What the heck is Cognitive Behavioral Therapy anyway?


Are you looking for therapy that “works”? Are you anxious about finally taking a chance to talk to someone and worried it will be a waste of time? Rest assured, you’re not alone (and therapy doesn’t have to be a waste of time).
If you’ve been considering therapy for a while, you’ve probably done some research of your own. Perhaps you’ve been Googling different types of therapy, talking to a few friends who’ve been to therapy before, or buying some self-help books to see if you could “fix” the problem on your own.
As a cognitive behavioral therapist, I believe my clients deserve treatment that has been proven effective through empirical research, so that’s what we offer. You’ve likely already heard about cognitive behavioral therapy (also known as CBT), but may be wondering what the heck that means exactly. If so, here are the answers you’ve been looking for.

So what is cognitive behavioral therapy exactly?

It is structured.

Sessions are planned out. There’s a tentative agenda for each session focusing on skills and information for you to learn and practice. CBT is a very knowledge and skill based type of therapy. It follows a predictable pattern, so you can understand the intention behind what you’re doing in and out of sessions and how it will help you to feel better.

It is evidence-based.

CBT, as with all forms of therapy widely available, has been subjected to a great deal of research to determine whether or not it’s actually effective. As it turns out, CBT has more empirical support to date than any other form of talk therapy – particularly in the treatment of depression, anxiety, and other common conditions.

It is time limited.

CBT does not typically go on for years. In fact, most clients find they start to notice a change in their mood after only a few weeks. This is possible partly because of the approach and party because of the emphasis on practicing skills outside of session (where you spend most of your time).

It is goal & problem oriented.

In cognitive behavior therapy, you’ll set a list of goals you would like to accomplish or problems you would like to resolve while in treatment. Sessions are strategically focused on dealing with these issues and much less about “let’s go wherever the hour takes us.” If urgent issues come up that need to be addressed, we can take a short break from our regular path, but then we’ll return to our goals and re-focus.

It is focused on the present with a nod to the past.

CBT looks at what is going on in your life now and how to make changes to help you feel better in the present. If there is only limited success because the past is getting in the way (such as a very difficult upbringing or a past trauma that has never been addressed) then we can revisit these things for a bit to see how they may have affected you and how they may relate to your present concerns.

It is cognitive.

As its name suggests, CBT focuses on your thoughts (your beliefs and your perceptions) and how these affect your mood. Through CBT you can learn to track your thoughts and challenge them so that you can begin to change the way you think, the way you see things, and thus the way you feel about them. Over time, CBT has also been shown to change your underlying beliefs that may be contributing to your troubles.

It is behavioral.

CBT focuses equally on your behaviors – your actions and reactions which often contribute to your mood as well. In cognitive behavioral therapy, you will practice changing the way you act and react in various situations, which often results in changing the way you feel. This means actively taking steps and testing out their effect on your mood. It’s a very active process.

There’s endless research to support this approach and its long-term benefits since the end-goal is to turn you into your own therapist. That way, you can recreate the process of therapy on your own for years to come, whenever you need to.
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What does cognitive behavioral therapy look like?

Sometimes when you’re trying something know, I find it can be helpful to have an idea of what the step by step process looks like. Most clients I work with are initially curious about what we will talk about, what sessions will look like, how therapy will work, and what the end goal is. Here’s a general idea of what you can expect if you come to us for CBT.

Step 1

Together we will work to create a “problem list” to help us understand all your current concerns and how they relate to one another. We start here because in order to make good use of our time together we need to know what we’re trying to accomplish.

Step 2

Together we will figure out what underlying problems may be contributing to all of your current concerns and see if this fits with your view of yourself and your life. We’ll take a short bit of time to get an idea of how it all ties together. This piece is crucial because it helps me to understand how best to help you so that we can be intentional with our work together. Otherwise we run the risk of trying “this and that” and simply hoping something “sticks” along the way, which would be frustrating.

Step 3

You will learn the basic process of cognitive behavioral therapy so that you know what to expect and understand the rationale behind the process. In order for CBT to be effective, you must understand the core principles of it and how it applies to your concerns.

Step 4

You will learn you the basics of self-awareness including learning to identify your thoughts, feelings, and reactions using everyday examples. Learning to monitor your thoughts and reactions to daily situations will help you to really experience the impact these things have on your emotions. This step also helps you to become a bit more objective as you begin to observe yourself and your reactions, giving you increased ability to make changes when needed.

Step 5

You will be encouraged to understand why these thoughts, feelings, and reactions “make sense” based on your past experiences, upbringing, and core beliefs. There is often a tendency to criticize ourselves for thinking and reacting the way we do at this point in CBT, labeling ourselves as “crazy” or “an idiot” when in reality it makes perfect sense that you think and react the way you do based on your beliefs and experiences.

Step 6

You will learn how to challenge your thoughts and change your behaviors. I will teach you to objectively re-evaluate the way you look at everyday situations so that you can begin choosing new perspectives that are less upsetting to you. We will also talk about new behaviors to replace old ones that might lead you to a more desirable outcome.

Step 7

You will work to gain faith in your new perspectives (because they will seem too good to be true at first) by finding everyday opportunities to “test” them out. Together we will find “experiments” for you to try in your everyday life so you can see if your new perspective or new behavior holds up.

Step 8

You will start to solidify these changes through practice and repetition. This is a key piece in what makes CBT effective long-term. As you practice changing your thoughts and reactions repetitively, over time you actually create lasting structural changes in your brain.

Step 9

Together we will come up with a plan to help you maintain the changes you’ve made so that you can keep up your progress on your own. This will involve identifying potential difficulties, putting accountability measures in place, and solidifying your motivation to keep up with the changes long-term.

Step 10

We will meet less often so that you have more time between sessions to practice maintaining the changes you’ve made without my support. Through this we will make adjustments to your maintenance plan and deal with any difficulties you have applying the techniques on your own.

The Final Step

Once you’re comfortable with your ability to maintain your progress without regular sessions, you’ll have successfully completed treatment. At that point, you can come back for maintenance sessions every so often or as needed if life really throws you a curve ball.

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