Using CBT to Think Better, Do Better, Feel Better

March is the month of therapeutic frameworks! It’s already here, which is hard to believe. 

I’d intended to do at least a couple more personality profiling tools before the end of February, but the days got away from me. We’ve been swapping sicknesses in our house for WEEKS and it still hasn’t let up. So in the name of not-perfectionism, I’m moving on to March and letting go of best-laid plans for last month. 

First up is Cognitive Behavioral Therapy (CBT), because it’s one of the best studied psychotherapeutic approaches we have for improving quality of life. Both in research studies and clinical practice, it’s been proven to produce meaningful change across a wide variety of mental health issues. It works. In fact, CBT is one of the most widely researched and widely practiced therapeutic approaches in modern psychology.

CBT Basics

CBT combines the best of Cognitive Therapy with Behavioral Therapy to create something brand-new and highly effective. On the cognition side, CBT works to identify harmful—often automatic—thought patterns. Then it traces their impacts and intentionally replaces them with more neutral or realistic thoughts. Behaviorally, it looks for patterns of action that have a negative impact on quality of life and intentionally adjusts those patterns to improve daily life experience. 

We can start identifying these patterns by looking at common events and noticing what they trigger within us. Here are two examples: 

Cognition-first: If I see my partner’s face first thing in the morning and he looks grumpy, doesn’t make eye contact with me, and doesn’t seem eager to jump out of bed to join the morning scramble… I might have the following thought, “He’s upset with me about something,” or “He’s grumpy because he doesn’t want to help.” Then I feel frustrated or hurt or unsupported, and so I act colder towards him, speak shortly, etc. Being treated this way actually does make him upset with me and quite likely makes him not want to help me. Thus, our negative thoughts often become self-fulfilling prophecies.

Behavior-first: If I’ve set up my morning routine with zero margin—only enough time to get out the door if everything goes perfectly—then we’re all going to be at least a little grumpy and rushed most mornings. We will forget things or do things out of order, leave late, and blame each other. This leads to the whole family feeling like mornings are awful and stressful, which reinforces not wanting to get up, which leads to more alarm-snoozing, which makes the morning routine even rougher. These repeated behaviors create a negative experience for everyone and increase the likelihood of more of the same.

In the first example, I can adjust my thinking to produce a different result. In the second, I can adjust my routine to produce a different result. 

Obviously, there’s a lot of overlap between our thoughts and our behaviors, and it isn’t always clear which we should address first. Good news! This isn’t math, and there’s no one right answer. We get to try different things until we find whatever works best for us in a given situation. 

The CBT Triangle

Therapists often use a simple visual model to explain how these pieces influence one another. The CBT Triangle is a helpful visual for understanding the cause-and-effect relationships between our behaviors, thoughts, and feelings. Our behaviors—our choices acted out in real time—affect how we feel and what we think. Our thoughts predict our behaviors and inform our feelings. Our feelings influence both our thoughts and our behaviors. They’re all interconnected. If we nudge one of them in a more helpful direction, it can have a compounding effect that slowly changes everything for the better.

This is why CBT can be useful for people living with depression, anxiety, loneliness, trauma, substance abuse, ADHD, autism, bipolar, and so much more. Rather than focusing primarily on uncovering root causes (which requires more deep healing work), CBT is about reducing daily suffering by relieving symptoms (thoughts, feelings, behaviors) and allowing people to live their lives more in accordance with their goals and values. Successful practice with CBT empowers people to live more meaningful lives, no matter their struggles.

Changing How We Think

Before we can change our negative thoughts, we need to see them for what they are. CBT refers to these patterns as cognitive distortions. Here’s a helpful tool for identifying common Negative Thinking Traps so that we can start to work with them. So that we have a real, concrete example, I’ll apply this to my current toddler potty-training dilemma. 

My almost-3-year-old still isn’t potty trained, and shows complete disdain for anything to do with the potty. He loves his diapers and sometimes even thinks it’s hilarious to take them off and pee on the floor. Or the couch. It’s very frustrating, and I have a lot of negative thoughts about this whole situation:

• Black and White: In my brain, he is not potty-trained and then someday he just will be, magically. I have a hard time embracing the idea of an in-between where he is learning.
• Focusing on the Negative: I can very easily drum up frustration and tell stories that reinforce that frustration. 
• Overgeneralization: He refused to use the potty the last time I ask him to, so I assume he will keep refusing and I quit encouraging him to try.
• Personalization: When he pees on the carpet or the chair and then I have to clean it, I feel personally attacked.
• Catastrophizing: Sometimes I wonder if there’s something wrong with him and he’ll be one of those kids who can’t attend kindergarten because he’s still in diapers. 
• Perfectionism: We are a busy family. I work full-time and he goes to daycare. So if I can’t “accomplish potty-training” over a long weekend or spring break (current dream/hope/plan), then it feels like a failure. 
• Mind Reading: Often I think that he does know when he has to go, is fully capable, and is just choosing not to use the potty. I also think that all his teachers at daycare are judging me for not getting this figured out yet. 
• Minimizing/Discounting: He has successfully pooped on the potty on his own once, and he’s peed on the potty quite a few times. Those successes are real, but because I don’t understand why they happened—I tend to discount them.
• Blaming: Sometimes I like to blame my husband. 

You can probably trace how all these negative thoughts affect my feelings and my behaviors around potty-training, and it becomes pretty obvious why we’re stuck. 

