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Behavioral Therapy (CBT)

It's important not to get this confused with the ever-popular practice of "positive thinking." In CBT the goal is accurate and rational thinking, the kind that is based as much as possible on logic and the available facts. Most of the time this does result in a more positive outlook, but there are also times when its value lies in correcting an undesirably rosy view of things.

The Behavioural Side of CBT

You've probably heard about the Russian physiologist and psychologist, Ivan Pavlov. The one who taught dogs to salivate when they heard a bell. Much, though not all, of behaviour therapy derives from Pavlov's demonstration that events occurring closely together in time are likely to be stored in the brain in a sort of mental package. Because Pavlov rang the bell just as he was about to give the dog some food, the bell and the food became associated with each other. As a result, after a while the dog began salivating when he heard a bell, whether he was given food or not.


The next thing Pavlov discovered was that if he rang the bell too often without coming through with some food, the dog no longer salivated just because there was a bell ringing. This is called, in the jargon of behaviour theory, "habituation." It refers to the fact that a conditioned reaction, in humans as well as dogs, can become substantially unlearned or overridden if it is no longer reinforced.


Reinforcement, in the Pavlovian learning model, means that some event like the ringing of a bell, which doesn't naturally bring forth a reaction such as a salivating, is experienced at the same time as something that does, such as the sight or smell of food. When this happens, the event can become an artificial cue or signal that triggers something resembling the natural response.

A Couple of Practical Examples

For example, if you are deathly afraid of riding in elevators, we can usually habituate that fear if you are willing to crank up your courage and take one elevator ride after another until you are no longer unreasonably afraid. It works because your conditioned fear reaction is not being reinforced, that is, the elevator doesn't fall or get stuck for hours. (On the other hand, if you give in to the fear and avoid elevators, you can pretty much count on spending the rest of your life being afraid of them.)


Or, to give another example, let's imagine that you become depressed following a major setback such as the loss of a loved one. You may feel that it's useless to try to live a normal life, since your energy and ability to enjoy things seem to have vanished. Acting on these feelings, you drop out of your usual activities and social relations, with the result that your life becomes even more constricted and unrewarding, and your morale goes still deeper into the hole.


What we are likely to do in CBT is move you gradually back towards leading a normal life, without waiting for it to feel as good as it once did. If you diligently follow this plan, the renewed contact with your friends, family and regular activities should eventually bring your mood and feelings back to normal. This is because before you became depressed, your usual activities and relationships were associated with more energy and enjoyment than you are feeling now. We are trying to take advantage of those connections as a means of bootstrapping your morale to a more satisfactory level.


Other behavioural aspects of CBT have nothing to do with Pavlov or "conditioning" of any kind. For instance, we often work with patients to experiment with taking some action that is likely to prove beneficial and instructive. Or, right in the office, to enact (rather than just talk about) an interpersonal or internal conflict, in the manner of Gestalt therapy "chair work" or psychochodrama.


These have been just a few illustrations of the hundreds of behavioural interventions that are possible. But perhaps now you have at least some feel for the "B" in CBT.

What Is Cognitive Behavioural Therapy?

Cognitive-behavioural therapy, or CBT for short, combines two very effective kinds of psychotherapy - cognitive therapy and behaviour therapy.


Behaviour therapy helps you break the connections between troublesome situations and your habitual reactions to them. Reactions such as fear, depression or rage, and self-defeating or self-damaging behaviour. It also teaches you how to calm your mind and body, so you can feel better, think more clearly, and make better decisions.


Cognitive therapy teaches you how certain thinking patterns are causing your symptoms - by giving you a distorted picture of what's going on in your life, and making you feel anxious, depressed or angry for no good reason, or provoking you into ill-chosen actions.


When combined into CBT, behaviour therapy and cognitive therapy provide you with very powerful tools for stopping your symptoms and getting your life on a more satisfying track.

The Cognitive Side of CBT

Cognitive therapy is effective with a wide range of problems, including very complex and challenging life situations. But it is based on an astonishingly simple principle:


The way we react emotionally and behaviourally to events is not just a reflection of the events themselves. It also depends on what we think, or simply take for granted, that the events mean.


You must have noticed that when you are experiencing an emotion, your body feels different. This is because you're sensing certain distinctive changes in your internal physiology. (It's no accident that the word "feeling" can be a synonym for "emotion.") In other words . . .


To have an emotion is to feel the physical

(bodily) consequences of our thoughts.


Imagine the following situation:


A friend is due to meet you for dinner at your house at 7:00. But it's now past 8:00, and there's been no sign of her, not even a phone call. How are you going to feel about this?

Well, as the above makes clear, there's more than one possible answer:


Now of course there are ways not shown above in which someone might interpret a friend's being late, and different ways, as a result, in which he or she might react emotionally


Note also that your thoughts about your friend's lateness don't affect just your feelings, they can also influence the actions you take. And while it might seem silly to consult a psychotherapist over nothing more than a dinner date, the basic principle is exactly the same when it comes to major and more complex problems.


As the philosopher Epictetus said almost 2,000 years ago:


"The thing that upsets people is not what happens

but what they think it means."


People routinely distress themselves and others with arbitrary interpretations of what is going on. Sometimes this is done out of blind habit, or under the influence of a bad mood or bodily discomfort; sometimes it happens for quite other reasons. Challenging, and at times changing, one's doubtful interpretation of events is much of the cognitive work of CBT.

WHAT YOU THINK

HOW YOU FEEL

WHAT YOU DO

"She might have been hurt on the way here."

Worried or anxious

Call hospital casualty to find out if she's there

"She didn't bother to let me know she was delayed."

Annoyed or angry

Be annoyed with her, or act chilly, when she does show up

"It doesn't matter to me whether people are on time."

Indifferent

Nothing in particular

"I needed the time to fix the house up anyway."

Relieved

Relax and enjoy yourself

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