Cognitive Behavioral Therapy
What is CBT (Cognitive Behavioral Therapy) and how can it help with the treatment of depression, anxiety, or PTSD?
Cognitive Behavioral Therapy happens when a trained therapist provides education to a client about the ways that negative thoughts (cognitive distortions) influence mood. The therapist also helps provide education about the way negative mood influences behavior. When we look at the full cycle, we also begin to recognize how behavior influences thinking and mood. The three factors of thoughts, mood, and behavior are often influencing each other. People can feel stuck if they do not understand how to get out of negative
Unfortunately, people can feel stuck if they do not understand how to get out of negative mood cycle. Feeling better is not as easy as wishing things would be different. After beginning CBT with a skilled therapist, clients start to better understand their patterns of negative thinking (cognitive distortions). They get more clear about what types of negative thoughts lead to negative moods. In time, they can also learn to challenge these negative thoughts and choose better coping skills, which improves their mood.
Building Trust with Your Therapist
It is essential that clients feel heard and understood by their therapist. We believe this starts at the beginning, so we make every effort to match clients with a therapist who has experience in treating the types of concerns that are distressing the client. If possible, we will also match clients with a therapist who understands their culture and background. It can be really hard to let your defenses down and ask for help. However, if you feel understood it can be so much easier. Trust is continually tested and earned throughout the therapy process.
Many times clients who seek therapy may have been told by others that they need to change in a way that makes them feel bad about themselves. This kind of feedback naturally makes people feel defensive and resistant. Therapy has to feel different. Our therapists take judgment and shame out of the equation. When clients feel supported, it can be a lot easier for them to make changes.
Rapport with the therapist is essential during this process. Our therapists understand that letting go of old ways of thinking about stressors is hard. Throughout the process of challenging cognitive distortions, the therapist is carefully monitoring the client’s responses. They also make sure that they are not pushing too hard, too fast, or challenging negative beliefs that actually feel true. The changes must feel right and real to truly have a positive impact on the client’s symptoms.
Gaining Objectivity by Learning to Take a Step Back
A big part of Cognitive Behavioral Therapy is learning to zoom out and get more objective about difficult situations. “Just because you think or feel it doesn’t mean it is true”- this approach is about recognizing and challenging emotional reasoning. This approach is not about invalidating clients, or thinking that every bad mood can be solved by simply “being positive”. It is about helping people see difficult situations differently and getting unstuck by decreasing the impact of emotional reasoning.
Learning to Recognize Behavior Patterns
Another key part of CBT involves recognizing behavioral patterns. As the clinician and client explore client responses to difficult situations together, the clinician also helps the client recognize the ways they have been coping with negative feelings that are not working. As well as helping the client identify different ways of coping.
Now the client is becoming more empowered as they have a full understanding of these cycles, and what parts of the cycle they can change. The client recognizes that they have options and choices. The client begins to feel unstuck. They realize they don’t have to keep dealing with problems the same way all of the time and are no longer feeling stuck and hopeless.
Let’s look at an example of a common type of client complaint that can be addressed with Cognitive Behavioral Therapy:
It Often Starts with Making Assumptions
Efren gets a new job and is feeling insecure about his performance. He is not getting feedback from his boss, and he assumes that he is not doing a good job. His parents were often critical when he was growing up and did not tend to praise him when he had done something well. So he has a core negative belief about himself, “I am a failure.” When things are uncertain, Efren, like many of us, tends to make assumptions based off of previous experiences.
The Cycle of Negative Thoughts, Depressed Mood, and Poor Coping
If Efren thinks that he is not doing a good job, Efren feels discouraged and hopeless. When he feels discouraged and hopeless, Efren tends to shut down; he avoids his boss and co-workers, overthinks things, and procrastinates on his work. This pattern of behavior leads to diminished performance and the cycle continues.
Now Efren is beginning to experience anxiety, in addition to depression. Efren is expecting that if he hears from his boss, it is going to be negative feedback because he knows he hasn’t been working very efficiently. He feels frustrated with himself for not doing more, and resentful of his boss for expecting so much from him.
Efren starts to fear that he will never get out of this cycle and he will get fired. He might even start to call off of work because of a desire to avoid his anxiety and then he falls even farther behind. The truth is that if this cycle continues, Efren might get fired or quit his job because of his negative thinking, but this type of outcome is often avoidable.
How could this scenario play out differently with the support of a therapist?
Starting Treatment with a CBT Therapist
Efren starts Cognitive Behavioral Therapy with chief complaints of depression, low self-esteem, and struggles with his work performance. During the assessment, his therapist notices that Efren reported that his parents were often critical and did not give much positive feedback, so it makes sense that Efren often assumes the worst about himself.
The therapist also notices that Efren seems especially sensitive to criticism, and he tends to assume that others are thinking negatively about him, even when there is no evidence to support this conclusion. The therapist also picks up on behavioral patterns of overthinking and avoidance.
