Everything I learned from Cognitive Behavioral Therapy and how You can use it

By TTorn

The first thing you learn in Cognitive behavioral therapy is that thoughts trigger feelings. You can read more about that here (I am not affiliated with this website I just found it useful) –http://www.allaboutdepression.com/workshops/CBT_Workshop/CBT_05.html

Cognitive Behavioral Therapy, or CBT teaches you how to challenge your thoughts and change them. Alleviating fear associations over time, as well as what is called automatic thinking time.

Thought challenging – This is that part of cognitive behavioral therapy where you learn how to proactively break down your anxious thoughts and come up with more realistic and helpful thoughts. This is the Cognitive part in Cognitive Behavioral Therapy

.Automatic thoughts

Some example of anxious automatic thoughts.

They will think I’m weird
They won’t want to talk to me
I will embarrass myself
They will know I am anxious
I will make it worse
I will make it awkward
I don’t know what to say
They will judge me
No one likes me
I can’t do this

Possible thinking errors

Personalization – when you blame yourself or feel overly responsible
All or nothing thinking – where you see things as either a success or failure “perfectionism”
Should statement – you emotionally guilt yourself into motivating yourself to do something
Catastrophizing – assuming the worst case scenario to be true
Fortune telling – anticipating that things will turn out badly
Ignoring positives – focusing on the negative and ignoring any success

Questions to ask yourself to help challenge your automatic thoughts.

What thinking errors am I making?
Is there another explanation for what happened?
Am I 100% sure my thought is true?
What facts don’t support my anxious thought?
What would I say to a friend in my situation asking for advice?

Then incorporate those challenges into an alternative more helpful thought.

example: Automatic thought – I won’t know what to say.
Thinking errors – catastrophizing

List all the ways you can think of that challenge this thought –

I have lot of things to say sometimes, sometimes people like my random facts. I don’t have to be the only one to talk in a conversation.
More helpful thought – I can think of ways to contribute to conversations and if I can’t think of anything that’s ok too, I’ll survive.

As you practice this more you will get more and more at ease with recognizing thinking errors and challenging them to turn them into more healthy productive thoughts.

Exposure Therapy

Exposure therapy is currently known to be the most effective tool for overcoming social anxiety. It’s the Behavior part of CBT. It is called exposure therapy because it involves gradually exposing yourself to situations that lead to you feeling anxious. When I first heard about it I thought that it sounded impossible, at first it sounded like it meant that I had to just go do things and just deal with the stress. That is not what this is and that is something that would most likely not work, or may even exacerbate the anxiety.

But then I learned more. I learned that the reason that it works is it’s gradual. You start with things that are challenging to your social anxiety, but still doable, working gradually through the goals and changing the way you think slowly and effectively. The other thing to keep in mind about exposure therapy that helps it feel less overwhelming is knowing is that it is controlled because it is self initiated. Meaning you choose when and where it happens.

Setting controllable goals that will help you measure progress and learn from each exercise. This is where you will practice everything discussed about automatic thoughts, basically practicing new cognitive skills.

Your exposure should should not be subjective, it should be visible to anyone present. Try not to include fears or feelings as part of the exposure goal. The goal isn’t to control how you feel but what you do. You can’t control how you feel but you can control what you do. Try not to repeat goals, it may be less effective to combine many situations into one ongoing exposure goal. Remember you should be giving yourself credit for each individual exposure goal set and met, even if you feel anxiety when doing them.

Most of us learn from experience. As you set goals for yourself and complete exposures your body and mind will begin to have vital and liberating realizations about previously feared situations

The bad outcome rarely happens.
Even if it does you can survive it.

The most effective exposure exercises are:

start gradually and work up from low to medium to higher difficulties.
ones that you can make them happen within the 48 hrs of setting the goal.
self initiated/controlled behavioral goal
have an observable goal

Proper examples of exposure exercises:

Ask a barista a question about coffee.
State my opinion at tomorrow’s meeting.
Text a friend.
Start a conversation with someone new.

These are good exposure exercises because they can be enacted within 48 hrs and you control when it happens.

Improper exposure therapy examples

When I am asked a question by a roommate I will ask them how their day is.
Share an opinion and feel confident.
Say something funny to the barista.
Stay somewhere for 1 hour when invited.

These are improper examples because they are not self initiated, they involve controlling how you feel, and/or can not be sure to take place within 48 hrs.

Here is what a basic exposure therapy exercise looks like. As you do this over and over it eventually becomes easier and easier.

Exposure therapy exercise –

Exposure Plan –Write out what and when you plan to do as your exposure – (example – ask someone to coffee) Note CBT research has shown that events that are planned in detail are much more likely to be completed.

Now take it one step further and include a backup plan in case something does not go as planned (example – if the exposure is asking someone to coffee but they turn out to be busy, what do you do?)

Behavioral Goal – (example– ask at least one question to the friend while having coffee)

Automatic Thought- (example- they will will know I’m anxious. I don’t know what to say.)

Thinking Errors- (example- catastrophizing, fortune telling)

Alternative Thought-(example- It’s ok if they know I’m anxious I will still be ok, I can think of things to say, I enjoy talking to people, and have a lot of opinions on things to share.

Core Beliefs

Core beliefs are deeper central thoughts that can contribute to your feelings of anxiety. These are often long held assumptions of one’s self. (example- I am unlovable, I am a screw up, I don’t belong, I’m getting what I deserve, I don’t matter, I am boring, I am incompetent, I will always be rejected, the world is a dangerous place)

These beliefs often are the underlying cause of a number of anxious thoughts or situations. Recognizing and directly challenging these core beliefs can help exponentially alleviate anxiety.

One technique I have learned to helping to uncover a core belief is called a downward exercise. This is where you ask yourself one of two questions.

what does it mean
what does it say about me

This will generate a new anxious thought. You repeat the exercise until you reach the core belief.

example – If you are anxious because your friends went to a party but they did not invite you, an automatic thought may be “My friends don’t like me enough”)

– what does it mean? “something is wrong with me”
– what does it say about me? “I may never be able to have real lasting friendships”
-what does that mean “I am unlovable”

The core belief being “I am unlovable”

Now challenge the core belief as you would any negative thoughts

List all evidence that contradicts this core belief
example – people have invited me to things in the past. I have friends. I’ve had long friendships. I’ve had good relationships.

Now incorporate this into a new more helpful belief.
example – I am lovable.