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Cognitive Behavioral Therapy

Casie Johnston, LPC
Clinician

Cognitive Behavioral Therapy (CBT) is an intervention therapists use to help the client identify how thoughts, feelings, and behaviors all connect. If one changes, they all change. This can help with unhealthy negative thoughts someone may be experiencing, due to certain diagnoses such as anxiety disorders and depression. These diagnoses can benefit from CBT in multiple ways, including cognitive restructuring, emotion identification, and relaxation exercises.

In session, CBT may be shown to the client by drawing a CBT triangle. Thoughts, Feelings, and Behaviors are on each point and arrows are pointing back and forth to each word to complete the triangle. When I draw this, I explain to the client how all three of these connect, and if one changes they all change. If you are feeling angry and instead of yelling, you told a joke and began laughing, your anger will most likely decrease. This is especially useful when working with children. For example;

**KNOCK, KNOCK**

Who’s there?

**RADIO**

Radio who?

**RADIO OR NOT HERE I COME**

If a parent says this to a child, and they start to chase after them and the child may laugh even more and forget why they were even angry!

Cognitive restructuring is one technique used in CBT. This includes identifying the negative thought, challenging this thought, then reframing it. For example, if someone walks into a room with people they are not familiar with, this may lead to negatively thinking everyone in the room hates them. To use cognitive restructuring, they must pause and recognize this as a negative thought, and challenge it by thinking of the reality of the thought, “is it realistic that every single person in this room actually hates me? Even if they do, why should I care?” Lastly, reframe the thought so it isn’t negative, “There are 30 people in this room, if a few don’t like me, that’s ok, I have a lot of love and support from all my family and friends who do love me!” Positive thoughts can help put people in happier moods by taking over the negative thoughts.

One way I can explain this to a child is by comparing their brain and thinking to a stop light. I draw a stop light with the 3 colored circles and ask the child to identify what the red, yellow, and green colors stand for. We then relate this back to their thinking (red = stop, yellow = slow/think, and green = go/act.) Before a car can “go” they need to get a green light so they must stop at the red light. Before acting/going right to green, think about a coping skill or something that helps you calm down, or think about a positive thought to take place a negative one and restructure your thought. This can also allow your emotions to deescalate before having an emotional outburst.

CBT can help with self-harming, for any age, by having the client stop and think before going right to self-harming. If someone wants to stop self-harming, they can replace the behavior with a more positive one as well. When a person wants to stop self-harming, they often experience feelings of guilt after self-harming. This cycle continues if they let the automatic thought take over instead of thinking before acting.

Emotional identification and expression are significantly important in mental health counseling, especially when working with children. Not all children are able to express to someone how they accurately feel, which is important to know how to help the child. When someone is scared, they may need a hug to calm down,however, if someone is angry, they might not want anyone to touch them, so a hug would not help. Learning what coping skills help yourself or your child, is beneficial to help decrease large emotions that can turn into “emotional outbursts.”

In session, there are endless amounts of ways you can help children identify and label different emotions. One way is to show faces to the child and have them tell you what feeling the person is expressing. If the picture is of a person crying and the child says happy, I’d be aware that the child needs to learn proper emotion identification. After, you can help the child learn how to say “I am ______” with whatever emotion they are feeling, and this can help the adult or parent know how to help the child.

Relaxation exercises are helpful when experiencing any unwanted emotions or emotional outbursts. Mindfulness is one technique used to help people relax by helping them be more present and grounded to the moment. One specific mindfulness technique you can use is the 5, 4, 3, 2, 1 method. In this method of relaxation, you find five things nearby you can see, four things you can touch, three things you can hear, two things you can smell, and one thing you can taste. This allows you to be present in the moment by focusing more on relaxing and less on unwanted emotions of fear or anger. In counseling, we would practice relaxation techniques in session then I would ask you to practice them outside of session, so you could learn to relax outside of session on your own.

Lastly, another technique in CBT to help with thoughts, feelings, and behaviors is journalling. This allows the person to write down their thoughts to get them out of their head. This can help with personal growth by restructuring thoughts, improving mood, and expressing emotions.

I personally love using CBT in sessions. This intervention can help with many different diagnoses for many different age ranges. I love to see my clients have those “aha” moments, and it helps change their outlook on something they were dealing with.

If you or your child can benefit from cognitive behavioral therapy, call the intake department at 330-397-6007 today to schedule your first appointment!