What is Cognitive-Behavioral Therapy?

For centuries, attempts have been made to explain how we behave and think and how we can change either of those. Dating from the 1950's, Cognitive-Behavioral Therapy (CBT) has attempted to answer these questions.  Research continues to demonstrate CBT to be a very efficacious therapy for a wide variety of complaints. Its premise is that behaviors and emotions are determined by what we think and how we process information. Of primary focus to practitioners of CBT are a client's beliefs (sometimes referred to as expectations), of which most are subconscious, and his or her distorted thinking processes.

The beliefs of most concern in therapy are not the grand scheme ones such as whether God exists, or the Earth is flat, but more subtle ones relating to how we interpret life events, people’s actions and comments, and how we think we and others should or ought to behave. These beliefs predispose us to react in predictable ways when presented with the same stimulus or situation. And because we "learn" most of them at an early age, we are not aware of them or that we might be different from anyone else we know. They often do not become an issue until we become old enough to enter into a relationship with someone of differing beliefs. Relationships such as employee to employer, employee to employee, friendships, romantic relationships, and business partnerships are most vulnerable.

One way beliefs can affect our lives is well illustrated by the example of a young girl who grew up in a family with a passive father figure. In the home, her mother took responsibility for directing the father’s behavior, telling him when to go to work and what to do in most other areas of his life. When that young girl marries, she is likely to bring with her the unconscious beliefs that first of all, she can control people, and secondly that it is the wife’s duty to make the husband into a responsible person. If the man she marries balks at her attempts, she feels sad and angry over her failure. So, she redoubles her efforts which, again, fail. As failure after failure fills her history, she becomes more angry, resentful, and depressed as she contemplates what a failure she is as a wife, or how stubborn her mate is. To date, numerous common faulty beliefs have been identified by researchers. A very brief list goes as follows.

	"A  spouse is supposed to make his/her mate happy."
	"Everyone gets what they deserve."
	"If I do what others want me to do, they will like and respect me."
	"I can accomplish anything I set my mind to accomplish."
	"My career determines who I am and my worth as a person."
	"I must meet the needs of others rather than take care of myself."
	"I am a failure when something I was involved in does not turn out well."
	"You can always tell how good a parent was by the way their adult children turn out."

The second area that CBT focuses on is what is called cognitive distortions. These differ from beliefs (or expectations) in that the focus is on how we process information. These patterns of processing are learned during childhood and persist into adulthood. They are called "distorted" because they do not accurately reflect reality and generally result in faulty conclusions.

Suppose we put two boys in a room with no windows. Both boys have been wearing sun glasses so long that neither of them is aware that they are still wearing them. And suppose the sun glasses are of good optical quality and color, and that one pair is pure yellow, and the other pair is pure red. We turn the lights out in the room except for one rather bright pure blue light. We then ask the boys to describe what color they see, and before long they are in a heated argument because one swears it is a green light and the other swears it is purple. Neither boy is accurately describing the light in the room, but rather how he perceives it. As long as each is unaware of the effect the sunglasses have on their perceptions, they are under the belief that what they perceive is what is actually out there.

One very common example of a cognitive distortion is "dichotomous thinking," also know as "all or nothing" thinking.  People who have learned to process information this way try to evaluate the world in to two camps, good - bad, right - wrong, holy - sinful, black - white, etc.  They struggle their whole life to categorize everything into one of two classifications -- boxes, if you will.  Such a person might go to a movie with a friend only to leave the theater in a fight because he/she must categorize the whole movie into one of two boxes, such as good or bad.  The friend might point out that parts of the movie were quite good, and some parts were pitiful, but to the person using dichotomous thinking, the movie cannot be broken down into parts, but must be evaluated as a whole. Such people often experience deep distress when trying to evaluate "gray" issues that do not lend themselves to be categorized into one box or the other, e.g. black - white.

Distorted cognitive processing takes on many forms and can cause the afflicted person to totally misinterpret what he/she hears, reads, or witnesses.  And because the processing is so familiar to the person, he or she is unaware of its nature or even its existence. Coupled with faulty beliefs, cognitive distorted processing can play very mean tricks on a person's mind.  I have frequently observed clients read a Bible passage which they claim supports a faulty conclusion or belief, and while reading out loud, either skip words that refute their conclusion or add words to support their conclusion. Working speedily in the background, the brain tends to modify anything that disagrees with, or threatens, a learned way of perceiving the world around them. When I point out the discrepancy, they are shocked, and sometimes will try to rationalize away the newly revealed text in order to maintain their belief.

The task of the CBT therapist is to help the client identify faulty underlying beliefs and distorted cognitive processing, then test those to reveal their legitimacy. Changing beliefs and behavior can, at first, be uncomfortable, even frightening, but those who do so are wise and blessed as a result. Sometimes, and with some clients, attacking an unrealistic belief or distorted cognitive process by using reasoning techniques is unsuccessful. Not all clients are wired to do this well, and even those who are will sometimes be so emotionally attached to their training that reasoning alone cannot relieve it. In those cases, their orientation can be challenged experientially, that is, by engaging in a behavior which proves their training to be untrustworthy.