Cognitive Behavioural Therapy (CBT)

CBT is focused on changing, challenging, and confronting negative automatic thought patterns and behaviours that are making our mental health concerns worse in the long-term. Ultimately, this CBT page is focused on helping people manage any mood or anxiety symptoms.

by Jordan Bateman, M.Ed., R. PSych.

Click here to return to home page

What does CBT help with?

Most behavioral techniques used in CBT are designed to help people:

1) increase participation in activities that improve mood,

2) change patterns of avoidance

or helplessness,

3) gradually face feared situations,

4) build coping skills, and

5) reduce painful emotions or autonomic arousal

6) challenge negative thinking patterns

Wright, J. H., Brown, G. K., Thase, M. E., & Basco, M. R. (2017). Learning cognitive-behavior therapy: An illustrated guide. American Psychiatric Pub.

CBT Self-Help Websites/Apps:

For more information about CBT check out Anxiety Canada, there you can find self-help modules applying CBT.

Anxiety Canada also created a free app called MindShift to help with various types of anxiety (e.g., general worry, social anxiety, perfectionism, panic, and phobias).

1.1 Cognitive Restructuring

Restructuring is a fancy word for changing thought patterns. It’s all about noticing our distorted thinking (don’t worry, we all do it!) and then practicing healthy alternatives. Our thoughts create pathways, they might start as a barely recognizable goat trail and turn into giant highways. Good news, we can practice new pathways!

Mind reading: You assume that you know what people think without having sufficient evidence.

Fortuntelling: You predict the future negatively,

“Things will get worse”.

Catastrophizing: You believe that what has happened or will happen will be so awful and unbearable that you won't be able to stand it.

Labeling: You assign global negative traits to yourself and others. "I'm undesirable," or "He's a rotten person."

Negative filtering: You focus almost exclusively on the negatives and seldom notice the positives. "Look at all of the people who don't like me."

Overgeneralizing: You perceive a global pattern of negatives on the basis of a single incident. "This generally happens to me. I seem to fail at a lot of things."

All-or-nothing thinking: You view events or people in all-or-nothing terms. "I get rejected by everyone," or "It was a complete waste of time."

Blaming: You focus on the other person as the source of your negative feelings, and you refuse to take responsibility for changing yourself. “She is why I feel ___.”

Emotional reasoning: You let your feelings guide your interpretation of reality. "I feel anxious; therefore, my job is not working out."

This list is found in a book called The Coddling of the American Mind (Lukianoff & Haidt, 2017).

See also: Unhelpful Thinking Habits

I forgot about an exam and I got 58%

2/10 mood - Frustrated and sad

I am never going to pass my program, I am such an idiot!

Catastrophizing/Fortunetelling and Labelling

“I am never going to pass my program”: 20% sure of this because this was one test and I am doing decent otherwise

“I am such an idiot”: 30% accurate

I am going to have to organize more effectively in the future (100% accuracy) and I am sometimes forgetful, but I can still be intelligent (90%)

1.2 Emotional Awareness

““Far from making emotions go away in therapy, you learn to change your relationship with them, to welcome them all, to pay attention to them, to see them for what they are, and to act in ways that will influence them and change the intensity of them. Emotions are neither your enemy nor your friend. They do not occur because your brain has a few cogs misaligned or because you are a sensitive soul.... Emotions are your brain’s attempt to explain and attach meaning to what is going on in your world and your body.” - Dr. Julie (Why Has Nobody Told Me This Before)

Learning mindful emotional awareness is a difficult thing! We often avoid our emotions; we suppress and escape. But it is valuable to make room for them and then let them flow by.

Click here to review an emotion wheel or download the How We Feel app from section 1.1

Become aware of “emotion-driven behaviours”.

Our emotions in themselves are not good or bad. But we sometimes allow fear, anxiety, sadness, and anger to drive our impulsivity and behaviours (e.g., yelling, avoiding, emotional eating, substance abuse, over-checking, over-washing, over-doing-anything, etc.)

Physical sensations

/feelings

(What I am feeling)

Thoughts

(What I am thinking)

Behaviours

(What I am doing)

3-Component Model of Emotions

Unified Protocol for Transdiagnostic Treatment of Emotional Disorders by Barlow et al. (2010)

Learn to recognize your tipping point. In many cases, stressors build and build until we reach our breaking point. If we pay attention to our emotions, we can learn to recognize when we are most vulnerable and take action to self-soothe so we don’t engage in behaviours that we regret later.

