Getting Better Everyday

The Client's Guide to Cognitive Behavioral Therapy Treatment

Jesus A. Salas PsyD ABPP

• Publisher: Fulton Books, Inc.
• Year: 2020
• ISBN:
  9781646546381
• Topic: Personal Development
• Subtopic: Self Improvement

Getting Better Every Day is based on the idea that personal growth through cognitive behavioral therapy (CBT) is not done to you; it is something you do for yourself. You may have many questions about CBT and its ability to help you. This book will answer them. It describes the knowledge, tasks, and skills you need for success inside and outside the therapist's office. It includes a workbook for logging your experiences and reflecting on each session. If you establish clear goals, practice the lessons in this book, and engage in teamwork with your therapist, you can overcome your challenges and lead a more fulfilling life.

Chapter 2

Frequently Asked Questions about CBT (Part 1)

Why Is It Called Cognitive Behavior Therapy?

Cognitive behavior therapy is so-called because it focuses on the causal role of dysfunctional cognitions (i.e., thoughts and images) and actions (i.e., behaviors) in the development and maintenance of psychological problems. CBT treatments typically involve changing what and how you think to change what you feel and what you do. CBT treatments also include changing what you do to generate changes in the way you think and feel.

You can directly and deliberately change your thoughts and actions but not how you feel (i.e., your emotions). Emotions are experiences that happen to you. That is, you cannot will yourself to stop feeling anxious, depressed, or angry, nor can you will find yourself to feel happy, worthy, or self-confident. During your CBT treatment, you learn how to change your emotional states through cognitive and behavioral modifications.

To promote emotional changes, CBT teaches you how to think and respond to internal and external stressors in more rational and constructive ways. A stressor is any stimulus, activity, situation, or event that causes you distress—that is, anxiety, depression, guilt, shame, anger, resentment, etc. CBT interventions may also attempt to help you change your bodily responses to stressors. Research proves that we can facilitate emotional and cognitive changes by modifying the typical physical reactions (e.g., tensing of the muscles or elevated breathing rate) associated with the psychological problem. For example, an essential component of the CBT treatment for generalized anxiety disorder is applied relaxation (AR) training, which teaches patients quick and easy bodily relaxation behaviors to cope with the anxiety before it becomes overwhelming.3

What Are Emotions and Why Do We Have Them?

Emotions have developed as part of the human evolutionary response and are usually aroused when your values, goals, needs, core beliefs, and motives are gratified, frustrated, or threatened.4 In those situations, they help you to rapidly and automatically process information so you can generate the appropriate response. In sum, emotions tell us, This is something that matters to me.

Emotions are crucial for rational information processing. They serve you by directing your attention; organizing your perceptions and memories; influencing your preferences, priorities, judgments, decisions, and motivations; and guiding your behavior toward appropriate reactions. For example, when you feel down, the world seems dark and negative, and when you feel anxious, it looks dangerous.

People rarely seek to change their behavior as a result of learning facts and reaching logical conclusions about the benefits of changing. In most cases, people attempt to change when they feel some intense distress and would like to feel better.

Your emotions are responsible for the richness of your life. They allow you to feel happiness, enjoyment, fear, sadness, shame, guilt, pleasure, remorse, pride, compassion, empathy, affection, gratitude, fulfillment, engagement, belonging, loneliness, anger, jealousy, envy, grief, embarrassment, amusement, or awe. Emotions also help you to make sense of reality. For a healthy mind and body and healthy relationships, you have to be able to identify, understand, and manage your emotions and drives.

Emotions are something negative not because they are uncomfortable, but because they harm your adaptation and growth. For example, anger is a common symptom of PTSD. The experience of anger in and of itself is not harmful; people who have been hurt, abused, traumatized, or disrespected have the right to feel angry. But anger can be problematic when it is out of control or misdirected and leads to unhealthy behaviors (e.g., substance use, violent behavior, deliberate self-harm). Sometimes there can be positive consequences of experiencing uncomfortable emotions and negative effects of comfortable emotions. For example, the feeling of fear may be unpleasant, but it tells us that we perceive some threat, and we may be in danger. We benefit from feeling the fear and examining the associated perception of risk because, if it is accurate, we should act to protect ourselves.

