When we hear about cognitive behavioral therapy (CBT), it’s often in reference to treatment for a specific disorder, such as Generalized Anxiety Disorder (GAD) or Obsessive-Compulsive Disorder (OCD). For years, research has provided evidence that CBT is extremely effective in treating many disorders. Although it’s important to have and utilize evidence-based treatments for disorders, what some might overlook is the effectiveness of CBT in non-disordered situations.
The basic principle of CBT is that our thoughts, emotions, and behaviors are interconnected, and by altering the way we think or behave (since we can’t directly change our emotional state), we can shift the other two as well. It sounds simple enough, but the actual doing takes effort. Patients learn about thinking errors (sometimes called thinking traps or cognitive distortions), which are ways of thinking about a person or situation that aren’t helpful. Common thinking errors include all-or-nothing thinking, sometimes called black-and-white thinking (“You’re always late” or “I never get anything right”), mind reading (“I know what they’re going to say”), and “should-ing” or “must-ing” (“I should go to the gym” or “I must never lose my cool”).
Recently, a patient and I were discussing a large home project she has to complete. She was focusing on the significant time demands of this project and how it seemed regardless of the time and effort she put in, it would “never” be completed. These thoughts led her to feelings of guilt, disappointment, and failure. In response to this way of thinking and those negative emotions, she avoided the project completely, making this her only behavior in the situation.
Reid Wilson, PhD, talks and has written about the “anxious moment,” wherein we embrace doubt and discomfort. Rather than respond with fear, Dr. Wilson asks us to consider what benefits we can gain from not just managing these anxious moments as they arise, but actually seek them out while simultaneously having a conflicting perspective. This allows our attitude to shift from defensive to aggressively wanting the anxious moment.
When the patient initially told me about her home project, she reeled off every necessary task. I watched her expression shift to hopelessness and dejection. I asked her to step back from the individual items and explain the goal of the work – not the steps or the details, but the goal. She paused and after a few minutes of thinking had her goal. It was logical and reasonable with legitimate payoffs once completed, meaning her thinking was on-point. I asked her what emotions she anticipated experiencing at the conclusion of the project, and as she said accomplished, lighter, less stressed, I watched a smile appear. I pointed that out to her, and explained that the behavior of her smiling was the result of her thinking differently, which focused her emotions, resulting in that smile.
Now we needed to replicate this on a smaller level.
We broke down the project into smaller tasks based on rooms, and scheduled small amounts of time to complete each task. Working on a task for 15 minutes on a weekday evening seemed manageable, and the structured schedule changed the behavioral goal from an overwhelming project to achievable tasks. Over the next few weeks she progressed further than she had in the past year, and she felt proud. So, by changing the way she cognitively approached the situation, her emotions and behaviors changed as well.
Implementation of CBT in daily life has limitless options. From losing weight to making new friends to saving money for a vacation, the situation doesn’t need to change for success to occur – we only need to change the way we approach, or think, about it.