The key principle behind CBT is that your thought patterns affect your emotions, which, in turn, can affect your behaviors and your behaviours can also affect your emotions and cognitions. Thus the angle of interventions in CBT is both on a cognitive and behavioural level.
For instance, CBT highlights how negative thoughts can lead to negative feelings and actions. But, if you reframe your thoughts in a more positive way, it can lead to more positive feelings and helpful behaviors. In the same way some negative behaviours can lead to negative feelings which in turn leads to negative thoughts.
Depending on the issue you’re dealing with and your goals, there are several ways to approach CBT. The approach usually involves: identifying specific problems or issues in your daily life becoming aware of unproductive thought patterns and how they can impact your life identifying negative thinking and reshaping it in a way that changes how you feel as well as learning new behaviors and putting them into practice.
Here’s a look at some of the techniques used in CBT:
1. Cognitive restructuring or reframing
This involves taking a hard look at negative thought patterns. Perhaps you tend to over-generalize, assume the worst will happen, or place far too much importance on minor details. Thinking this way can affect what you do and it can even become a self-fulfilling prophecy. Your therapist will ask about your thought process in certain situations so you can identify negative patterns. Once you’re aware of them, you can learn how to reframe those thoughts so they’re more positive and productive.
For example: “I blew the report because I’m totally useless” can become “That report wasn’t my best work, but I’m a valuable employee and I contribute in many ways.”
2. Guided discovery
In guided discovery, the therapist will acquaint themselves with your viewpoint. Then they’ll ask questions designed to challenge your beliefs and broaden your thinking.
You might be asked to give evidence that supports your assumptions, as well as evidence that does not.
In the process, you’ll learn to see things from other perspectives, especially ones that you may not have considered before. This can help you choose a more helpful path.
3. Exposure therapy
Exposure therapy can be used to confront fears and phobias. The therapist will slowly expose you to the things that provoke fear or anxiety, while providing guidance on how to cope with them in the moment.
This can be done in small increments. Eventually, exposure can make you feel less vulnerable and more confident in your coping abilities.
Exposure is a powerful technique used to help clients face their fears or phobias in a controlled way. Basically, you’re asking the client to be exposed to the very thing they fear. It will, of course, be scary for them.
When used properly, exposure has been proven to be effective in the reduction of fears and phobias. Exposure techniques are best utilized as part of a therapeutic intervention with a therapist who is well trained in their use.
There are many exposure techniques, and even more ways to implement them. Here are some of the more common and well known techniques.
- Situation exposure hierarchies
In this technique, the therapist helps the client make a list of feared objects or situations. The client then rates, on a scale of 0 to 10, how distressed they would be by each item. For example, a person who fears dogs might say “Not seeing a dog in the yard” is 0. “A dog licking my hand” might be their 10.
Starting with the least distressing, the therapist helps the client work through each situation in the list. This is a way of gradually increasing exposure and diminishing the distress of exposure.
Flooding also uses exposure hierarchies, but generally begins with the more difficult or distressing scenarios or objects. Caution should be used when choosing this technique, as it can elicit strong responses. This technique is best utilized as part of a therapeutic intervention.
- Systematic desensitization
This technique involves combining exposure with relaxation exercises. The client is taught strategies to remain relaxed in situations that would normally elicit fear. Gradually, they start to associate their feared object or situation with relaxation rather than powerful negative feelings.
4. Journaling and thought records
Writing is a time-honored way of getting in touch with your own thoughts.
Your therapist may ask you to list negative thoughts that occurred to you between sessions, as well as positive thoughts you can choose instead.
Another writing exercise is to keep track of the new thoughts and new behaviors you put into practice since the last session. Putting it in writing can help you see how far you’ve come. To identify and understand patterns of behaviour.
5. Activity scheduling and behavior activation
If there’s an activity you tend to put off or avoid due to fear or anxiety, getting it on your calendar can help. Once the burden of decision is gone, you may be more likely to follow through.
Activity scheduling can help establish good habits and provide ample opportunity to put what you’ve learned into practice.
The rational here is that the behaviour can change how you feeel.
6. Behavioral experiments
Behavioral experiments are typically used for anxiety disorders that involve catastrophic thinking.
Before embarking on a task that normally makes you anxious, you’ll be asked to predict what will happen. Later, you’ll talk about whether the prediction came true.
Over time, you may start to see that the predicted catastrophe is actually not very likely to happen. You’ll likely start with lower-anxiety tasks and build up from there.
