Common Misconceptions of Cognitive-Behavioral Therapy

In this previous post I provided an overview of cognitive-behavioral therapy (CBT), a therapeutic approach based on the idea that our thoughts (i.e., running commentary in our heads), feelings (i.e., emotions), and behaviors (i.e., things we “do”) are all related to and influence each other. To follow up, I thought it would be useful to address some of the common misconceptions people have about CBT. Given how popular it is, there is plenty of information about CBT on the web, not all of it good or accurate.

CBT teaches you to think positively.

Because CBT theory emphasizes the interaction of thoughts and emotions, a major component of therapy is challenging unhelpful patterns of thinking (i.e., cognitive distortions), such as all-or-nothing thinking (“My girlfriend recently broke up with me, I’ll never find anyone to love me”) or catastrophizing (“Since I got a bad grade on this test, I’ll likely fail this class and won’t graduate”). Because the vast majority of these distortions are negative, many people assume that one goal of CBT is to replace negative thoughts with positive thoughts. However, that is not quite correct. The key is the word “distortion” – the goal of therapy is to challenge thoughts that are not rational, helpful, or based on evidence, and replace them with more adaptive thinking. See this video from the Beck Institute for a great explanation of this issue.

CBT is rigid and manual-based.

A common misconception of CBT is that it is a rigid, one-size-fits-all therapy based on manuals. I believe this belief is popular because there are a variety of CBT manuals for therapists attempting to learn the technique and for use in clinical trials evaluating the effectiveness of the therapy. However, well-trained therapists are skilled in tailoring the approach to the needs of individual clients, and most will also incorporate techniques from other therapy approaches as needed (see my example below of how to use motivational interviewing and CBT together!).

CBT only works with motivated clients.

Because it often includes exercises (homework!) done outside the therapy session, it’s commonly assumed that CBT is only effective with very motivated clients. There are a few reasons why this is not true. First, any therapist, regardless of their orientation, should be trained in how to engage clients through the careful use of language, matching their interpersonal style to that of the client, or by leveraging the rapport built in the therapeutic relationship.

Second, many therapists are trained in a range of therapeutic approaches and can combine approaches as necessary to meet the needs of their client. One approach I’ve found effective is blending techniques from Motivational Interviewing with CBT. It’s a relatively common approach (common enough for an entire book to be written about it!). The thing I like most about motivational interviewing is that it is a “meet your client where they are at” approach that is supportive, gentle, and non-judgmental.

Lastly, one nice feature of CBT is the notion that the therapist and client work on small, approachable goals throughout therapy. A client is not asked to take on more than feels manageable or reasonable, and they get to quickly see tangible results of their efforts. This is reinforcing and often strengthens motivation.

CBT is only supported for use with anxiety and depression.

Cognitive behavioral therapy was developed by Dr. Aaron Beck, who originally applied his theory to the treatment of depression. Since then, it has also become recognized as the gold standard for the treatment of anxiety. However, CBT is recognized as an effective therapy for a wide range of psychological disorders including schizophrenia, ADHD, and eating disorders. See this analysis by the American Psychological Association evaluating the evidence supporting the use of CBT for a variety of disorders.

I hope that you have found this blog post helpful today. If you are in the Austin area and contemplating starting psychotherapy, I am happy to speak with you on the phone to answer any questions you may have, including those about CBT. Please reach out to me at laura@drlaurawahlstrom.com or 512-521-1531.

3 Tips for Surviving the Holidays

The holidays are upon us! Social media, TV commercials, and Hallmark movies depict it as “the most wonderful time of the year.” While that may be true for many, for others it is a time filled with anxiety, loneliness, and bad memories. Regardless of if you are filled with holiday cheer or can’t wait for January 2, here are some tips that will make the holidays go a little smoother.

Watch your drinking.

Between the holiday parties and cold nights hunkered down at home, people tend to increase their alcohol consumption during the holidays. Not only does drinking (especially excessively) exacerbate depression and anxiety, it also makes it more likely you may embarrass yourself at the company party, get in a fight with Aunt Jean about politics at the dinner table, or skip that morning run that helps you feel energized and ready to tackle the day.

Keep up your healthy habits.

Let’s face it: between the constant supply of cookies at the office, cold weather, and hectic social schedule, healthy habits tend to fall by the wayside during the holidays. The best way to keep your mood stable is to practice moderation and continue with a healthy exercise, diet, and sleep regimen. Haven’t made these things a priority in 2018? No need to put off making a change until January 1 – now is the perfect time to create new healthy habits.

Say no.

When we overextend ourselves and don’t take the time we need to recharge, those holiday parties end up feeling like a chore. You know yourself – if two parties in a weekend is too much, choose the one that is more important to attend and send your regrets to the other. Or decide you are going to go to each for a set amount of time, say 1 hour.

In addition to social and work obligations, family get-togethers can be extremely stressful. If you find that you are emotionally depleted after a trip home for a few days, limiting your time with your family may be what is best for you. It is better to spend a few hours together and have it be pleasant than stay for several days and end up in an argument or leave feeling depressed.

If adhering to the above suggestions sounds difficult, or you feel too overwhelmed to make those changes on your own, it may be time to enlist help. Just like you don’t need to wait until January 1 to make lifestyle changes, you also do not need to wait until then to start psychotherapy. If you are in the Austin area, please reach out to me at laura@drlaurawahlstrom.com or 512-521-1531 to discuss your situation.

The Power of Breath

Not long ago I was watching the Today Show, and the topic was how to live a longer and healthier life. One of the segments was focused on deep breathing and how researchers believe may play a key role in slowing the aging process. Deep breathing, also known as diaphragmatic breathing (more on that shortly), is one of my go-to skills I teach my clients. Why? It is highly effective, and can be used anywhere, at any time. And, now I may be able to add to that list it helps you live longer!