The importance of our emotions was dramatically illustrated by neuroscientist Anthony Damasio in his best-selling book Descartes’ Error: Emotion, Reason, and the Human Brain.5 Damasio described the cases of several patients who, because of brain damage, lost their ability to experience emotions and gut feelings. He reported how this emotional deficit impaired the patients’ decision-making ability even though they were capable of conducting rational analyses of situations. His findings indicated that problem-solving and making life decisions are not just rooted in reason. Without the assistance of our gut feelings and bodily reactions, our choices can lead to very poor results.

Why Don’t We Sometimes Feel What We Expect to Feel?

Our brain allows the possibility of causing different reactions, at the same time, from the same triggers. I often hear patients say that they know something intellectually, but they do not feel it in their “gut.” One patient of mine, Christian, who was dealing with issues of low self-worth, told me, “I genuinely believe that my self-esteem should not depend on my wife’s approval of me, but I still feel like I need it. And when I don’t get her attention and acceptance, I feel worthless.”

It is likely that you have had a similar experience and have told yourself something like, I know better in my head now. I can say to myself, “Don’t be silly. You know that isn’t true,” but I still don’t feel it in my heart. I feel like my body just does not listen to my mind.

It is also common to feel something different from what we think we should or would like to feel in a particular situation. For instance, another patient, Carla, who had issues with feeling one thing and expressing a different emotion on the outside, told me, “I don’t know why, but when I have a confrontation with someone, and I feel angry, I also feel like crying! It’s so annoying! I don’t want to cry when I am angry at someone.”

The coordination (or lack thereof) among response systems (i.e., what we think, feel, and do) is not intrinsically good or bad. On the one hand, synchrony among response systems produces more intense and consistent emotional experiences, for example, feeling excited and motivated whenever a particular piece of music is played. On the other hand, even though, the lack of coordination can be confusing at times (e.g., arguing with ourselves about what we are supposed to feel), it may also help to control our emotions, for example, by allowing us to face rather than avoid something we are scared of.

Closing the Knowing-Feeling Gap

Emotions arise from your evaluations of situations. Sometimes feelings are triggered by conscious and deliberate assessments. Other times, the valuations are primitive and fast, generated without any associated thought. Once activated, however, emotions cannot be sustained without causing and repeating evaluative thoughts (the sentences, words, and phrases we tell ourselves) and images.

Neurologically speaking, automatic evaluations involve the subcortical brain region and are the direct result of exposure to specific stimuli—external (e.g., events) or internal (e.g., thoughts). Meanwhile, conscious and deliberate evaluations engage the cortical brain region to produce well-considered and rational emotional responses.

Events that carry strong emotional resonance are likely to be registered at both the cortical and subcortical levels. Consequently, to change the emotional meaning of an event, CBT interventions involve rational modifications (cortical level) and new experiences that lead to new associations with old emotional stimuli (subcortical level).

Your ability to retain and benefit from CBT learning opportunities is affected by how you feel at the time of learning. A patient shared the following about his process of change: “I realized that to achieve consistent emotional changes, I need to put these new thoughts into practice, even when I am feeling bad.” And she was right. With persistence and practice, your therapy will lead to lasting results.

For that purpose, CBT therapists use a combination of in-session and out-of-session emotional-activation interventions.

The aim of such intervention...

Table of contents

• What Is Cognitive Behavior Therapy?
• Frequently Asked Questions about CBT (Part 1)
• Frequently Asked Questions about CBT (Part 2)
• Why Do We Behave As We Do? (Part 1)
• Understanding Your Appraisals
• Why Do We Behave As We Do? (Part 2)
• Are You Ready to Change?
• The Typical Course of Therapy
• The Importance of Your Goals for Therapy
• A Typical Therapy Session
• Setting the Agenda
• Treatment Plan in Action
• Self-Help Activities between Sessions (Homework)
• How You Will Change in Therapy
• Key Terms and Definitions