How CBT Can Help Address Negative Thought Patterns
Let’s explore the psychotherapies CBT, DBT, and ACT and what they can do for us and our chaotic minds
Do you find yourself lost in an endless cycle of negative rumination? Is your inner voice incredibly self-critical? Do you struggle to identify and express your emotions? Do you have intrusive thoughts you wish you could manage better?
Then perhaps you could benefit from Cognitive Behavioral Therapy (CBT)!
Many people who seek therapy try only one, you know the one, the “How does that make you feel?” type. CBT is a very different type of therapy that focuses on actionable steps we can take to help us overcome unhelpful thinking patterns.
There are actually many types of CBT, but today we’ll be looking at three.
To be clear, I am not a mental health professional. This article represents my own perspective on therapy after exploring 11 forms of therapy as a patient as well as an avid reader who has read dozens of books about therapy and disorders.
Please refer to a real mental health professional for more information and to see which therapy is right for you!
Now with that out of the way…
Fundamentals
To understand Cognitive Behavioral Therapies as a category, we’re going to have to learn about cognitive distortions. Many disorders such as Borderline Personality Disorder (BPD), Bipolar Disorder (BD), Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), and Attention-Deficit/Hyperactivity Disorder (ADHD) suffer greatly from cognitive distortions.
One of the main goals of CBT is to identify and dispel cognitive distortions.
Here are examples of a few very common ones:
- Black-and-white thinking. Believing that things or people are either all good, or all bad. For example, if you have this distortion, you might think your partner doesn’t care about the relationship and is purposefully trying to spite you after they arrive late on date night. However later, you quickly change your tune and believe your partner is the best thing that ever happened to you after they give you a gift.
- Personalization. Believing that you are to blame for matters that are not connected to you. Maybe you have a friend who is chronically depressed and you decide to meet them for lunch. At the end of your hang, your friend leaves still feeling depressed. If you have this distortion, you might feel personally responsible for not being able to cheer them up despite their chronic condition.
- Negative Bias. Discounting positives and emphasizing negatives. If you experience this distortion, instead of celebrating after you get a promotion, you might remember all the mistakes you made at work in the last year. You feel as though you don’t deserve your promotion or that your boss must have forgotten about your perceived poor performance.
These are just a small sample of the types of cognitive distortions the following psychotherapies address. To see a more comprehensive list, check out Healthline’s article on cognitive distortions.
If you’re a visual person, Dani Donovan created an amazing article illustrating the different cognitive distortions as cartoon characters. You should definitely check it out!
Another common goal for the therapies in this bucket is to improve communication around feelings.
People often are unable to communicate their feelings, and sometimes they can’t even identify what they’re feeling themselves. The following therapies all use this wheel to help patients not only communicate better but also improve their vocabulary and reframe the way they perceive their feelings.
You use the wheel by feeling into your emotion and matching it to one of the large categories in the center. Then, you look at the center ring to see how you might break that down further. Then the outer ring to really hone in on what exactly you’re experiencing. A more detailed and more official version can be found at feelingswheel.com.
Ok, enough fundamentals. Let’s drill down into the specific types!
Cognitive Behavioral Therapy (CBT)
Though all of these are types of cognitive behavioral therapies, this is the grandfather of the family.
CBT operates on the belief that most psychological issues we face in life are caused by negative ways of thinking, unhelpful modes of behavior, and poor coping mechanisms. It focuses on your cognitive distortions and creates structure around how to address each one.
It not only aims to identify and dispel cognitive distortions, but it is also a form of exposure therapy that focuses on overcoming fears by breaking down fear into more manageable chunks and exposing yourself to that fear in small steps.
Imagine you have a fear of giving presentations to large crowds, but you work to overcome this fear by presenting to yourself, then your best friend, then a few of your coworkers. You expose yourself little by little until you’ve built a strong base from which you can leap to the real deal.
Much of CBT is observation and recording. In the process of recording, you can see the trends and pick apart your thoughts and behaviors. By applying a critical eye to your thoughts, you can understand how they might not serve you and work to reconstruct them.
In that vein, one of the core concepts in CBT is the hierarchy of cognition.