Our typical breathing tends to be shallow and happens in our chest. When we experience anxiety or stress, our breathing tends to become even more shallow and rapid, and can set off a downward spiral of physical symptoms, thoughts, and behaviors. Hyperventilation (i.e., an imbalance of our oxygen and carbon dioxide levels) may set in, which leads to feeling dizzy or lightheaded, which leads to thoughts that something is wrong with you, which leads to more rapid breathing, which leads to…

You get the idea, right?

One of the keys to stopping this cycle is to change your breathing. This is where diaphragmatic breathing (also known as deep breathing and belly breathing) comes into play. Instead of taking rapid, shallow breaths from your chest, you take slow, deep breaths from your belly. This encourages full oxygen exchange, slows your heartbeat, and lowers blood pressure. All of those scary physical symptoms that are signaling to you “something is wrong with me!” have been thwarted.

What if you don’t struggle with anxiety – can diaphragmatic breathing help you? Absolutely! For those who deal with day-to-day stress, have difficulties, winding down, difficulties sleeping, trouble “shutting your brain off” at the end of the day, diaphragmatic breathing can help you relax.

Diaphragmatic Breathing Instructions:

To start, find a quiet, comfortable place to sit or lie down. Place one hand on your belly, and begin taking a slow, deep breath in. You should feel your chest expand, and your belly rise. Then, slowly expel the air from your chest. Continue breathing this way, counting as you breathe in and out. Each person is unique, so the number of seconds for the in and out breaths do vary some. I usually start with “In… 2… 3… out… 2…. 3” with my clients and adjust from there. You do not want to breathe so deeply that you are feeling dizzy or lightheaded – that is specifically what we are trying to counteract! If you find that happens, breathe more shallow or take shorter in and out breaths.

It is most helpful, especially at the beginning, to have someone else (therapist, friend, spouse) count for you while you breathe. There is also a great app you can download called Breathe2Relax that will give instructions and guide you through diaphragmatic breathing exercises.

There are 2 things I think are crucial for diaphragmatic breathing to be effective:

Expectancies – Simply put, if you believe in the rationale and science behind diaphragmatic breathing, it is more likely to be effective. If you believe it is simplistic or silly, it probably won’t help you.

Practice – How likely do you think it is you would make the Olympic track and field team if you had only run one time in the last year? Just like athletes need to train to improve their physical fitness and skills, diaphragmatic breathing needs to be practiced to be effective. A good place to start is daily practice of 5-10 minutes,during a time you are not in the throws of anxiety or significant stress.

I’ve included some helpful links on diaphragmatic breathing below. If you are interested is learning more about anxiety management and relaxation, and live in the Austin area, please reach out to me at 512-521-1531 or laura@drlaurawahlstrom.com.

Mayo Clinic: Decrease Stress by Using Your Breath

Psychology Today: Diaphragmatic Breathing Exercises and Your Vagus Nerve

A Primer on Cognitive-Behavioral Therapy

Is it just me or does it feel like it has been raining forever in Austin? We’ve had fewer opportunities to spend outside, we are seeing much less of that beautiful Texas sunshine, and our already terrible traffic has been worse than usual. Maybe you were already struggling with feelings of depression or anxiety, and the weather has sent those feelings into overdrive. You’re at a point that it feels like too much to deal with on your own and you are considering psychotherapy. My blog post today will give you a primer on cognitive-behavioral therapy, a treatment that my clients and I have found highly effective and helping to overcome a variety of problems.

Cognitive-behavioral therapy, or CBT, is based on the notion that our thoughts (i.e., running commentary in our heads), feelings (i.e., emotions), and behaviors (i.e., things we “do”) are all related to and influence each other. Let’s take a look at an example:

Lindsey was scheduled to meet Justine for lunch at 12:00 p.m. It is now 12:30 and Justine has not shown up for lunch. Lindsey has the thought “she blew me off – what a terrible friend!” This thought leads to her feeling angry (emotion) and ignoring Justine (behavior). However, what if instead she had the thought “something bad must have happened!” This thought would lead to her feeling worried (emotion) and calling Justine to see if she is okay (behavior). Depending on the thought that Lindsey has, the same scenario can lead to very different emotions and behaviors.

So, if we can change the way we think and what we do, we can change the way we feel! Psychotherapy can provide you with step-by-step instructions on how to do that. Some strategies that are used in CBT include modifying things you are doing (and may not be aware of!) that are contributing to your symptoms, learning new ways to cope with distressing feelings, and identifying and changing thoughts that are irrational and/or not helpful to you.

Does this sound too simple or good to be true? The proof is in the pudding! Over 1,000 research studies have examined CBT, and it has consistently been found effective for a variety of problems, including, but not limited to, depression, anxiety, substance use disorders, bipolar disorder, schizophrenia, anger, stress, and chronic pain. Due to this wealth of support, CBT has been identified as an “evidence-based therapy.” The National Institute of Mental Health strongly supports the use of evidence-based therapies (including CBT) for many reasons, with one of the most compelling being to prevent a situation where you spend months or years in psychotherapy and don’t feel like you are getting any better!

If cognitive-behavioral therapy sounds like something you are interested in trying or learning more about, I’ve included some helpful links below. If you are in the Austin area, feel free to give me a call at 512-521-1531 or email me at laura@drlaurawahlstrom.com to discuss your situation and see if I may be able to help you.

Psychology Today Find a Therapist Tool

Association for Behavioral and Cognitive Therapies

Beck Institute for Cognitive Behavior Therapy

Mayo Clinic