Fundamentals

To grasp Cognitive Behavioral Therapies, we must first understand cognitive distortions. Various conditions, including Borderline Personality Disorder (BPD), Bipolar Disorder (BD), Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), and Attention-Deficit/Hyperactivity Disorder (ADHD), can significantly suffer due to these distortions.

One of CBT's primary objectives is to identify and counter cognitive distortions.

Here are a few prevalent examples:

• Black-and-white thinking: This involves viewing situations or people as entirely good or bad. For instance, if you think your partner is neglecting your relationship after being late for a date, you might later swing to the opposite extreme, believing they are perfect after receiving a gift from them.
• Personalization: This refers to the tendency to take responsibility for events that are not your fault. For example, you might feel responsible for a friend's ongoing depression, thinking your failure to cheer them up reflects poorly on you.
• Negative Bias: This distortion involves disregarding positive outcomes while focusing on negatives. For instance, rather than celebrating a promotion, you might dwell on past mistakes that undermine your sense of accomplishment.

These examples illustrate a fraction of the cognitive distortions that the therapies discussed here aim to address. For a broader overview, Healthline offers an excellent resource on cognitive distortions.

> If you prefer visual aids, Dani Donovan has created a fantastic article that illustrates various cognitive distortions as cartoon characters. It's definitely worth a look!

Another key focus of these therapies is to enhance emotional communication.

Often, individuals struggle to express their feelings, sometimes even failing to recognize their emotions. The therapies utilize a feelings wheel to help clients communicate more effectively and expand their emotional vocabulary.

To use the wheel, start by identifying a core emotion in the center, then delve deeper into specific feelings using the surrounding rings. A more detailed version can be found at feelingswheel.com.

Now that we've covered the basics, let's examine the specific types!

Cognitive Behavioral Therapy (CBT)

While all these methods fall under the umbrella of cognitive behavioral therapies, CBT is the foundational approach.

CBT posits that numerous psychological challenges stem from negative thought patterns, ineffective behaviors, and poor coping strategies. It emphasizes recognizing cognitive distortions and devising structured methods to tackle each.

CBT also serves as a form of exposure therapy, which helps individuals confront fears by breaking them down into manageable steps.

For example, if you fear public speaking, you might start by rehearsing alone, then presenting to a trusted friend, and gradually working your way up to larger audiences. This step-by-step exposure builds confidence.

A significant aspect of CBT involves observation and documentation. By keeping track of thoughts and behaviors, individuals can identify patterns and gain insight into how their thoughts may not be beneficial.

Central to CBT is the hierarchy of cognition.

In any given scenario, our initial thoughts shape our emotions, which in turn influence our actions. This model elucidates why different individuals may respond distinctively to the same event; their interpretations vary, leading to divergent emotions and behaviors.

For instance, a new opportunity might excite one person, prompting proactive planning, while another may feel anxious, leading them to withdraw.

By documenting your thoughts and feelings, you can uncover the underlying reasons for unwanted behaviors. This practice creates distance between you and your negative thoughts, enabling a clearer perspective.

In a CBT session, you might find yourself:

• Reflecting on your day and pinpointing cognitive distortions that contributed to feelings of anxiety or frustration. For example, you might realize that black-and-white thinking led you to blame a friend entirely for a conflict, helping you acknowledge shared responsibility in future situations.
• Gradually confronting fears by taking small, manageable steps.
• Conducting a thorough Cost-Benefit Analysis on beliefs or habits to assess their rationality and value.
• Learning to evaluate choices in a more balanced way, focusing on two options at a time.

Some CBT therapists may provide worksheets to help organize your thoughts and structure your therapeutic journey. For instance, a Decision-Making Form by psychiatrist David Burns can guide your evaluations.

If you think worksheets could be beneficial, consider exploring his book "Feeling Good."

Dialectical Behavioral Therapy (DBT)

DBT is a specific form of CBT. The term "dialectical" refers to the interplay of opposing forces, which this therapy seeks to harmonize. It's particularly effective for individuals dealing with trauma, PTSD, Bipolar Disorder, and BPD, as these conditions often involve extreme emotional fluctuations.