For more information click here

Jon Kabat-Zinn

9 attitudes of mindfulness

1.3 Exposure

Therapy

= Facing our fears in a controlled/safe environment. It usually involves gradually mastering what was anxiety inducing in the past. It leads to emotional processing, habituation (we get used to it), extinction (we learn new/healthier assoications), and we build self-efficacy (feeling like we can manage stuff.

Description of anxiety/panic:

1) Body and mind sense a threat

2) Amygdala (emotion centre/security system) gives control to the hindbrain and cuts off some logical thinking

3) Hindbrain activates survival instincts to get more oxygen to our brain and muscles

4) We experience physical symptoms (e.g., quick/shallow breathing, upset stomachs because we don’t need digestion, sweaty so it’s easier to get away and cools us down, blood vessels dilate, narrowed vision, etc.)

5) Often catastrophizing thoughts follow (e.g., I am going to pass out, throw up, embarrass myself, have a heart attack, or die) which exacerbates the sensations

Safety Behaviours = Short term gain for long term pain

Unified Protocol for Transdiagnostic Treatment of Emotional Disorders - Barlow et al. (2010)

Exposure therapy is the most effective treatment for most anxiety-based symptoms.

Here is an APA information sheet about exposure.

Exposure usually involves creating a fear hierarchy or ladder: Starting with things are within reach but still anxiety inducing and slowly working up as lower items are mastered.

Click here for a video about exposure therapy for phobias.

Cycle of Avoidance

Peak anxiety

Habituation - anxiety coasting

Return of the trigger

Every time we engage in avoidance = Short term gain for long term pain

Exposure helps us learn the skills to decrease fear and increase the feeling of being capable to manage anxiety and process emotions

1.4 Stress Management

There is an optimal level of stress that leads to flourishing, focus, and flow. We need stress to get things done! But too much or too little is when we run into problems.

Basics... (not easy but start with these)

1) Be mindful of your eating habits

2) Sleep! This is a complicated one for many people but check out this sleep hygiene sheet

3) Engage in movement! Any sort of movement can help us regulate

4) Limit or avoid mood altering substances

5) Limit doom scrolling (mindlessly scrolling social media for hours)

This page talks a lot about not avoiding our emotions/thoughts but sometimes it is important for us to learn how to take breaks and self-soothe.

The following 4 things (TIPP) from DBT can help us reset emotionally:

1) Temperature change = changing our internal temperature

2) Intense exercise/or any movement

3) Paced breathing - 4 secs in, pause, 4 secs out, belly breathing/bottom of your lungs

4) Progressive muscle relaxation - purposefully tighten muscle groups for 5 secs and then relax

Walsh (2011) recommends 8 therapeutic lifestyle changes or TLC’s - click the purple text for the article:

1) Exercise

2) Nutrition and diet

3) Time in nature

4) Meaningful relationships

5) Recreation

6) Relaxation and stress management

7) Religious or spiritual development

8) Service to others

Humans have 3 universal psychological needs:

Autonomy

(a sense of choice and independence)

Competence

(a sense of mastery or feeling you are good at something)

Relatedness

(a sense of belonging and connection)

Reflect: How can I improve my sense of choice, mastery, and belonging?

For a similar model, click on the purple text: Circle of Courage

1.5 Behavioral activation

Even a sliver of action often leads to more action...

Thoughts, feelings, and actions all influence each other - Change one and others follow!

Thoughts

Emotions

Behaviours

1.6 Problem Solving Skills

Problem solving skills are so individualized but here are some things that can help:

James Clear wrote the best seller Atomic Habits. Click on this article for a summary about his book.

