Sometimes it feels like everyone has got some form of mental health concern, whether it’s based in depression, anxiety, or generally distorted thinking. Despite how frequent the experience of mental health problems is, many people don’t really know what their options are aside from medication and basic talk therapy. While medication is definitely an option for some people, psychotherapy is also a great option. CBT, or cognitive behavioural therapy, is a form of treatment for many mental disorders including depression, anxiety, OCD, PTSD, borderline personality disorder, and addictions among many others. Studies have shown that it can be just as effective as medication for many people and in some cases more effective in the long-run. It’s often used with the help of a therapist or psychologist, but you can learn the basics on your own and use it to help yourself.
How CBT works and how to get started
So what exactly does CBT involve? The basic belief is that situations trigger thoughts which result in an emotional response. For those experiencing some form of mental health trouble, CBT is typically used to step in and change the thoughts that cause the emotional upset being felt. When these thoughts are altered or replaced, the emotional response is different and you can train your brain to think thoughts that keep you comfortable and happy more often. Some describe it as a way of developing coping mechanisms so you can better handle whatever undesirable thoughts you’re experiencing or behaviours you’re exhibiting.
CBT is often done in a session that is set aside specifically for the purpose of therapy, either with a professional or on your own. Multiple sessions are needed for best results, typically 5 to 20 depending on the individual and the problem at hand. First you’ll do an assessment so you can figure out what is causing you to get stuck in a negative cycle of thinking and actions. It’s helpful to commit a bit of time to doing this. You likely know what kind of situations set off your emotional reactions, but you might not give much consideration to the thoughts that take place between those two things. So ask yourself some questions—why do you feel the way you do? What are you afraid will happen? What do you think a certain situation means for you? For example, if you’re agoraphobic and leaving your home makes you panic, ask yourself what you think will happen when you go out. For some exercises, knowing exactly what thoughts are causing you distress is necessary.
After you’ve figured out the issues you want to address, you’ll move into doing the real work. Through exercises and analyzing your experiences, you’ll challenge your thoughts and beliefs so that you can change them. The goal is for this to ultimately result in the formation of new thought patterns that allow you to feel happier, more secure, and more balanced.
One technique is carrying out “behavioural experiments” where you try out “what if” thoughts in a situation that usually sets off your negative emotions or actions. It helps you identify what thoughts would be good to replace your current ones with. Here’s an example: if you’re struggling with binge eating, you would choose a couple of different thoughts that could potentially lead to the desired outcome which would be not overeating. These might be, “If I’m hard on myself, I won’t overeat” and “If I’m kind to myself, I won’t overeat.” Then, at meal time or throughout the day, try the first one—criticising. Did it make you eat less? Or more? Record the results. Next time you eat or through the following day, try the second thought—being kind to yourself. Did that one make you eat less, or more? Record those results and compare them to your earlier exercise to see which phrase was more accurate. This exercise can help you learn what you need to think or do in order to achieve the outcome you’re after. In this case, you would have learned what kind of thought resulted in eating less and you could then focus on the thought pattern that proved more beneficial.
Pleasant activity scheduling
Pleasant activity scheduling is a technique that is especially helpful for people with depression. It’s very simple—just plan one enjoyable activity for yourself for each day of the coming week. Make it something that you don’t usually do but that you like doing. It could be drawing, going for a walk, or watching the sunset—anything that can be done in a short period of time and that is a healthy activity. The goal is to get you into a happier, more positive mindset for a bit of time every day. You can even increase to two or three of these activities each day if you’re feeling ambitious. The exercise can be altered, too, by planning activities that make you feel another positive way, like confident, accomplished, or relaxed. This technique is highly adaptable and can be used to actively help you get into the mental state you want to be in.
Thought records are easy to do and great for helping you work through distorted thoughts. In so many forms of mental illness, so much misery is a result of thoughts that don’t accurately reflect reality, despite how true they feel at the time. To do this exercise, start by writing down the thought that’s upsetting you at the top of a piece of paper and divide the paper into two columns. In one you’ll write down evidence that supports the thought and in the other you’ll write evidence that the thought is not true. Let’s say you have social anxiety and you’re struggling with the thought that everyone is judging you when you’re in a place with a lot of people. You’ll write, “Everyone is judging me harshly” at the top of the page. In the “support” column, you might write down that you caught a couple of people looking at you. In the “against” column, you could write that people are busy going about their own business or that the people you interact with are generally friendly. You can then examine the evidence and determine which statements are objective facts and which side is more representative of the truth. Doing this activity can help you to weed through the emotional thoughts that are rooted in anxiety and change your beliefs through logical analysis.
Exposure and response prevention
If you’re struggling with OCD, exposure and response prevention, or ERP, is a form of CBT that could be really helpful for you. In most forms of OCD, an obsessive thought leads to a feeling of anxiety which the individual then tries to alleviate by carrying out a compulsion or ritual, though the relief is only temporary. They often wind up repeating the compulsion over and over. With ERP, you’re exposed to a situation that sparks the anxiety but then you don’t indulge in any compulsion. Instead, you sit with the anxiety until it starts to fade. The idea is that being exposed to your fear will help resolve it. This exercise is a bit more intense than the others mentioned here since it can raise your anxiety before it helps ease it, but it’s very effective for overcoming fears.
A common manifestation of OCD is an intense fear of contamination that leads to compulsive handwashing. For this situation, you would touch something you normally fear is contaminated—like a door handle, a light switch, or even the inside of a toilet—and then resist washing your hands. Immediately after this exposure, rate your anxiety on a scale of 1 to 10, then do it again in a minute, then in another, and so on for several minutes. The number should start to decline as you realize that nothing bad is going to happen. Customize the exercise for your particular problem and repeat it over multiple sessions to help you get over your fears, whether they’re the type that results in compulsions or not. If you’re especially scared, it can be helpful to ask someone you trust to stay with you while you sit with the anxiety and resist compulsions the first couple times you do this exercise.
These are just a few options for cognitive behavioural therapy exercises, but are some popular ones that can be done on your own fairly easily. Which exercise will be best for you will depend on what kind of patterns you’re struggling with, but most of these can be customised to fit with and address almost any thought- or behaviour-based problem. Remember that CBT is most effective when repeated over the course of several sessions, so if you don’t feel significant improvement after one or two, don’t feel discouraged; just keep going and give it a chance. It’s a well-studied method of improving mental health and is established as being highly effective. But if you keep up with it and learn that it’s not for you, don’t worry—there are always more options. You just have to find what works for you.