DBT aims to integrate these extremes, asserting that balanced decisions arise from a combination of logic and emotion. This balance is termed the Wise Mind:

This framework suggests that rational decisions may feel misaligned with our values, while emotional choices can be impulsive and regrettable. The goal is to find a middle ground.

DBT emphasizes factual analysis when grappling with difficult emotions. If acting on emotional impulses proves ineffective, one should consider performing the opposite action.

For instance, if job hunting leaves you feeling defeated, assess the facts. You might discover that your resume is impressive and you have supportive colleagues. Recognizing this can help you combat feelings of inadequacy. Instead of succumbing to despair, you could take proactive steps like going for a walk.

Another key component of DBT is the ability to observe, describe, and engage with our experiences in a factual manner. This skill helps alleviate anxiety and fosters a sense of presence.

Imagine missing a crucial goal in a soccer game. As anxiety and shame set in, you might hesitate to face your team. Instead, begin by observing your surroundings—what do you see, hear, or feel? This sensory focus grounds you in the present.

Next, describe the situation factually: you missed a shot, your team is supportive, and they want to celebrate together. This perspective helps you detach from overwhelming emotions.

Finally, choose to engage with your teammates, allowing yourself to remain present and uplifted.

In a DBT session, you might:

• Practice observing and describing emotions during moments of disconnection.
• Keep a daily record of your feelings and activities, assessing what positively or negatively impacts your mood.
• Utilize structured communication techniques like DEARMAN to enhance your ability to express needs effectively.

Acceptance and Commitment Therapy (ACT)

ACT encompasses more than just an appealing acronym. Its central tenet is to learn to remain in the present while accepting thoughts and emotions as they arise. It posits that emotions often lie beyond our control and advocates for letting them flow without judgment. Cultivating inner calm and truly experiencing ourselves fosters resilience against negative thoughts and feelings.

One visualization I find helpful is imagining yourself by a river in autumn, where each negative thought is a leaf drifting away. Instead of fixating on them, simply watch as they float down the river.

Acceptance extends beyond thoughts and emotions to include self-acceptance.

This philosophy fosters stress management, boosts self-esteem, and tackles anxiety.

ACT also encourages individuals to identify their core values—traits they hold most dear. This process often involves sifting through a list of adjectives to pinpoint a select few that resonate most deeply.

Once you identify your values and embrace your authentic self, it's crucial to prioritize which traits you want to embody and seek in others. Collaborating with your therapist, you can develop a structured plan for healing and progressing in alignment with your values.

This is the point at which you commit to self-improvement and follow through with actionable goals. Unlike other therapies, ACT offers a structured roadmap to guide your journey.

Another fundamental aspect of ACT involves cognitive fusion and defusion. Cognitive fusion occurs when individuals become entangled with their thoughts and emotions, which can be particularly harmful in cases of severe anxiety or depression. Those experiencing fusion may identify solely with their feelings, believing they are inherently flawed.

Cognitive defusion entails distancing oneself from these thoughts. In ACT, you might visualize stepping outside of a box and confronting fused thoughts. For example, a person who thinks, "I’m a loser," can reframe it as, "I’m someone who thinks they are a loser."

In an ACT session, you might:

• Complete worksheets to explore your core values.
• Engage in mindfulness practices, such as meditation and journaling, to stay present and embrace the uncontrollable aspects of life.
• Personify negative emotions, like Anxiety or Depression, and write letters to them, allowing for a healthier distance.
• Explore your identity, distinguishing it from your thoughts and emotions.

I hope this exploration of these therapeutic philosophies and principles proves beneficial. Has it inspired you to seek a therapist specializing in one of these CBT forms? If so, check out PsychologyToday’s therapist directory, which I find to be a reliable resource for finding professionals.

This article is the first in a series that will cover various therapy categories. In the coming weeks, I’ll write about therapies for trauma and expressive communication. If you enjoyed this piece, please share your thoughts to guide my future writings!