For any situation, good or bad, we have initial thoughts or impressions which feed our emotions. That emotion then fuels our behavior. This model in CBT explains why people experiencing the same event may react differently; their initial interpretation differs, which results in feeling different emotions and subsequently behaving differently.
In an inspirational situation, you may look forward to a new prospect, become excited, and go into a planning frenzy. In a negative situation, you may initially think everything will go wrong, which makes you feel fearful and anxious. The fear and anxiety cause you to isolate and not participate.
Writing down your situations and resulting thoughts and emotions in this way can help you get to the root causes of unwanted behaviors in your life. It gives you the distance from your own negative thoughts, emotions, and behaviors and allows you to see them as they are rather than being swept away by emotion.
If you were a patient of a CBT therapist, you might find yourself…
- Recounting your day and identifying which cognitive distortions were at play during times of high anxiety, rage, isolation, and other negative emotional experiences. For example, you might have a fight with your friend and realize that you were experiencing all-or-nothing thinking that caused you to think something was entirely your friend’s fault when you both shared the responsibility. Coming to this realization will help you recognize it in the future and work through it instead of falling prey to it.
- Exposing yourself to your fears in small steps to build a progression toward facing your fears in full
- Performing a thorough Cost-Benefit Analysis on common beliefs or behaviors you have to demonstrate more rationally and quantitatively what are worth keeping. For example, you might want to thoroughly explore the benefits and costs of your penchant to instantaneously blame yourself if your partner gets annoyed or upset about something, even if it isn’t your fault.
- Learning to evaluate decisions more rationally by comparing only two options, A and B, at a time. This can be done quantitatively by assigning numerical scores. Speaking of…
Some CBT therapists will even hand out worksheets to encourage you to organize your rational thoughts and help structure your journey. Here’s an example of a Decision-Making Form created by David Burns, a psychiatrist, professor, and pioneer in the world of CBT:
If you think you’d find worksheets like these helpful, check out his book “Feeling Good”!
Dialectical Behavioral Therapy (DBT)
DBT is a type of CBT. The word “dialectical” means “concerned with or acting through opposing forces”, which is exactly what this type of therapy focuses on. This type of therapy is well suited for people with trauma/PTSD, Bipolar Disorder, and BPD because these disorders often cause uncontrollable oscillations between extremes; whether between depression and mania, devaluation and idealization, or generally logic and emotion.
As the name implies, DBT aims to integrate our extremes and assert that our best decisions and best selves come from a good balance of emotions and logic. This balance is called the Wise Mind:
In this framework, our rational minds will make the most logical decisions but often those decisions don’t feel right because they may stray from our sense of morality or ignore our true feelings. It is more likely to do what is comfortable and secure, instead of taking risks to follow our dreams or wants.
On the contrary, decisions made entirely with the emotional mind will be ones that feel the most right at the moment but are usually made while in a heightened emotional state. Often, we regret these impulsive decisions and realize that we were chasing a fantasy rather than seeing the reality of a situation for what it truly is.
We all seek to make decisions with both halves. This is a mindful and anchored place to be that is neither impulsive nor stoic.
Just like vanilla CBT, DBT is focused on the facts.
When struggling with a difficult emotion, we look at the facts of the situation as objectively as possible. Only from there, can we move forward in our actions. If we find acting upon our emotion is ineffective, we should consider performing the opposite action of what our impulse is telling us.
For example, if you feel depressed because you can’t find a job and you believe you are a failure that no one would want to hire, check the facts. Perhaps you have a stellar résumé and ex-colleagues who would be willing to chat with you. Then you’d realize your depression does not fit the facts. Despite knowing that, perhaps you want to stay in bed all day, to which you ask yourself “Is staying in bed all day effective? Will it make me feel better?” If you think it wouldn’t, then consider doing the opposite action: getting out of bed and taking a walk.
Another core element of DBT is to improve our ability to observe, describe, and participate in our emotions, situations, somatic experiences, and surroundings in a factual manner. This can help us quell anxiety and be more present.
Imagine you missed a goal in your soccer match. The time is up and that goal would have been the one to ensure your team’s victory. You start feeling anxious and ashamed of your blunder and you don’t want to face your team in fear that they’ll be mad at you.
