Cognitive Behavioral Therapy (CBT) Primer

Have you heard of Cognitive Behavioral Therapy? I first heard of it when I was in graduate school and went to therapy to help manage the stress I was experiencing (thanks, Yale!). The therapist gave me a handout with the most common mental distortions and an exercise: every night I was to write down everything that went well or okay during my day.

At first, I was a little disappointed with this, I think perhaps I wanted confirmation that what was being asked of me was too hard or that there was something wrong with me. But as I read over the list, I was shocked at how many of the distortions resonated with my own patterns of thoughts.

As a habitual high achiever, I was especially guilty of discounting the positive. When I got a performance review I generally skipped over any positive or neutral comments, assuming that they were a given, and fixated on any critical comments. So the Cognitive Behavioral Therapy exercise to write down things that went well or even just okay was a shift in mindset for me. I was feeling pretty desperate at the time, so decided it couldn’t hurt and that I would give it a try. 

I actually find it difficult to explain exactly why or how, but after doing this exercise day after day, I started to feel my confidence growing. I probably made the same number of mistakes as previously, but I now had a history of written proof that actually, almost always, things went pretty well, and often they went very well.

This gave me confidence when taking on new things or facing new challenges, because I realized that while there was a chance that things would go badly, there was also a strong chance it would all be okay. The middle of the night anxiety I used to feel didn’t immediately go away, but I could actually talk back to it and give myself some relief. 

This extremely simple technique gave me what felt like a super power. At the time I didn’t do any further research into Cognitive Behavioral Therapy. I kept doing the technique on and off over many years when I felt down or stressed and often stopped when I was feeling okay. Fast forward to five years later and I decided to research it more. I was in a bit of a slump and thought to myself “well, that Cognitive Behavioral Therapy thing worked well for me before, I wonder if there is more to that”? I then found and purchased Dr. David Burns’s book Feeling Good, and my mind was again blown at how well I saw some of my thought patterns being described. 

As a basic description, Cognitive Behavioral Therapy (CBT) is a form of therapy that looks at cognitions (aka thoughts) and works to correct them when they are distorted. In this case, distorted means thoughts that for various reasons don’t accurately represent reality, even though they feel very real when you’re thinking them.

Whatever you are feeling emotionally is the result of your thoughts, so to help improve your mood, CBT focuses on changing your thoughts to either new ones that better reflect reality or quite simply to thoughts that serve you better. This is done through a number of exercises (including the one I had learned in graduate school). CBT is often administered by a therapist to treat a wide range of symptoms including depression and anxiety, but what I find most useful about it is that a lot of the exercises can be done independently by anyone…at no cost.

Quick disclaimer moment to say that I am not a medical expert and if you are struggling with your mental health, please consult a professional. One option that I have used and found helpful is BetterHelp, an online service that will match you with a therapist for a reasonable monthly price. This link will give you one free week of services if you are interested in trying it out.

But for those of you that are looking for some tools to manage the ups and downs and stresses of daily life, I’ve found Cognitive Behavioral Therapy to be one of the clearest and most useful ways to improve my mood and overall sense of well-being. I’ll likely reference it often and go into more detail in future posts, but here are a couple of exercises to try to get you started. These techniques were developed by Dr. Burns and are described in more detail in his book, Feeling Good. 

Exercise 1: The Three Column Technique

This technique helps you to examine your thoughts head on and identify patterns of thought in order to help reshape them. The three columns are: negative thoughts, mental distortion, and rational response. When you are feeling a negative emotion, here are the steps in this exercise: 

• First, write down the automatic thoughts in your head. It is important to frame these as a thought, not a feeling – for example, if I was feeling stressed because I was running late to a meeting, the thought might be, “I’m so disrespectful for being late and everyone is going to judge me and think that I am flakey and unorganized” rather than “I’m so stressed and angry right now about being late”. This takes a bit of practice to identify the actual thought driving the feeling. Keep asking yourself “why?” or “so what?” until you get to the root of the thought. 
• The second step is to identify the mental distortion, using this list. In my example above, I would write “All-or-Nothing thinking”, “Mind reading”, “Magnification”, and “Labeling”. This step is sometimes tempting to skip, but I think it is important because it helps distance you from the thought and also over time helps you to recognize what distortions you are most likely to use in your automatic thinking. 
• Finally, you will write down rational responses to the negative thoughts. So again, in this example I might write down, “I will likely be late today, but I am on time for meetings the majority of the time. It is possible that some people will judge me for being late, but it is also possible that they will not even really notice, or they will relate to my situation. Everyone is late sometimes and that doesn’t inherently make them flakey and disrespectful. It is also possible that I won’t be as late as I think I might be, or that the meeting might get started a bit late anyway.” These responses should be realistic and something that you actually believe to be true. I wouldn’t want to say, “the train will be extremely fast today and get me there twenty minutes earlier than normal” or “no one will see me come in late”, because those are highly unlikely statements and my brain would probably just reject them and stick with the original thought. 