After educating Efren about cognitive distortions, the therapist shares their insights about Efren’s negative thinking patterns and ineffective behavioral patterns.
Identifying Different Ways of Thinking
Efren’s therapist starts with helping him identify different ways of thinking about his lack of feedback from his boss.
*It is possible Efren’s boss is not saying anything about Efren’s performance because everything is mostly OK.
*Efren’s boss may not be used to giving feedback when things are going well, and instead is focused on fixing problems. This issue doesn’t have anything to do with Efren personally.
*Maybe Efren’s boss is just busy and hasn’t had a chance to evaluate Efren’s performance.
Efren’s therapist helps Efren recognize that instead of assuming the worst and shutting down, it would be more helpful to approach his boss to talk about his performance.
Applying What Is Learned in Therapy
Efren and his boss schedule a time to discuss his performance and he gets some positive feedback, as well as some areas that he could improve on. Efren’s therapist helps him see that having areas that need improvement does not mean that Efren is not doing a good job, it just means that he started a new job and having a learning curve is normal. Efren starts to see what he is doing well, and also starts to get less defensive about the areas of his performance that need improvement.
Through this experience, Efren learns that it is better to gather valid information than to assume the worst is true in all scenarios. Efren has also learned some effective communication techniques, and has learned to be more proactive about approaching a boss when he is feeling unsure.
Positive Outcomes From working with a CBT Therapist
Efren learns even if feedback is not 100% positive, that does not mean he is a failure. By starting the conversation about his needs, Efren develops a better relationship with his boss and co-workers. Efren’s boss appreciates that Efren spoke up about his concerns and has been responsive to the feedback given. Efren feels empowered to address challenging situations and ends up being more successful in his career in the long run.
Because Efren is losing less time to negative coping patterns such as avoidance and overthinking, he has more time to engage in healthy coping skills, such as exercise, or participating in activities he really enjoys. Efren spends more time with peers, and coming into these interactions with improved self-esteem helps Efren be more outgoing. Efren is no longer isolating, and instead is building a positive peer support network.
What about when negative thoughts are not actually cognitive distortions?
The reality is that negative experiences are part of our world, and not every negative thought is a cognitive distortion. We often hear from clients who are trying hard to manage their mood by thinking positively, but then confess that they feel like they are gaslighting themselves . While our therapists are motivated to help clients find a positive outcome, we also recognize the value in holding space for negative emotions.
We understand that pushing for a positive outcome too quickly can sometimes be counter-productive. For some people, finding a space to talk through and get validation of their negative feelings is a very important step in their recovery, and this part of the process cannot be skipped over.
Distinguish the Difference Between Fact and Fiction
A skilled counselor trained in Cognitive Behavioral Therapy can help clients distinguish when the reality of a situation may have some negative truth to it. However, even in these situations, cognitive behavioral therapy can still be helpful when the therapist recognizes and validates the client’s negative feelings. Sometimes even when a negative thought may be true, it may be partially true and not completely true. Or, the negative thought may be true sometimes but not all of the time.
Even if a client’s negative thought about a situation is grounded in reality, therapists can help clients recognize the ways they are responding to this unfortunate truth, and make some decisions about if these responses are helpful or not. If the current responses are not helpful, a therapist can help the client figure out different responses that might bring a different outcome. Recognizing what you are in control of and what you are not in control of is key.
What if a client is already aware of cognitive distortions, is already using healthy coping skills, and is still feeling depressed?
Cognitive Behavioral Therapy is a great therapeutic modality, but it is not right for everyone. Some other evidence-based strategies utilized by Shift Counseling, PC therapists include Acceptance and Commitment Therapy (ACT), Mindfulness, and EMDR therapy.
ACT and Mindfulness can be helpful when a client chooses to address their depression by accepting current challenges, recognizing that these challenges are temporary, practicing staying in the current moment, and learning to be more compassionate with themselves and others. Saima Shaik is trained in ACT therapy and Mindfulness.
EMDR therapy can help when depression is a part of the client’s experience of PTSD or when it is the result of “little t” trauma (trauma that does not involve intense, acute, life-threatening experiences, but instead involves chronic struggles such as relational issues, chronic health issues, etc.) EMDR therapy can help people identify and process unresolved “little t” trauma that may be contributing to symptoms of depression. Our EMDR trained therapists are Noel Cordova and Rebecca Malley Fitzgerald.
Begin Counseling with a CBT Therapist Near Chicago
Getting started with a CBT therapist is easy. Our North Riverside, IL counseling practice is convenient to multiple areas of Chicagoland including Riverside, La Grange Park, Brookfield, Broadview, and more. If you’re ready to begin, simply follow these steps:
- Reach out to schedule an initial therapy consultation.
- Begin working with a skilled, depression therapist.
- Take back your life and thrive!
Other Services Offered Near Chicago, IL
Shift Counseling, PC specializes in treating young adults with mental health concerns with a variety of techniques. We offer PTSD and Trauma Therapy, Young Adult Focused Therapy, and Anxiety Therapy online or in person.