing Avoidance
It shows the connection between avoidant behavior and depressive disorders (which helps clients regulate their emotions by changing their behavior. For e.g.: Not getting presentation done --- missed opportunity --- academic performance is limited ---stress is elevated Maybe ---- research well about the topic, seek for necessary guidance (problem solved to block avoidance in the future)

Problem Solving
Problem Solving is a CBT exercise to help people take an active role in finding solutions to problems. For e.g., You have great work pressure. You can make the list of your possible solutions and take interventions accordingly. You can evaluate what went well and what you could have done differently with the help of your therapist.

Skills Training
Skills Training is a CBT exercise to help remedy skills deficits. The most common subjects of skills training are social skills training, assertiveness training, and communication training. For e.g., If you have a social skills deficit, you can perform role-plays with your therapist. This allows you to receive direct feedback from the therapist and correct any problems before actually using them. Finally, you can use the skills in actual situations, mastering the most basic skills first, then moving on to next.

Acceptance and Commitment Therapy (ACT)
ACT is an action-oriented approach that helps clients learn to stop avoiding, denying, and struggling with their inner emotions and, instead, accept that these deeper feelings. Further, after accepting your emotions, it encourages you to make a commitment to stop fighting your past and your emotions and, instead, start practicing more confident and optimistic behavior, based on your personal values, goals.

Self-Regulation Therapy
Self-regulation Therapy comprises of:

  • Behavioral self-regulation
    Behavioral self-regulation helps you become your own personal motivator by checking on and act to your long-term best interest, consistent with your deepest values. If you are ever dreaded getting up and going to work in the morning, but you remember your goals (e.g., a raise, a promotion) or your basic needs (e.g., food, shelter) and got up and out the door—you displayed effective behavioral self-regulation.
  • Emotional Self-Regulation (ERT)
    ERT is a CBT skill that helps identify, differentiate, and describe negative emotions, decrease use of emotional avoidance strategies (such as worry, rumination and self criticism) by attention, allowance (targeted towards increasing implicit regulatory ability), targeted towards more flexible responses to emotional stimuli; i.e., reactivity), and reframing emotions. It is basically similar to a thought record, but you do it for emotions. For e.g., You have this company's party coming up that you did not want to go. You can write/think of situations that would create several negative emotions, also write/think about how you are going to face it in a more rational way instead of simply running away.

(Sameila Shrestha, the author of this article is a psychology graduate. She is currently serving Nepal Hypnosis as an intern.)

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