5 Tips for CBT Success

CBT stands for Cognitive Behaviour Therapy. It's a popular therapy that was created by Aaron Beck in the 1960s (1). In the 1950s, Albert Ellis created Rational Emotive Behaviour Therapy (REBT) that has some similarities and differences from CBT (2). I tend to use a mixture of both with my clients. CBT is the most researched therapy approach (3). In treatment studies, CBT has been beneficial for individuals experiencing depression, eating disorders, obsessive compulsive disorder (OCD), posttraumatic stress disorder (PTSD) and many other mental health conditions (4). CBT has been helpful for individuals using in-person therapy, online therapy, self-help books, and even in online self-help programs. 

CBT involves noticing changes in your mood and then writing down the situation, the thoughts, emotions, physical sensations, and behaviours that occurred when your mood changed. You can record these observations on a CBT thought record. Thought records can be completed on paper, on a computer, or using mobile apps. After you record the situation, thoughts, emotions, and behaviours, you identify any distorted thoughts and challenge them. Finally, you create an alternative thought that is more balanced and reasonable. 

Although there has been so much research about CBT and it has been helpful for so many people, it doesn’t work for everyone, and some clients dislike it. These are some reasons why CBT hasn’t worked for some of my clients: 

• They could not identify their thoughts. In fact, some people don’t have internal dialogue and don’t hear words in their head that they can record in thought records (5).   
• Sometimes clients dislike their thoughts, or they trigger such intense emotions, they don’t want to write them down or examine them.
• It takes several minutes (sometimes up to 15 minutes) to complete a thought record. It may seem like a burden or extra work to busy people. 
• They may find it inconvenient to carry thought records or fear they may be discovered by others.
• They can challenge their thoughts and make up alternative thoughts, but don’t believe the alternative thoughts. 

Here are my 5 Tips for CBT Success

1. Face Your Fears. If you fear your thoughts, the best way to overcome that fear is to face them head on. Avoidance will not stop the negative thoughts from coming, but if you don’t believe them, they lose their power. 
2. Make the Time. Although completing a thought record may take several minutes, it saves you time overall. It shortens the amount of time you spend feeling upset about situations because you will challenge and let go of unhelpful thoughts. Unhelpful thoughts will no longer get in the way of the things you want to do.
3. Use a CBT App to Complete Thought Records. By using an app, you won’t have to carry papers around. If your phone is password protected, no one you know will see your thought records. The app will blend in with the rest of your phone apps so no one will be looking for it. 
4. Challenge Core Beliefs. It takes time to change beliefs that you’ve had for many years, sometimes since childhood. These deep thoughts are called core beliefs and you may need to challenge these too. You will require more therapy sessions to identify and challenge your core beliefs. 
5. Complete 30 Thought Records. CBT is a way of thinking that you can use for the rest of your life, but it takes practice. Doing thought records once or twice will not lead to a long-lasting change in the way you think. I would recommend writing down 30 thought records over the course of a few months. That would be enough practice to change your thinking habits in the long term. After this point, you may be comfortable challenging thoughts in your head. But you don’t have to ever stop using thought records for difficult situations. Feel free to pull out a thought record or your CBT app whenever something upsets you.

References

1. The History of Cognitive Behavior Therapy 
2. All About Rational Emotive Behavior Therapy (REBT) 
3. David D, Cristea I, Hofmann SG. Why Cognitive Behavioral Therapy Is the Current Gold Standard of Psychotherapy. Front Psychiatry. 2018 Jan 29;9:4. doi: 10.3389/fpsyt.2018.00004. PMID: 29434552; PMCID: PMC5797481. 
4. Cognitive Behavioural Therapy 
5. What it's like Living Without an Inner Monologue 

Author

Dr. Candice Bovell, Ph.D., C.Psych. is a Clinical Psychologist who treats adults with depression, anxiety, and stress online in Ontario, Canada.