Our thoughts have a major impact on the way we feel, way more than you might imagine. The thing is, we’re so used to the chatter that’s happening inside of our heads 24/7 that it often goes unchecked and unnoticed. This does not, however, mean that these thoughts are without impact. Without even realizing it, these thoughts determine the type of activities we engage in, what we say and don’t say, how we interact with others, and ultimately, serve to shape our feelings and behaviors.
Cognitive-behavioral therapy, or CBT, was developed by Aaron Beck in the 1960s when he was working as a psychiatrist at the University of Pennsylvania. Beck had been trained in psychoanalysis (the classical Freudian method of therapy involving accessing the patient’s unconscious that has since fallen out of favor in most modern circles) and he was involved in running experiments to test the efficacy of psychoanalysis as a treatment for depression. When these experiments did not show that the psychoanalytic model he had been using was an effective treatment, Beck began to try to find other ways to conceptualize depression through talking to his patients and identifying common factors. Through this method, CBT was born.
Research on the effectiveness of CBT has shown to be useful in the treatment of a wide range of diagnoses, including anxiety disorders, body dysmorphic disorder, depression, eating disorders, chronic pain, personality disorders, psychosis, schizophrenia, and substance use disorders, among others. It has been shown to be particularly useful for anxiety disorders, which involves thoughts that are often catastrophic in nature and tend to be inaccurate or negatively biased.
The Link Between Thoughts, Feelings, and Behaviors
An example I like to give in session to illustrate the link between thoughts, feelings, and behaviors is as follows: Imagine that you have the day off from work and you need to take the bus to run some errands that day. As you are walking to the bus stop, you turn the corner just as you see the bus pulling away from the stop, and you miss the bus. You think to yourself, “Of course I missed the bus. I’m such an idiot. I can’t do anything right!” How might you feel in this situation? Most people answer that they would probably feel sad, angry, disappointed, frustrated, stupid, or some combination of all of these. Given these thoughts and feelings, some possible behaviors (depending on other factors like coping style and personality) might be to say that the day is ruined and return home to stew in bed and beat yourself up. Or, if you do choose to wait for the next bus and continue on with your errands, you will likely carry those feelings of sadness, anger, and frustration with you throughout the day and they will color your thoughts going forward, perpetuating the cycle of negative thinking that leads to negative feelings and behaviors.
Now, imagine the same scenario, but this time when you realize that you missed the bus, you think to yourself “That’s a bummer. Oh well, the next bus comes in 15 minutes, I’ll just listen to my podcast while I wait.” What kinds of feelings might arise based on these thoughts? Most people say that they would probably feel irritated at worst, and probably neutral at best. The point is, they feel substantially less upset based on these kinds of thoughts than in the previous scenario. Based on these thoughts and feelings, the likely behavioral outcome is that you would wait for the next bus and carry on with your day without much further impact.
The Cognitive Triad: Self, Others, and the Future
CBT posits that when people are struggling or consistently find themselves in a negative mood-state, three factors are at play. These make up the cognitive triad: negative views about the self, others/the world, and the future. For example, someone who is depressed may think “I’m worthless. Other people don’t care about me. Things will never get better.” Therefore, in treating depression, each of these three areas would be targeted in order to challenge the negative thoughts and replace them with more adaptive and accurate ones. A more realistic thought about the self may look like “I’m struggling right now, but my mental health does not determine my worth as a person.”
Automatic Negative Thoughts (or ANTS)
Automatic negative thoughts are those thoughts that pop into our head right away and tend to skew toward the negative about any aspect of the triad (the self, others, and the future). These kinds of thoughts are very common, especially in the list of diagnoses mentioned earlier for which CBT is an effective treatment. Whether the ANT is about yourself (“I’m an idiot”), your body “I’m so fat”) a situation (“This is going to be terrible”), or something else, a very important part of CBT involves raising awareness of these thoughts so that they can be challenged and replaced with more accurate (which in many cases often means more positive) thoughts.
Cognitive distortions, also known as unhelpful thinking styles, are specific, distorted ways in which we see the world. Even people without depression or anxiety fall victim to these kinds of thinking styles; the most common one I see is black or white thinking, were the individual perceives something to be all or nothing with no in-between. For example, they think that either they must be perfect and get an A on the test, or that they are a total failure. It’s very important to raise awareness of and catch ourselves engaging in these kinds of thinking styles, so that we can recognize when our thinking is inaccurate and leading us to feel inaccurately negative as a result. For more information about specific cognitive distortions, check out a previous blog that I wrote here: https://integratedcareclinic.com/blog/cognitive-distortions/
Core beliefs are strongly held assumptions about the three facets of the triad mentioned above that are often learned in early childhood and that color and shape our experiences every day. For example, a core belief that someone might hold about themselves is “I am unlovable.” Even if this person is in a healthy and loving relationship, the affection and proof of another’s love that this individual receives will not be enough to challenge this core belief learned so early on. Rather, cognitive behavioral therapy helps us become aware of the core beliefs we hold so that we can allow them to change and shift in the presence of new information, rather than simply overlooking or disbelieving any evidence to the contrary.
Examining the Evidence
The crux of CBT, after learning about all of the other aspects and raising awareness of our thoughts and distorted thinking, is learning how to challenge these thoughts by examining the evidence. To do this, I often use a thought record, which is a worksheet with different columns to be filled in for each ANT we want to challenge. First, record one single ANT. Next, write down all of the emotions associated with that ANT and rate them on a 1-10 scale of intensity. Now, here’s the fun part: we’re going to examine the evidence both for the ANT and against the ANT. I think this is the fun part because in my experience, when we finally make it to the part where patients try to think of evidence that supports their ANT, they often struggle to even find a single piece of evidence. It is often much easier for people to come up with evidence that does not support the ANT, which is exactly why the thought record is helpful: when you really break it down, the negative things we tell ourselves often don’t have a strong basis in reality. After you’ve examined the evidence on both sides, you use this evidence to generate a more realistic alternative thought based on evidence. Once you have your alternative thought, you re-rate the emotions you listed previously on the same 1-10 scale. Frequently, people’s ratings of their thoughts go down by at least a few points when they’re basing them off of the alternative thought, rather than the ANT.
