What is Cognitive-Behavioral Therapy (CBT)?

Cognitive-behavioral therapy (also known as CBT) has been studied extensively and is considered one of the most effective forms of talk therapy for a variety of psychological problems, including depression, anxiety and anger management.

CBT emphasizes the role of thinking (cognition) in how we feel (emotions) and what we do (behavior). For example, if one thinks something like “I am worthless,” then this thought may contribute to feelings of shame or sadness. If on the other hand, one thinks “I am a lovable and kind person,” this leads to a different set of emotions, such as feelings of contentment and happiness. CBT helps individuals identify automatic and repetitive thoughts that contribute to emotional distress and negative behavior. After this, the challenge is to examine these thoughts for validity and replace the irrational thoughts with more realistic appraisals of self and others.

The other component of CBT looks at behavioral change. Changing what one thinks often leads to changes in behavior. Alternatively, changing behavior can also lead to greater well-being. For example, with depression it’s common to experience a lack of motivation and decreased activity level. The feelings and internal thoughts (i.e., self-talk) associated with depression may tell one to stay home, sleep more, not participate in many activities, etc. This is a downward spiral where more inactivity then leads to greater depression. On the other hand, by choosing to increase one’s activity level, regardless of how one feels, one will increase their exposure to potentially pleasurable experiences. More pleasurable experiences can help improve mood.

Cognitive-behavioral strategies work well with mindfulness techniques because both philosophies emphasize how internal shifts in perspective can contribute to more positive mood and behavioral changes. Within this model, individuals have greater access to their inherent internal power in any situation, which is a contradiction to a more helpless, externally-focused mentality. This isn’t to say that there aren’t difficult, external forces out there; of course, there are many. However, by shifting perspective and thinking more rationally, people not only feel better, but also are more empowered to act in useful ways to effect change in their lives and others.

The A-B-C-D Model

The A-B-C-D is a classic model developed by one of CBT’s founders, Albert Ellis, PhD. The model, outlined below, can be used in a variety of circumstances, to help one think and act more rationally.

A = Activating Event
This refers to the initial situation or “trigger.”

B = Belief System
Your interpretation of the situation, what you tell yourself about the event (your self talk) and your beliefs and expectations of others.

C = Consequences
How you feel and what you do in response to your belief system (the emotional and behavioral consequences).

D = Dispute
Examine your beliefs and expectations. Are they unrealistic or irrational? If so, what may be an alternative, more rational appraisal of the situation? A more realistic interpretation is likely to lead to different, healthier emotional and behavioral consequences.

Here is a simple example to illustrate the model:

A – Activating Event
You’re strolling down the street and someone you know walks right by you without saying hello.

B – Belief System
You think to yourself, “What did I do? He/she must be upset with me or doesn’t like me anymore.”

C – Consequences
You start to worry and feel bad about yourself, then you get a little angry and decide to give this person the cold shoulder next time you see them.

D – Dispute
Then you catch yourself and say, “Wait, he/she probably didn’t see me; perhaps he/she was distracted by something difficult that happened earlier that day.” After you say this to yourself, you notice that you feel more relaxed, less worried, more rational. You decide to approach this person next time you see them to inquire about how they’ve been doing.

For the model to work, awareness is the first step. The “B” part – one’s belief system – is very conditioned (i.e., our beliefs and expectations of others are often conditioned by past experiences). Therefore, the thoughts and self-talk that initially occurs is typically quite automatic and on a subconscious level. The challenge is to pause, slow down and increase your level of awareness to identify the contents of A, B and C. With this information, you’re then more empowered to evaluate the situation rationally and alter your response (the “D” part) in a healthier way.

A great way to start experimenting with this model is to write down the contents of A-B-C on a piece of paper after you experience a challenging or difficult situation. Once you review A, B and C, fill in the D part (assuming that you didn’t already take this step). Writing the information down is better than trying to sort through it in your mind. Writing will heighten your awareness, bring more clarity and make a more lasting imprint on your memory bank. Practicing the ABCDs after the fact will eventually lead to implementing these changes in the moment, when you’re actually experiencing the problem.