 This exercise is called the “Three Column Technique” because the idea is that you write them down in three columns on a page. I usually just pull out the Notes app on my phone and write them down in order. One of the most interesting things I have found is rereading the negative thoughts in old entries. When I’m not in a negative mood like I was in at the time, it can actually be quite shocking how negative and harsh my thoughts were. Just another good reminder that thoughts are not always objective reality. This becomes clearer once you are able to get some distance from your thoughts. This technique is basically the keystone technique of a lot of CBT work, so practicing it often will help set you up for success. 

Exercise 2: Anti-Procrastination Sheet 

Through this work, I have realized I often overestimate how difficult tasks will be. The Anti-Procrastination sheet helps you to attack problems or tasks that you have been putting off for whatever reason. 

• First, write down the task that you have been putting off. If it is a big, overwhelming task, break it into smaller portions. 
• Next, for each task listed, predict on a 0 to 100 percent scale how difficult or hard you think it will be. Then predict how satisfying and rewarding it will be to complete. 
• After completing the task, go back to your sheet and note how difficult and how rewarding it actually was in reality. 

For an example of this, I had been putting off organizing our important papers for about five months. Since we moved into our new house, I had created a drawer where I put every important paper and just kept throwing new paperwork into that drawer. The task of getting out our file holder and going through and organizing everything seemed extremely daunting and I kept putting it off until it got to the point that I could barely close the drawer with the papers, not to mention that I couldn’t find anything important when I needed to. The feeling of dread I had when we got new papers gave me a hint that this was something probably something I should stop avoiding. So here is how I used this technique on this task: 

Task: Sorting Important papers

Predicted Difficulty before completing: 70%

Predicted Pleasure before completing: 10%

I decided to do this task on a Saturday while watching a soccer game with my partner. I grabbed all of the papers, our file holder, some new files and set up shop on the floor in the living room. It took me all of 30 minutes to complete. And through the process I was able to find a check I had thought I misplaced and find the paperwork to answer some questions we had about an account. So going back to my Anti-Procrastination sheet, this is how I would rate the task after completion:

Actual Difficulty after completing: 20%

Actual Pleasure after completing: 60% – I say this, not because it was the most thrilling time of my life, but because it was quite painless after all and I felt really great that afterwards I was quickly able to find some information I had been struggling to find.  

Cognitive Behavioral Therapy is a great compliment to much of the other growth and development work I have done and there are more useful techniques and ideas that I will weave into future posts. If you would like to learn more on you own, I highly recommend the books by Dr. David Burn, as well as checking out his website at “The Feeling Good Institute”. The website is primarily geared for therapists, but still has useful information for anyone. There is also some substantial research showing the effectiveness of CBT for those of you that like to dig into data.

Also, as an easy way to incorporate this into your life, check out the Moodpath app. This asks you a series of questions each day and has a place for you to track your daily thoughts and moods. Based on your answers to questions, after a certain number of days it will provide a possible diagnosis of your mental health. But the most valuable feature in my opinion is the discipline of regularly tracking your thoughts and moods, which will give you insight into where to apply some of these techniques (or other forms of self-care and therapy) to improve your overall wellbeing. 

For more CBT tips, download my free “How to transform a negative Emotion Workbook” to see more CBT techniques in action.

Take action!

Pick an area in your life that you are struggling with a bit. Write down your current automatic thoughts related to it. Then for one week, every night, write down everything in that area that went well or even just okay. Even if you don’t feel any positive impact at first, keep doing this for at least one full week. At the end of the week, write down how you now feel about the area. How does this compare to your thoughts at the start?