Mental Health Matters: Cognitive Behavioral Therapy

There are dozens, if not hundreds, of types of therapy for improving mental health and well-being. Some come from the Freudian tradition, while others have been a reaction against Freud’s way of thinking and practicing.
One of the most popular and effective therapies we use today was developed independently by Aaron Beck and Albert Ellis. Beck called his theory “cognitive behavioral therapy” (CBT), while Ellis called his “rational emotive behavior therapy” (REBT). Beck was an academic researcher while Ellis was more focused on self-help, which may be one reason CBT has spread more widely among therapists than REBT. Today’s column will focus on the basic use of CBT/REBT and how you can apply them to your own life.
Imagine you are driving down the road and suddenly your tire goes flat. How do you feel? You might be angry, scared, frustrated, depressed, anxious, calm or any other emotion you can think of.
We may speak as if there is a causal relationship between events and our feelings (that flat tire made me so depressed), but there is not. We know this because we can have different feelings about the same things. What makes one person happy brings anxiety to another. The things I find funny, you may find hurtful. Why is this?
CBT and REBT say that instead of situations causing our emotions, our thoughts and beliefs cause them. We can imagine three people who have flat tires with the first feeling depressed, the second feeling angry and the third feeling calm. Person one feels depressed because she is thinking about how her savings will be drained and she never has a chance to get ahead. Person two is rageful because he thinks his son has carelessly driven the car through nails. What pushes them farther into those emotions is an additional, often unrecognized, belief which says, “… and it shouldn’t be that way.” The depressed woman ends up dwelling on how life shouldn’t be unfair, while the enraged man dwells on thoughts that his son ought to be more responsible.
The person in the third example is likely thinking, “I wish my tire wasn’t flat, but I can deal with it.” The important difference between the calm person and the depressed and angry people is that the calm person is not making any demands on the situation. He may not be happy about it, but he also does not have a belief that it must be any way other than the way it is.
Why is it important to recognize situations for what they are and not demand they be some other way? It helps keep us emotionally level, which then helps us do a better job problem solving.
When demands push our emotions into the red zone, we often do not think clearly and may focus on the wrong thing. For example, the angry man may be more focused on punishing his son than he is on safely changing his tire. The depressed woman may feel too depressed to even cope with the flat.
You can use CBT/REBT to work through situations where you have strong feelings which make it hard to function rationally. First, name the situation you were in as well as the feelings you had. You can also look at any behaviors you did (yelling, crying, leaving, etc.)
Next, write down the thoughts you had in that situation. You will probably notice that the thoughts you identify with a strong negative feeling include some form of demand, such as: I shouldn’t act like that, I must change, people have to like me, there ought to be another way, etc.
For each thought, you will then ask four questions: 1) Does this thought help me? 2) Is this thought consistent with reality? 3) What is the evidence for this thought being true? and 4) Are things really as awful as they could be?
If a thought is pushing an unhealthy negative emotion, then it will not be helpful to you, it will not reflect how the world really works, there will not be good evidence for it being true and there will be plenty of other situations which could be much worse. For example, demanding that people like you tends to lead to feeling rejected more often, so that is not helpful. It is not consistent with reality because no one must like you, plus just because you want something does not mean it will happen. There may be plenty of evidence that you want to be liked, but none that everyone must like you. Finally, there are situations you would find worse than rejection.
Going through these steps helps us gain objectivity about the role of demandingness. With more objectivity, we can see that our thoughts are merely preferences, not laws of the universe, which helps us settle into more helpful thoughts and emotions. None of this means you have to like every situation which upsets you -- some things are truly negatives in our lives. It is, however, possible to feel disappointed instead of depressed, irritated instead of enraged, mild embarrassment instead of shame and concerned instead of highly anxious.
Nora Sinclair is a licensed professional counselor and a national certified counselor based in Lexington, S.C.