Good news! There are so many ways to change how and what we think. The easiest way is to just write down each negative thought, then write a corresponding helpful thought next to each one, and practice replacing them. For example, I can choose the following new thought: “He is learning new things all the time, he can learn this too. How can I help him learn?” Then, I have to pay attention to my thoughts throughout the day, notice when a negative one pops up, and intentionally repeat my new thought instead. The practice is the toughest part because it requires effort and consistency. But just like you can change a habit, you can change your thoughts. 

If your negative thoughts are really sticky or you aren’t sure how to replace them with a more helpful thought, here are a couple of worksheets to break down that process into manageable steps: 

• Challenging Thoughts Exercise
• Cognitive Restructuring Exercise

Changing How We Behave

In CBT, this process is often called behavioral activation or behavioral change. Typically, we already know our own bad habits. We don’t need a worksheet to figure out what they are, but we are often at a loss as to why we do these things. Sometimes, we do things that cause us to feel intense shame, disgust, or disappointment in ourselves and we make commitment after commitment to stop—but we just keep doing it. CBT can help. 

In the interest of not oversharing, I’ll choose a fairly benign bad habit of my own to serve as an example to work through. 

I am in charge of the laundry in my family, and I dislike doing it alone but I also don’t allow anyone else to help because they don’t do it right. I’m a fastidious folder, and it hurts my brain if things aren’t folded or hung in a way that eliminates wrinkles and cares for the shape of the clothes. Also everything has to fit nicely in our drawers, bins, and closets, so each type of clothing item has an ideal folded shape. Anyways. By the time I am finished folding a load of clean clothes, I am “too tired” to put everything away and so I’ll leave it overnight, or sometimes over days, in an in-between place. The changing table, the rocking chair, the kitchen table. 

Currently, my kitchen table is covered with stacks of clothes folded last night. I can’t sit there to write, I can’t start making breakfast, its in my way and disrupting my flow. But I do not want to put them away. So I don’t. Why? 

Instead of dissecting my thoughts on this one, I want a quicker path to doing something different. So I’ll map out the behaviors.

1. Laundry piles up throughout the week, but I choose to do it all on the weekend. 
2. This means I have lots to do at once. Usually five or six loads between Saturday and Sunday.
3. I fold them as soon as I can after they come out of the dryer to reduce the chance of wrinkling. 
4. Then I add to all the folded stacks with each finished load, telling myself I’ll put them all away at the end so I’m only putting things away once.
5. By the time I am done folding, there are enormous stacks to put away and I don’t feel like it. 
6. So I leave it, but then I am frustrated and tired each time I look at the stacks until I finally put them away. 
7. By the time I’ve put them away, it’s caused me triple the distress that just putting them away immediately would have wrought on my nervous system.

I think I’m going to try a combination of all of the above. I’ll put them in charge of putting everything away, as it gets folded vs. waiting until the end. Some of it might still land on me, but not nearly as much. When the whole laundry journey is over and everything’s in its place, we will all get a treat.

Even though I haven’t done it yet, just the exercise of planning a new course of behavior has me feeling more optimistic and motivated! I’m planning what to say to my family, how to choose our treats, and imagining our celebration moment together later tonight. The power of CBT!

Changing How We Feel

While we can’t necessarily control how we feel—emotions come and go, moods can shift quickly or feel stuck—we do have many ways to influence them.

Our moods and emotions are rooted in our physical bodies—think hormones, neural pathways, and brain structures—so one of the best ways to shift feelings is by adjusting what we do with our bodies.

We can do this through exercise, relaxation techniques, eating or drinking, interacting with another person, sleeping, or intentionally experiencing a significant sensory change—like taking a shower or bath, going outside, stretching, jumping into a cold body of water, getting a massage, sitting in a sauna, etc.

If you want to change how you feel, change what you’re doing with your body. Make a list of activities or practices that work best for you, and then use it! 

For me, practicing mindfulness has been the most helpful tool to get me into my body and paying attention, so that I can make adjustments when needed. My insurance (yours too if you have Kaiser!) covers a premium membership for the Calm App, and I’ve used their tools extensively. 

Even when I couldn’t find 20 minutes to sit and truly meditate, listening to the daily meditation on my morning commute and doing my best to follow along with my eyes open still made a big difference in my brain. Hearing the relaxing cues over and over allowed me to start using them reflexively whenever I felt stressed or anxious through the day. Noticing sadness or apathy sours me to stand and stretch, or go find someone for a quick chat. 

You can’t control how you feel in any given moment, but you can change it. All you need is the tools. 

CBT for All

CBT is not a cure-all, but I truly believe it is a help-all. It’s often one of the first approaches therapists recommend because its tools are practical and adaptable to many different situations. If you’re able to, finding a therapist to help you through exercises and provide accountability for your ongoing work can result in feeling better faster. If that’s not possible for you, there are lots of ways to use CBT on your own. 

Here’s a great link to some CBT self-help videos and practices out of the UK. Or you can always check your local library for helpful books! Just search for “CBT” and you’ll find some of the most popular options out there, designed specifically for personal use.

CBT for Me

My own takeaway from writing this post is that I have work to do. Right now, I’m dealing with some stressful life stuff and I’m realizing I’ve been letting my negative thoughts run rampant. I’ve been reverting back to unhelpful behaviors. And I’ve been sulking in all my bummer feelings instead of doing what I know I can to shift them. Rather than wallowing in all this, waiting for validation about how bad it is, it’s time for me to choose helpful thoughts, shift my behaviors, and move through my sad feelings.

CBT empowers me to do that.