Cognitive Behavioral Therapy

It is estimated that over 250 million people worldwide suffer from an anxiety disorder. The mainstream method of treating such disorders is cognitive behavioral therapy, or CBT. CBT is based on the idea that certain situations trigger false core beliefs that negatively impact our thoughts, emotions, behavior, and physical reactions. Once we learn how to identify what situations bring upon such destructive thoughts, we can practice developing new interpretations that will then change our pattern of reaction. CBT was initially developed in 1964 by Aaron Temkin Beck and is widely used to help people with phobias, depression, anxieties, or addictions. Follow the story of Lily to see how it can be used to treat school anxiety.

The Full Story
CBT

Cognitive Behavioral Therapy is based on the idea that certain situations trigger false core beliefs that negatively impact our thoughts, emotions, behavior, and physical reactions. 

Once we learn how to identify what situations bring upon such destructive thoughts, we can practice developing new interpretations that will then change our pattern of reaction. 

The therapy is widely used to help people with phobias, depression, anxieties, or addictions.

To show how it works, let’s look at Lily, a teenage girl who hates going to school due to her fear of being judged and humiliated.

The first session

In her first session, the therapist tries to build trust and explains how CBT functions since the better Lily understands the process, the more likely it is that the therapy is effective. The therapist also illustrates how our brain, in specific situations, follows a fixed path of reason — which gets stronger after years of having the same thought process.  

Many of our destructive behaviors are based on false core beliefs — thoughts that objectively don’t make sense. We acquired these false beliefs when we were too young to interpret others correctly. Throughout the therapy, Lily will try to unlearn these false beliefs and create new mental pathways that will replace the false beliefs she holds of herself with more realistic thoughts.

The Socratic Method

Once Lily understands the process, the counselor begins to ask questions following the Socratic method, a form of argumentative conversation that stimulates critical thinking to draw out false ideas and underlying assumptions.

“Would you like to tell me why you are here today?” Starts the therapist.

“Because I think I’m not normal,” Lily responds.

Therapist: You appear perfectly normal to me, can you be more specific?

Lily: I think I’m afraid of people.

Therapist: So, you are afraid of me?

Lily: No 

Therapist: Do you feel socially insecure?

Lily:  I’m not sure what you mean.

Therapist: Tell me how you feel about school.

Lily: I’m scared of going because they think I’m stupid.

Throughout the interview, the counselor takes notes of Lily’s answers and identifies the signs of social anxiety based on a false core belief – Lily believes she is stupid.

Homework
Introspection

For homework, Lily should practice introspection. The goal: to find out which situations trigger her negative thoughts. She gets a learning journal to keep record of all triggers and other observations, such as self-talk or interpretations of particular events and people. 

During the following week, Lily becomes more aware of her thoughts and the physical reactions they trigger. By paying attention to her feelings, she identifies a specific pattern which occurs every time during math class. The moment her teacher begins to ask questions her heart starts racing and her palms get sweaty – she worries about having to answer the question, about making a mistake, about looking dumb in front of all the others.

The second session

In her second session, Lily shares her observations and the therapist helps her realize that her cognitive-behavioral patterns are false. First, her math grades are great, so she should feel anything but stupid. Second, she explains that there are always more interpretations to the same thing. What to her may look like her “stupid” face, to others she may just look unhappy about having to answer. The reason she is afraid of what people think is a form of social anxiety — a completely irrational cognitive behavioral response.

Strategies
Strategies

As the sessions continue, the therapist suggests three practical strategies:

Through Journaling, Lily records her negative beliefs and reformulates them into positive ones she can replace them with.

Constructive Self-talk, helps her to replace a critical voice with a positive one.

And she starts exposure exercises, which means Lilly deliberately puts herself in situations where she becomes the center of attention.

Along the way, the two set goals that are specific, measurable, achievable, realistic, and time-based. SMART goals give her control over how she progresses thus helping her to gain confidence in herself.

Over time and with a lot of practise, her brain builds new neural pathways that lead to different, more neutral reactions to the same old triggers. And one day, Lily may even enjoy the thrill of speaking in front of her class. Her interpretation of the situation is more realistic and more aligned with those of the others.

Cognitive Behavioral Therapy
Blind

CBT was initially developed in 1964 by Aaron Temkin Beck. Beck hypothesised that people’s feelings are determined by the way they interpret situations, rather than by the situations per se. About depression he once said: “If our thinking is bogged down by distorted symbolic meanings, illogical reasoning and erroneous interpretations, we become, in truth, blind and deaf”.

Sources

Dig deeper!

Take a more in-depth look at journaling with this article on thought diaries.

Classroom exercise

Journalling is a fundamental part of CBT, why not recommend your students start journaling their worries about school. Together, if they ask for help, or individually if they want to keep their journals private, you can set SMART goals based on reducing stress and anxiety around school.