“How to create a good habit:

1. The 1st law (Cue): Make it obvious.
   
2. The 2nd law (Craving): Make it attractive.
   
3. The 3rd law (Response): Make it easy.
   
4. The 4th law (Reward): Make it satisfying.”
   

Click here for a communication article by Kim Pratt (2014)

General Communication Tips:

1.) Active Listening / Use Feedback

2.) Edit Criticism

3.) Be Gentle

4.) Seek First to Understand vs. Being Understood

5.) Ask Open-Ended Questions

6.) Stay Calm

7.) Use “I” statements

8.) Self-soothing

9.) Accept Influence from the Other

10.) Share Appreciations

Strategies for Ending Arguments:

1.) Validate and Apologize

2.) Change the topic of conversation in a gentle, sensitive manner

3.) Use humor

4.) Yield to the other

5.) Make physical contact

6.) Take a break and re-approach later

7.) Acknowledge common ground between the two of you

8.) Set a timer

Article for 11 Ways to Manage Procrastination

(Lombardo, 2017)

Click Here

Boundaries

The following is quoted from the Set Boundaries Workbook (2021) by Nedra Tawwab:

“As a result of unhealthy boundaries, you might:

• Loan money to people when you don’t have it to give
  
• Offer advice when it isn’t requested
  
• Do things that you don’t like
  
• Be codependent
  
• Complain about how others mistreat you
  
• Not have any time for yourself
  
• Give people several chances to hurt you
  
• Tell people more than you’re comfortable sharing
  
• Feel resentful because you are overwhelmed
  
• Allow others to say things to you without speaking up for yourself
  
• Be frustrated by others whenever they request your support”
  

it gets complicated....

One party might want boundaries to look like this...

So they pull away to get the other party to move closer in their boundaries

And sometimes we leave relationships completely...

Set Boundaries Workbook (Tawwab, 2021)

“Unhealthy Boundaries (Porous and Rigid): There are two unhealthy ways people place boundaries.

Type 1: Porous Boundaries

Porous boundaries are weak or poorly expressed, and they are unintentionally harmful to you. They lead to feeling depleted, overextending yourself, depression, anxiety, and unhealthy relationship dynamics. Porous boundaries are often the cause of enmeshment (lacking emotional separation between you and another person), codependency (unhealthy closeness), and people-pleasing.

Examples of porous boundaries (enmeshment):

• Spending no time apart
  
• Entangling other people’s emotions and thoughts with your own (no separation)
  
• Sharing everything because it’s expected
  
• Seeing differences as a threat
  
• Agreeing with everything
  
• Believing it’s your job to fix other people
  
• Maintaining all the same thoughts and values
  
• Never making decisions without including others
  
• Being unable to say no” (p.20)
  

“Type 2: Rigid Boundaries (Strict Rules)

Rigid boundaries involve building walls to keep others out as a way to keep yourself safe. But staying safe by locking yourself in is also unhealthy and leads to a whole other set of problems. Rigid boundaries are a self-protective mechanism meant to build distance. This typically comes from a fear of vulnerability or a history of being taken advantage of. People with rigid boundaries don’t allow exceptions to their stringent rules even when it would be healthy for them. Rigid boundaries lead to counter-dependency, where we start to believe that we don’t need anyone. Think “the strong one” who believes that they can handle everything without help. Examples of rigid boundaries include: never sharing, building walls, avoiding vulnerability, cutting people out, having high expectations of others, [and] enforcing strict rules” (p.21)

“Healthy Boundaries: When your boundaries are healthy, you are clear about your needs, you say no when needed, you respect other people’s boundaries, and you share yourself in ways that feel comfortable to you. Healthy boundaries in one relationship don’t mean healthy boundaries across relationships. You can be excellent at setting boundaries at work and with your friends but struggle with setting boundaries with your parents. For example, your fears and how people have made you feel comfortable or uncomfortable in a relationship may determine the level of difficulty you have in setting boundaries in certain areas.

You may need boundaries with: your parents, your kids, your partner, your time, in-laws, family, friends, neighbors, exes, strangers, work, social media, yourself.” (p.22)

Exercise - Boundaries Brainstorm (p.30, 37)

“When I help _______________________ with _____________________, I feel ________________________. It would be helpful to ___________________________________________.

I haven’t expressed my needs to ____________________________________________________ about _____________________________________________________________ __________________________.

I find it hard to say no to ________________________ because _____________________________________________________________.”

“Seven Benefits of Setting Healthy Boundaries

1. You’ll reduce any feelings of guilt.

2. You’ll rid yourself of some unhealthy relationships.

3. Your healthy relationships will improve.

4. You’ll discover your strength.

5. You’ll create relationships that make you feel happy.

6. You’ll learn to respect other people’s boundaries.

7. You’ll improve your ability to be as” (p. 32)

Unified Protocol for Transdiagnostic Treatment of Emotional Disorders by Barlow et al. (2010)