Cognitive Behavioral Therapy or CBT is the bread and butter of all psycho-therapeutic modalities. This is because it’s one of the few empirically valid talk therapeutic practices proven in clinical trials to effectively treat depression and anxiety.
Certain fundamental aspects of CBT have been identified in various ancient philosophical traditions, particularly in Stoicism. Stoic philosopher Epictetus believed that logic could be used to identify and discard false beliefs that lead to destructive emotions. This influenced the way modern CBT therapists identify cognitive disruptions that contribute to depression and anxiety.
CBT was originated from Aaron Beck in cognitive therapy, which was later developed into CBT, and Albert Ellis, who created Rational Emotive Behavior Therapy, or REBT, and came up with the ABC Method.
Let’s look at an example of this starting from an activating event. Let’s say your girlfriend tells you to put the toilet seat down. A lot of people know this scenario. After the event occurs, it goes through our filter of perceptive beliefs where we add subjective to the meaning to the event with our thoughts. A lot of guys would have an error in thinking and take it personal by saying something like, she thinks I’m lazy, and the resulting emotion would be anger. And you say something like, why the hell should I? She’s such a nag. Then finally, the resulting behavior would probably be a fight.
That emphasizes the importance of two people having drastically different thoughts about similar events, based on our beliefs and the way we see the world. Therapists attempt to make the client aware of these negative thoughts or cognitive errors. One technique is to challenge them by simply reframing them. Let’s look at a couple more of these beliefs that don’t coincide with reality.
Let’s say one morning you wake up you’re angry. You’re angry because you don’t want to go to work. And later that day it begins to rain, and you just can’t help but complain about that too. But what if you got a full night’s sleep, and the first thing you did in the morning was realize how grateful you are to have another day to experience life. And then when it inevitably rains later that day, it reminds you of your childhood, stomping in puddles. And you think to yourself, this is awesome.
Humans are very emotional creatures. We make decisions and perceive our world based on how we feel in the moment. Major companies notice so they market to people’s emotions rather than their logic. We see the world through the lens of our emotions. This is known as a mental filter or emotional reasoning.
We also tend to make assumptions about how good we are at something or about how an event will go based on previous similar events. However, when reality goes against our expectations, we become sad, angry and depressed. These assumptions are known as jumping to conclusions. Have you ever been late to work and while you’re rushing there you think, oh, my gosh, my boss is going to get mad at me, he’s going to yell at me, and I’m going to get fired, and I’ll probably end up homeless on the streets.
People who do this exaggerate the importance of problems, shortcomings and minor annoyances. This is known as magnification or catastrophizing, where we think of the worst possible outcome for a given situation. CBT works because it makes our often times unaware internal processes and behaviors noticeable.
And it shows you that each of these processes are all connected to each other. Recent research by Jonathan Haidt, who wrote the book, Happiness Hypothesis, says that our emotions actually are the old software that has been developing for thousands and thousands of years. And our higher cognitive part of the brain in the frontal part of the lobes is like the new software.
So in reality, what really happens is, as an activating event occurs, we always experience the emotion first. Then our cognitive process comes in, like a little lawyer, to explain that said emotion. We may not be able to control how something makes us feel at first, but we can choose how to think and act on those feelings.
Behavioral Activation for Depression
Depression can have a devastating impact on patients and their families. People who have experienced one depressive episode are more likely to have a second, and once that has occurred, the risk of third episode is high.
Behavioral activation, a main component of Cognitive Behavioral Therapy, is an effective treatment for depression. It is based on the view that depression stems from certain ‘learned behaviors’ than can be unlearned. Individuals in whom depression can be linked to loss, trauma or biological factors, lack positive reinforcement in their lives. They may indulge in certain behaviors that make them feel good in the short run, but have adverse effects in the long run. Such coping strategies maintain or aggravate depression, making it worse.
Individuals who keep experiencing frequent episodes of depression tend to get more and more socially isolated, which only maintains or aggravates their symptoms. Behavioral activation believes that, by increasing engagement in meaningful activities, patients can address the tendency towards isolation and avoidance, which in turn, can gradually decrease depression.
For instance, a person may decide to sleep in late to avoid the stress he/she anticipates the next day. That leaves him/her with fewer hours for meaningful, enjoyable experiences, which can lead to more depressing thoughts and feelings, further exacerbating or continuing the isolation/avoidance behavior. Behavioral activation seeks to halt this vicious cycle through active engagement, even when the patient is unmotivated, sad or anxious.
The treatment can comprise of activities that the patient engaged in prior to developing depression, daily activities that they have shirked off, or rewarding activities that are related to their values. They include going out to dinner, learning new skills, interacting with family members, doing household chores, or even taking a bath.
Behavioral activation is an evidence-based therapy. Studies have suggested that that it can be as effective as anti-depressant medication in addressing unipolar depression/major depression, without the physical side-effects. It has also been seen to be more effective than anti-depressant medications in preventing relapse after the end of the treatment. The effectiveness has been attributed to the ‘outside in’ approach taken by the treatment, which targets patients’ behaviors to influence their thinking patterns and emotions.
In behavioral activation therapy, therapists try to understand the environmental sources behind patients’ depression, and focuses on behaviors that maintain or exacerbate the depression. As therapy progresses, patients learn how to analyze the consequences of their behaviors/responses to depression. The therapist may use role-based activities or assist with problem-solving.