Putting Thoughts to the Test
After these foundational principles of CBT have been taught and understood, it’s time to design and run some behavioral experiments! When someone’s negative thoughts have been dictating their behaviors and feelings for so long, it is usually the case that that individual has avoided situations or circumstances that might allow for disconfirming evidence to occur. For example, if someone views themselves as socially awkward and thus avoids parties and social gatherings, then they are hindering any opportunity to engage in new experiences that might disconfirm this thought. This is where our tests come in: collaboratively with the client, we will jointly decide on some situations that the client will participate in order to take their thoughts on a test drive. This might mean doing things you haven’t done in a while- or maybe ever- and it could be uncomfortable. If clients are hesitant to try out new behaviors, I remind them of a quote I really love in a therapy context: In order to get something you’ve never had, you’ll have to do things you’ve never done! Additionally, this time when you enter a situation that used to be a landmine for negative thoughts, you’ll have a handy toolbox to use to be able to combat those pesky ANTS and distortions.
CBT in St. Petersburg, FL
If you live somewhere as awesome as Saint Petersburg, Florida, there are LOTS of opportunities to get out there, challenge your negative beliefs, and run some behavioral experiments! Living in St. Pete means that on any given day (weekday or weekend), something fun, interesting, or unusual is going on! Before moving to St. Pete, I had no idea that one place could offer such a variety of activities. From a trendy art scene to cool parks and trails, to being super pet-friendly, there is something for everyone right in our own back yard. Feel like you’re struggling with ANTS and cognitive distortions? Pick an activity that is within your comfort zone to put some of these distorted thoughts to the test.
Because there are so many events happening, you can customize your experience! For example, if you’re struggling with feeling incompetent, pick an activity that is within your wheelhouse. For one person, that might be going to a make-and-take craft event, and for others that might be playing a game of giant Jenga at Park and Rec. If you’re having thoughts about doubting your ability to connect with others, attend an activity where social discourse is encouraged and facilitated, like going on any number of the walking tours offered in St. Pete where you have easy conversation starters built into the tour, or go to the Dog Bar, where friendly dog owners would love to chat with you about their furry kids! As the old adage goes, watching cute animals play is as socially lubricating as alcohol! (OK, I made that up, but I do really believe it!)
After you’ve gained some mastery over catching your ANTS and challenging your distorted thoughts, it might be time to up the ante and push a bit farther out of your comfort zone to truly put your thoughts to the test. If you feel like it’s been a while since you’ve challenged yourself to try anything new, you could start with something easy and low-pressure, like signing up for a guided kayak tour at Clam Bayou. Feeling more adventurous? You could try going to a free improv jam at Spitfire theater, where audience members are taught how to play short improv games and get to try them out in a supportive, encouraging atmosphere. After all, it’s hard to have an automatic negative thought disrupt you while you’re having to think on your feet!
Don’t forget the regular monthly events you could go to in St. Pete, like First Fridays downtown, Second Saturday Artwalks where you can take a free trolley to galleries around the city, and the Saturday morning market (in Williams Park for the summer!) The point is, there are SO many opportunities for growth and fun in our vibrant city; if one of the things holding you back from trying them out is your negative thoughts about yourself, others, or the world, I would highly encourage you to try cognitive behavioral therapy to help challenge and correct this type of thinking.
Dos and Don’ts
Remember, when you’re learning anything new, the process takes time. Once you become more aware of your thoughts and how they impact other areas of your life, it can be tempting to beat yourself up for slip-ups or catching yourself engaging in unhelpful thinking. This just simply adds an additional layer of negative thoughts to the existing ones!
DO remember to be kind to yourself through this process of retraining your brain. If you notice yourself engaging in negative thinking styles, simply notice this, and redirect yourself to use your new skills.
DON’T judge yourself harshly for engaging in the old behaviors. Changing habits of any sort, and particularly cognitive habits of thinking that you were likely unaware of before, takes time and effort. It is not going to happen overnight, therefore…
DO have reasonable expectations of yourself. Be prepared for challenges, or the fact that using your skills might not be totally successful at the beginning. This is normal and OK!
DON’T feel like you have to do this alone. If you have someone if your life who you are comfortable sharing with, let them know that you’re working on challenging your thoughts. That way you can have additional support outside of therapy, and an additional set of ears to listen for any thinking errors that might come up for you!
Wrapping It Up
Going to any of the events mentioned above with a brain full of self-defeating, inaccurate, and negatively biased thoughts are enough to take what would otherwise be a pleasurable experience into one that only serves to reinforce our existing thoughts. This kind of headspace could turn an innocuous glance in your direction into a spiral of fears that someone was judging you, or found you unattractive, or was upset or offended by something you did. Using the tools in your CBT toolbox, in my view, allows you to take off the “dark-tinted glasses” that come with depression, anxiety, and other disorders and take in a more realistic, accurate picture of a situation. It is my hope that each and every person learns to recognize the fundamental truth underlying cognitive behavioral therapy: just because we think it, doesn’t mean it’s true! Thoughts have as much or as little power as we give them and can be used for good or for evil. Choose to use yours to boost yourself up by giving us a call today to schedule an appointment with a cognitive-behavioral therapist!