7. Relaxation and stress reduction techniques
In CBT, you may be taught some progressive relaxation techniques, such as: deep breathing exercises muscle relaxation imagery
You’ll learn practical skills to help lower stress and increase your sense of control. This can be helpful in dealing with phobias, social anxieties, and other stressors.
8. Role playing
Role playing can help you work through different behaviors in potentially difficult situations. Playing out possible scenarios can lessen fear and can be used for: improving problem solving skills gaining familiarity and confidence in certain situations practicing social skills assertiveness training improving communication skills
9. Successive approximation
This involves taking tasks that seem overwhelming and breaking them into smaller, more achievable steps. Each successive step builds upon the previous steps so you gain confidence as you go, bit by bit.
10. Motivational Interviewing
MI is a collaborative, guiding conversational style used for strengthening a person’s own (intrinsic) motivation and commitment for change. MI has proved to be a frontline, evidence-based, successful intervention approach for facilitating positive behavior change, and is increasingly utilized in the areas of substance abuse, mental health, and primary and specialty health care.
11. Meditation and mindfulness
Mindfulness is the basic human ability to be fully present, aware of where we are and what we’re doing, and not overly reactive or overwhelmed by what’s going on around us.
12. Physical Exercise
Research has shown that excercise can bean effective behavioural intervention in the treatment of both depression and anxiety. Excercis e not only has a neuro-biological effect on the body which can lead to a more positive mindset, it also has an impact on a person’s self esteem and their sense of accomplishment and general sense of wellbeing.
13. Sleep Hygiene
What is sleep hygiene?
Sleep hygiene is a variety of different practices and habits that are necessary to have good nighttime sleep quality and full daytime alertness.
Why is it important to practice good sleep hygiene?
Obtaining healthy sleep is important for both physical and mental health. It can also improve productivity and overall quality of life. Everyone, from children to older adults, can benefit from practicing good sleep habits.
How can I improve my sleep hygiene?
One of the most important sleep hygiene practices is to spend an appropriate amount of time asleep in bed, not too little or too excessive. Sleep needs vary across ages and are especially impacted by lifestyle and health. However, there are recommendations that can provide guidance on how much sleep you need generally. Other good sleep hygiene practices include:
- Limiting daytime naps to 30 minutes. Napping does not make up for inadequate nighttime sleep. However, a short nap of 20-30 minutes can help to improve mood, alertness and performance.
- Avoiding stimulants such as caffeine and nicotine close to bedtime. And when it comes to alcohol, moderation is key4. While alcohol is well-known to help you fall asleep faster, too much close to bedtime can disrupt sleep in the second half of the night as the body begins to process the alcohol.
- Exercising to promote good quality sleep. As little as 10 minutes of aerobic exercise, such as walking or cycling, can drastically improve nighttime sleep quality. For the best night’s sleep, most people should avoid strenuous workouts close to bedtime. However, the effect of intense nighttime exercise on sleep differs from person to person, so find out what works best for you.
- Steering clear of food that can be disruptive right before sleep. Heavy or rich foods, fatty or fried meals, spicy dishes, citrus fruits, and carbonated drinks can trigger indigestion for some people. When this occurs close to bedtime, it can lead to painful heartburn that disrupts sleep.
- Ensuring adequate exposure to natural light. This is particularly important for individuals who may not venture outside frequently. Exposure to sunlight during the day, as well as darkness at night, helps to maintain a healthy sleep-wake cycle.
- Establishing a regular relaxing bedtime routine. A regular nightly routine helps the body recognize that it is bedtime. This could include taking warm shower or bath, reading a book, or light stretches. When possible, try to avoid emotionally upsetting conversations and activities before attempting to sleep.
- Making sure that the sleep environment is pleasant.Mattress and pillows should be comfortable. The bedroom should be cool – between 60 and 67 degrees – for optimal sleep. Bright light from lamps, cell phone and TV screens can make it difficult to fall asleep4, so turn those light off or adjust them when possible. Consider using blackout curtains, eye shades, ear plugs, “white noise” machines, humidifiers, fans and other devices that can make the bedroom more relaxing.
What are signs of poor sleep hygiene?
Frequent sleep disturbances and daytime sleepiness are the most telling signs of poor sleep hygiene. In addition, if you’re taking too long to fall asleep, you should consider evaluating your sleep routine and revising your bedtime habits. Just a few simple changes can make the difference between a good night’s sleep and night spent tossing and turning
Dr JC Coetzee Christian Clinical Psychologist, Psychotherapist, Cognitive Behavioural Therapy Centurion, Midstream, Midrand, Pretoria.