Patrick J. Hart Psy.D.
Seattle Private Practice: Cognitive Behavioral Therapy

The Below Summary:
Reflections by an anonymous client undergoing cognitive behavior therapy.

Dynamic Interaction: Belief ~ Emotion ~ BehavorCognitive behavioral therapy is so named because it focuses on the dynamic interaction of cognition (belief), emotion (feeling) and behavior (action). The practice is based on developing a clear understanding of just how our thoughts (beliefs) come to determine (shape) our feelings (emotional experience) and therefore guide our choices for the actions (behavior) we take.

Conditioned Response: Cognitive Interpretation Another way to view this dynamic is to see the process as that of stimulus (event of the world) "causing" a thought (i.e. cognitive interpretation or judgment) which then gives rise to an emotional "reaction." Through this dynamic process emotions get associated with various (life contexts) stimuli. This is how "pathological" fear (frequently distorted judgment) starts and it is often where anxiety or depression begins. An outgrowth of anxious and depressive thinking . . .

Irrational Beliefs: Maladaptive ThinkingWhat results, in someone with a propensity for negative thoughts (irrational beliefs) is a "cognitive-behavioral problem cycle" where, for example, a lack of self-esteem (rating oneself negatively) leads to complaints of "low self-esteem" (arbitrary negative and self berating) and a perceived sense of helplessness and hopelessness to accomplish effective personal change. The way to break the cycle is not simply to decrease (get rid of) of maladaptive thoughts and beliefs but to recognize  thoughts for what they are (maladaptive self-ratings) rather than presuming them to be "correct" or "believable" (accurate) reflections of reality.

Reality Distortion: Changing Your Mind . . .The client, with help and guidance from the cognitive therapist learns to see (become aware of) these maladaptive irrational beliefs (reality distortions) and learns to dispute irrational beliefs and develop functional thinking habits (adaptive thinking). Cognitive therapy seeks to repair (modify) the reasons (cognitive distortions) that people feel anxious or depressed -- and modify the behaviors (actions) that are associated with such maladaptive thinking.

Rational Beliefs: Adaptive ThinkingThis is quite a clever psychotherapeutic "prescription." And this takes loads of dedicated rehearsal and practice to become a "masterful" (psychologically adaptive) thinker. Psychologists and counselors are trained to help others practice such adjustments in their cognitive appraisal (judgments) of the world, themselves and others. Cognitive and behavioral counseling is based on an abundance of scientific evidence that show it to be an extremely useful adjunct to the resolution of anxiety and depression.

What is Cognitive Behavioral Therapy Used to Treat?Cognitive therapy is best suited for the treatment of, as the name suggests, behavior-based problems such as alcohol and drug addiction, anger management, depression (really sadness),  anxiety (worry), panic, disorder, phobias (irrational avoidance), delusional disorders (reality distortions) and obsessive compulsive disorder.  However, the process of cognitive behavior modification can be used for a wide array of psychological (behavioral) and emotional problems.

What is Cognitive Behavioral Therapy Like?Cognitive therapy, also known as cognitive behavioral therapy was developed in the 1970s by a psychologist named Aaron Beck who grew frustrated with the pace of traditional psychotherapy. Cognitive therapy is intended to be a relatively short-term treatment but still has long-term mental health as its objective, most treatments go 3 to 6 months but this is highly dependent upon the needs of the client.

Principles Behind Cognitive Behavioral ThearapyThe principles behind cognitive therapy are based on the philosophy of the Stoics, a school of thought that was prominent during the Greco-Roman period and cognitive behavioral therapy takes it cues from two central tenets of Stocism. The first is that life, by its very nature, involves good and bad, that pain and obstruction are normal parts of being alive and that both positive and negative events should be met with a certain detachment, a certain intellectual distance; the second significant component of stocism is a skeptical view of superstition.

Basic Assumptions of Cognitive TherapyCognitive therapy takes these two basic ideas and turns them into a process of inductive reasoning whereby the client is able to views their actions and reactions using a inductive or logic process. The goal is to demystify the chain of events that leads to depression, negative thoughts, irrational fears, anxiety, etc. and provide psychological and emotional tools that the client can use whenever the feelings arise.

What Goes On In the Cognitive Therapy Sessions?Cognitive therapy is a process of learning to combat negativity (maladaptive conclsions) with reason. By approaching the problems with (systematic) logic, it is easier to isolate (identify) the emotions that we construct by our thinking, and therefore it is easier to see how, if at all, they actually relate to the trigger (situational) events. Once this separation can be made, it is easier to see how the negativity can creep in and poison the client's thought processes. The process is essentially one of exposing (and disputing) the distortions in the client's thought processes.

Goal Directed Behavior RegulationThe first step in beginning cognitive therapy is a mood assessment of the client by the counselor, this is true of the first sense where a general assessment is made but is also true for each session. By constantly monitoring their mood in this way, both the client and the counselor are able to gauge progress and adjust goals, if necessary. By keeping the agenda both flexible and foremost in the process, cognitive therapy focuses on skill acquisition.

Cognitive Therapy: Reduction of Behavioral AvoidanceFor many clients, cognitive behavioral therapy involves reducing avoidance of the cause of emotional and psychological distress. A pattern of avoidance only serves to reinforce any irrational fears the client may have and, often, exposure to the source of the fear helps to demonstrate that these fears are constructed by fear rather than based in reality. Over time and with practice, the client's negative ideations will lose their power over their emotions. In short, changing behavior is a matter of changing the client's frame of mind and emotional frame of reference; by taking a logic approach to fears and anxieties, the client is able to understand them as irrational and counter-productive.

Cognitive Behavior Therapy Is About Realizing Valued GoalsIn cognitive therapy the client and the counselor work as a team to address the needs of the client. The client has as much control over the process as their therapist does and, in fact, the first step of the process is for the client to decide what, exactly, it is that they want from the therapy. Generally this is a specific problem such as "I want to be able to manage my anxiety and panic attack and get over my fear of flying", "my depression is ruining my marriage", etc. However, the initial goals do not have to be this specific, part of the process of cognitive therapy is often working to isolate what exactly is the nature of the problem in the first place. How long this process takes depends upon the individual needs and desires of the client.

Learn Lasting Tools for Personal Change!In short, cognitive behavioral therapy is geared towards dealing with the client's response (actions) to emotional situations (interpretations) and teaching them (learning) to react in rational, situationally appropriate (functional) ways. The goal is to provide the client with a set of tools that they can carry with them at all times.

Cognitive Behavior Therapy Seattle:
Anger Management, Panic Attack and Anxiety Disorder: Cognitive Therapy for Depression, Post Traumatic Stress Disorder, Addiction Treatment and the Resolution of Trauma and Abuse

Patrick J. Hart Psy.D.
Seattle Cognitive Behavioral Therapist
206-547-HELP (4357)