Cognitive Behavioral Therapy (CBT) is considered to be the first-line treatment for most psychological conditions. Despite its widespread use and proven efficacy, however, CBT can still be highly misunderstood. When many people think of CBT, they automatically jump to the concept of "thought challenging." However, this view is overly simplistic and fails to capture the true essence of the therapy.
It is true that CBT assumes that between a situation and a distressing emotion is someone's interpretation. However, it also looks at other determinants such as predisposing factors, precipitants, intrinsic and extrinsic reinforcers, and early childhood experiences that shape our core beliefs and the meaning we make of things that happen to us. CBT is not about challenging someone's thoughts; instead, it is about helping individuals explore more adaptive perspectives when they are in distress.
The term "thought challenging" can be problematic, as it suggests that CBT assumes that the problem is only with the person's perspectives. In reality, if we were approaching therapy with this perspective, we would be likely be at risk of damaging the therapeutic relationship and hindering progress. Through the use of Socratic questioning, CBT aims to help individuals develop more adaptive perspectives and build skills to cope with psychological distress. Therapists are never assuming that clients' thoughts are invalid; rather, they assist their clients through a process of guided discovery to determine whether there are other more balanced perspectives they could be taking. Furthermore, therapists guide clients to recognize their own internal resourcefulness and ability to problem-solve when appropriate.
One common question that arises in discussions about CBT is: "But what if a client's thoughts are true? What then?" This question highlights some of the misconceptions about CBT and the assumption that it is solely about changing someone's thinking. In reality, there are several ways that CBT can approach thoughts that are reflective of reality:
1) Help the client problem-solve the things that are within their control while giving them the tools to deal with uncomfortable emotions. For example, a client may be distressed about an upcoming job interview. A CBT therapist may help the client identify specific steps they can take to prepare for the interview, such as researching the company and practicing common interview questions. The therapist may also provide tools to help the client manage their anxiety, such as emotional regulation strategies.
2) Investigate any potential invalid conclusions that the client may have made about their reality that could be contributing to or exacerbating their distress. For example, a client who has recently had a fight with their friend after something they regret saying. While their thoughts may be reflective of reality, such as "I shouldn't have said _____, that was unkind." The invalid conclusions that they have made such as "This makes me a terrible person. I am not worthy of this friendship. I am a failure," could still be investigated for its validity. A therapist may work with the client to examine the evidence for and against this belief, and help them develop a more balanced perspective about themselves.
3) Lastly, CBT can help individuals move towards a place of acceptance over that which is uncontrollable in their lives. It is important to note that the above approaches may not always be applicable. In some cases, a client's distress may be entirely justified, and their thoughts may accurately reflect their situation. In these cases, CBT can still be helpful by providing tools to help the client manage their distress and build resilience. For example, a client who is grieving the loss of a loved one may benefit from learning coping strategies such as self-care, mindfulness, and acceptance based strategies to sit with their grief. Sometimes, people just need a safe space to be heard, validated, provided empathy, and unconditional positive regard, and CBT can provide all those things. In conclusion, Cognitive Behavioral Therapy (CBT) is a powerful tool for helping individuals cope with psychological distress. However, it is important to understand that CBT is not just about thought challenging, but rather a collaborative and exploratory process that aims to help individuals develop more adaptive perspectives and build skills to cope with difficult emotions.
By recognising the many determinants of psychological distress, including early childhood experiences, predisposing factors, precipitants, intrinsic and extrinsic reinforcers, and current stressors, CBT practitioners can better understand and guide their clients towards more adaptive coping strategies. And even when a client's thoughts may reflect reality, CBT offers several approaches, such as problem-solving and acceptance, to help individuals move towards a healthier and happier life.
For those who are interested in learning more about CBT, I am offering extensive training through an online all-day professional development workshop in May. It is worth 8 hours of CPD and I hope to help you gain a deeper understanding of CBT and how it can be applied to your practice. You can learn more about that here.