Cognitive Behavioral TherapyColumbia, MD

Core Principles of CBT

The main idea behind CBT is that thoughts, feelings, and behavior impact each other and that replacing harmful thought patterns with more helpful ones will result in more positive feelings and behavior. The three basic principles of CBT are as follows:

Core beliefs

There are deep-rooted beliefs about how people view themselves, their environment, and their future. Childhood experiences inform these core beliefs.

Dysfunctional assumptions

Humans have a negative bias. They tend to give more emphasis to the negative than to the positive. This negative bias leads to irrational thought patterns that distort perceptions of reality.

Automatic negative thoughts

People have involuntary negative thoughts and perceptions that are difficult to recognize and lead to negative emotions. These automatic negative thoughts usually come in the form of cognitive distortions such as all-or-nothing statements and overgeneralizations. For example, thinking one is a failure for one mistake. These thoughts are often so ingrained and quick to trigger negative emotions that one does not even realize the thought is a distortion of reality.

Cognitive behavioral therapy helps patients identify their core beliefs, dysfunctional assumptions, and automatic negative thoughts so they can see the world more accurately, feel better and engage in more positive behaviors. Techniques psychiatrists use to help patients do this include:

• Cognitive restructuring. Becoming aware of negative thoughts so the patient can reframe them in a more positive way
• Guided discovery. Asking the patient questions that challenge the patient’s viewpoint to broaden their thinking
• Exposure therapy. Exposing the patient to their fears and phobias
• Journaling. The patient keeps a record of their thoughts each day
• Role-playing. Playing out difficult scenarios so patients can improve their problem-solving and communication skills
• Stress reduction. Breathing exercises and other relaxation techniques to ease anxiety

The above list is just a quick snapshot of some of the techniques CBT practitioners use. A psychiatrist will assess a patient's situation and match them with the tools and exercises that will be most helpful.

The CBT Process

The first session involving CBT is similar to most first psychiatry appointments. The intake or consultation is a chance for the patient to ensure the doctor is a good fit. Next, the patient will discuss their problems and give the psychiatrist a picture of their past and present emotional and physical health. Finally, the patient will talk about their goals and expectations for treatment.

The path toward reaching those goals is where CBT differs from other forms of therapy in that its steps involve dealing with the present through action rather than intensely analyzing a patient's past. The practitioner will take the patient through in-office exercises and assign homework aimed at taking the patient through the following steps:

1. Identify troubling situations. These tend to be the current issues in a person’s life causing them the most trouble, such as job loss, mental health disorder, grief, loss of a relationship, or financial concerns.
2. Awareness of thoughts, emotions, and beliefs about situations. Once the patient identifies the troubling situations, they share their thoughts on these situations with the mental health care provider. The patient may keep a journal of all the beliefs and thoughts they hold about their troubles.
3. Identify negative or inaccurate thinking. Next, the practitioner will ask the patient to pay attention to their emotional and behavioral responses to different situations to help the patient realize the thinking and behavior patterns that may be contributing to their troubles.
4. Reshape negative or inaccurate thinking. Finally, the psychiatrist will help the patient realize which beliefs are inaccurate and tainting their perception of reality. Though this step can be difficult, it can help the patient realize where their thinking is unhelpful so they can replace it with more accurate and helpful thinking. This practice should lead to the patient making more healthy decisions.