Chapter 1

Discovering How Thinking and Behavior Affect Emotions

IN THIS CHAPTER

Defining CBT

Exploring the power of meanings

Understanding how your thoughts lead to emotions and behaviors

Getting acquainted with the ABC formula

Cognitive behavioral therapy - more commonly referred to as CBT - focuses on the way people think and act to help them with their emotional and behavioral problems.

Many of the effective CBT practices discussed in this book should seem like common sense. In our opinion, CBT does have some straightforward and clear principles and is a largely sensible and practical approach to helping people overcome problems. However, human beings don't always act according to sensible principles, and most people find that simple solutions can be difficult to put into practice. CBT can harness your reason and good sense, helping you consistently think and act in a healthy and self-enhancing way.

In this chapter, we take you through the basic principles of CBT and show you how to use these principles to better understand yourself and your problems.

Understanding CBT

Cognitive behavioral therapy is a school of psychotherapy that aims to help people overcome their emotional problems.

• Cognitive means mental processes like thinking. The word cognitive refers to everything that goes on in your mind, including dreams, memories, images, thoughts, and attention.
• Behavior refers to everything that you do. This includes what you say, how you try to solve problems, how you act, and what you try to avoid. Behavior refers to both action and inaction. As an example, biting your tongue instead of speaking your mind is still a behavior even though you're trying not to do something.
• Therapy, in this context, is a word used to describe a systematic psychological approach to combating a problem, illness, or irregular condition.

A central concept in CBT is that you feel the way you think. Therefore, CBT works on the principle that you can live more happily and productively if you're thinking in healthy ways. This principle is a simple way of summing up CBT. We have many more details to share with you later in the book.

Combining science, philosophy, and behavior

CBT is a powerful treatment because it combines scientific, philosophical, and behavioral aspects into one comprehensive approach to understanding and overcoming common psychological problems.

• Getting scientific. CBT is scientific not only in the sense that it has been tested and developed through numerous scientific studies but also in the sense that it encourages clients to become more like scientists. For example, during CBT, you may develop the ability to treat your thoughts as theories and hunches about reality to be tested (what scientists call hypotheses) rather than as facts.

• Getting philosophical. CBT recognizes that people hold values and beliefs about themselves, the world, and other people. One of the aims of CBT is to help people develop flexible, nonextreme, and self-helping beliefs that support them in adapting to reality and pursuing their goals.

  Your problems aren't all just in your mind. Although CBT places great emphasis on thoughts and behavior as powerful areas to target for change and development, it also places your thoughts and behaviors within a context. CBT recognizes that you're influenced by what's going on around you and that your environment contributes toward the way you think, feel, and act. However, CBT maintains that you can make a difference in the way you feel by changing unhelpful ways of thinking and behaving - even if you can't change your environment. Incidentally, your environment in the context of CBT includes other people and the way they behave toward you. Your living situation, culture, workplace dynamics, and financial concerns are all features of your larger environment.

• Getting active. As the name suggests, CBT also strongly emphasizes behavior. Many CBT techniques involve changing the way you think and feel by modifying the way you behave. Examples include gradually becoming more active if you're depressed and lethargic, or facing your fears step by step if you're anxious. CBT also emphasizes where you focus your attention. Mental behaviors, such as worrying and chewing over negative events, can be helped by learning to focus your attention in a more helpful direction.

Progressing from problems to goals

A defining characteristic of CBT is that it gives you the tools to develop a focused approach. It aims to help you move from defined emotional and behavioral problems toward your goals of how you'd like to feel and behave. Thus, CBT is a goal-directed, systematic, problem-solving approach to emotional problems.

Using Scientifically Tested Methods

The effectiveness of CBT for various psychological problems has been researched more extensively than any other psychotherapeutic approach. CBT's reputation as a highly effective treatment is based on continued research. Several studies reveal that it's more effective than medication alone for the treatment of anxiety and depression. As a result of research like this, briefer and more intense treatment methods have been developed for particular anxiety disorders such as panic, anxiety in social settings, or feeling worried all the time.

As scientific research of CBT continues, more is being discovered about which aspects of the treatment are most useful for different types of people and which therapeutic interventions work best with different types of problems.

Research shows that people who have CBT for various types of problems - in particular, for anxiety and depression - stay well for longer. This means that people who have CBT relapse less often than those who have other forms of psychotherapy or take medication only. This positive result is likely due in part to the educational aspects of CBT: People who have CBT receive a lot of information that they can use to become their own therapists.

More and more physicians and psychiatrists refer their patients for CBT to help them overcome a wide range of problems with good results. These problems include the following:

• Addiction
• Anger problems
• Anxiety
• Body dysmorphic disorder
• Body image problems
• Chronic fatigue syndrome
• Chronic pain
• Depression
• Eating disorders
• Gender identity and sexuality issues
• Obsessive-compulsive disorder
• Panic disorder
• Personality disorders
• Phobias
• Post-traumatic stress disorder
• Psychotic disorders
• Relationship problems
• Social anxiety

We discuss many of the disorders in the preceding list in more depth throughout this book, but it's difficult to cover them all. Fortunately, you can apply the CBT skills and techniques in this book to most types of psychological difficulties, so give them a try whether or not your particular problem is specifically discussed.

Making the Thought-Feeling Link

Like many people, you may assume that if something happens to you, the event makes you feel a certain way. For example, if your partner treats you inconsiderately, you may conclude that they make you angry. You may further deduce that their inconsiderate behavior makes you behave in a particular manner, such as sulking or refusing to speak to them for hours - possibly even days; people can sulk for a very long time! We illustrate this common (but incorrect) causal relationship with the idea that "A causes C." In this equation, A stands for a real or actual event, such as being rejected or losing your job. It also stands for an activating event that may or may not have happened. It could be a prediction about the future, such as "I'm going to get fired," or a memory of a past rejection, such as "Hilary will dump me just like Judith did ten years ago." C stands for consequence, which means the way you feel and behave in response to an actual or activating event.

A (actual or activating event) causes C (emotional and behavioral consequence)

CBT encourages you to understand that your thinking or beliefs lie between the event and your ultimate feelings and actions. Your thoughts, your beliefs, and the meanings that you give to an event produce your emotional and behavioral responses.

So in CBT terms, your partner doesn't make you angry and sulky. Rather, your partner behaves inconsiderately, and you assign a meaning to their behavior such as "They're doing this deliberately to upset me, and they absolutely should not do this," thus making yourself angry and sulky. In the next formula, A × B = C, B stands for your beliefs about the event and the meanings you give to it.

A (actual or activating event) × B (beliefs and meanings about the event) = C (emotional and behavioral consequence)

This is the formula or equation that CBT uses to make sense of your emotional problems.

Emphasizing the...