What is cognitive behavioral therapy (CBT)?

Part 1: The Basic Model

Cognitive behavioral therapy, or CBT, is a very popular type of psychotherapy for several important reasons:

CBT is structured.
CBT provides practical, hands-on skills.
CBT is focused on the present.
CBT is goal-oriented.

CBT is well-supported by science and research.

Sounds pretty good, right?

The underlying theory behind CBT is that thoughts, emotions, and behaviours are all related. CBT focuses on identifying and changing unhelpful thoughts and behaviours that are causing problems and messing up your life. Thoughts, in particular, play an important role in maintaining negative emotions and problem behaviours. Physical sensations accompany emotional states, and are therefore related to thoughts and behaviours. Here's what the model looks like sketched out:

The easiest way to understand the model is to work through examples. So, with that in mind, here are two examples, one related to a non-sexual situation, and one related to a sexual situation.

Example 1: In the first example, Sam, who struggles with bad anxiety, is supposed to meet a friend for a drink but the friend pulls a no-show. Sam doesn't know why.

Sam experiences a strong emotional response - anxiety, sadness, embarrassment, and shame. Behind those emotions are a set of related negative thoughts that often occur automatically for Sam in similar types of situations. Accompanying those negative emotions are several uncomfortable physical sensations. Because of those strong negative emotions and the related uncomfortable physical sensations, Sam is going to be more likely in the future to avoid putting herself in similar situations. This may lead Sam to isolate herself, which isn't really what she wants. What Sam really wants is to have friends and be able to hang out with them. But because of the way that she thinks, doing what she really wants becomes very difficult.

Example 2: Dan suffers from difficulties with his erections, caused by bad anxiety. This is a significant source of distress for Dan. His girlfriend is understanding. She regularly tries to initiate sex with Dan because she finds it enjoyable, even though Dan believes he's letting her down when he doesn't have a full erection. In this example, Dan's girlfriend starts flirting with him.

When Dan's girlfriend starts flirting with him, Dan starts feeling anxious, scared, frustrated and ashamed. He feels this way because he thinks that she's going to want sex, and fears that he won't get an erection. If that happens, which he's sure will, he'll see himself as an inadequate sex partner. He believes that his girlfriend will be unsatisfied and will leave him. Thinking this way makes him feel physically ill. To reduce the negative emotions he's experiencing and mitigate risk of what he fears happening, Dan starts acting in ways that will insure that sex doesn't happen, such as shutting down (disengaging), making excuses not to have sex (avoidance), or making his girlfriend angry with him so that she won't want to have sex. Dan would much rather be able to have awesome sex, but his thoughts associated with his erectile difficulties are ruining it for him.

Once things are sketched with the CBT model, it becomes clear what the targets of therapy are (i.e., the specific maladaptive thinking patterns, negative beliefs, and unhelpful behaviours). 

There is much more to CBT, but this model forms the basis. Using the model can be extremely helpful for clients to learn how to manage emotions and change behaviour.

Some Questions to Ask Yourself

Are there certain situations that cause you distress? What is the nature of your distress (i.e., what are the emotions)? Is there a pattern?

How are you thinking in those situations, and how are those thoughts related to the way that you feel? Are those thoughts distorted, biased, or exaggerated in some way?

Are you behaving in a way that's helpful, desired, and that aligns with your values? If not, what needs to change?