First, you would observe the situation and your surroundings. What can you see in the stadium? Can you smell the grass of the field? Do you feel thirsty after all that running? By focusing on the sensory, you bring your body and nervous system back to the present reality.
Second, you would describe the situation. You were playing soccer, and you missed a shot. You’re on an intramural team and the bleachers are nearly empty. Your team is patting you on the back and saying it's okay and they’re asking you if you want to head out for post-game drinks. They’ve always been very supportive of you and everyone is there just to have fun. By focusing on facts, you distance yourself from the chaos in your mind and remind yourself that the world is not ending.
Third, you would choose to participate. Yes, you might still feel ashamed and maybe even embarrassed, but choosing to join your teammates and enjoy a drink with them allows you to stay in the present, stay social, and will improve your mood.
If you were a patient of a DBT therapist, you might find yourself…
- Observing, describing, and participating in situations in which you feel dissociated or not-present
- Recording your feelings and activities on a daily basis in an app and monitoring what affects your mood in a positive or negative way. Observe your progress in addressing your cognitive distortions as you use that information to dial into a lifestyle and mode of thinking that works for you
- Using structured communication frameworks like DEARMAN to improve your success in expressing and negotiating your needs with others. Speaking of…
Acceptance and Commitment Therapy (ACT)
ACT is so much more than a great acronym. The core philosophy behind ACT is to learn to stay in the present and accept your thoughts and emotions as they are. It purports that emotions and thoughts are often out of our control, and we should learn to allow them to pass through without judgment. Learning to stay calm and fully feel into ourselves will help us develop stronger resistance to negative thoughts and emotions.
My favorite visualization I learned was to imagine yourself sitting next to a river in autumn. Every negative thought or emotion is a dying leaf falling to the river. Instead of collecting them all into a leaf pile and obsessing over where to put the leaves, just watch them sail down the river on their own.
You must not only accept your thoughts and emotions, but you must also accept yourself for who you are.
Its core philosophy of self-acceptance is extremely useful for stress management, rebuilding self-esteem, and addressing anxiety.
ACT also encourages the identification of the core traits a person values most in themselves and others. Sometimes this is done by providing an exhaustive list of adjectives and allowing only a small set of words to be chosen. This forces people to think deeply about what is most important to them.
After you identify your values and learn to accept yourself in full, you must prioritize which traits and values are most important for you to embody and find in others. From your priorities, you work with your therapist to craft an actionable plan to heal in a structured way, as well as a plan for moving forward in every aspect of life in a way that aligns with your chosen values.
This is when you commit. You must commit to your own self-improvement and follow through on your milestone goals. Unlike other therapies, ACT is very structured and almost like a project roadmap.
Another core concept in ACT is cognitive fusion and defusion. Cognitive fusion is when we become one with our thoughts and emotions. This can become dangerous in people with severe depression or anxiety; if they are fused with their emotions, they cannot perceive themselves outside of their depression. Oftentimes, they will believe that they are naturally a depressed person rather than a person who is experiencing depression.
Cognitive defusion is the act of distancing oneself from their emotions or thoughts. In ACT you can do this by imagining yourself taking a step out of a box and challenging those fused thoughts you might have. A depressed person who thinks “I’m a loser” might then say “I’m a person who thinks she is a loser” or even “I am a person who is telling herself that she thinks she is a loser”.
If you were a patient of an ACT therapist, you might find yourself…
- Filling out worksheets to explore your cores and values
- Practice meditation, breath work, journaling, and other skills that can help keep you in the moment and accept that you cannot control everything
- Personifying some of your negative emotions, like Anxiety or Depression, and writing letters to them as a way to distance yourself and observe them rather than act out from them.
- Explore your identity as a person and identify how it differs from your thoughts or emotions
I hope learning these philosophies and core principles was helpful to you. Has it inspired you to find a (new) therapist that specializes in any of these forms of CBT? If it has, check out PsychologyToday’s therapist directory. I’ve found it to be the easiest and most effective way to find therapists (and believe me, I’ve been to quite a few!)
This is the first of a series of articles about the categories of therapies that I’m writing. Over the next couple of weeks, I will be writing two more of these on therapies to treat trauma and expressive/communication therapies. If you enjoyed this one, let me know what you think so I know how to best write the next ones!
