Cognitive Behavioral Therapy: Why it Works

By Carissa Weber

Photo by Akil Mazumder on

On to more of the healthy and healing skills (finally)! These are the posts I bet the majority of you have been waiting for. Now that you have a basic knowledge of how the brain works, what neurotransmitters are responsible for what, and the general idea that practice produces change, we can explore more coping skills!

Want to jump straight to the coping skills? Click here to learn how

Cognitive behavioral therapy (better known as CBT) has been the gold-standard for therapy for the last 20 years. Developed by Dr. Aaron Beck in the 1960s, CBT assists people struggling with depression and/or anxiety, identify the automatic thoughts that contribute to our mental health by gaining awareness of our role in changing those automatic thoughts so we can change behaviors that decrease our mental health. Confused yet? Let me explain further.

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Let’s use the common example of someone not returning a message. You look at your phone, you see that they’ve seen your message, but there is no response. What thoughts do your brain naturally gravitate to (“why aren’t they responding?” “Are they mad at me?” “I must not be that important”)? Once that thought has popped up, do you notice a change in your feelings and mood based on that thought (you know, going from happy to anxious, or sad, or even angry)? How did that thought, that mood, impact your day? We’ve all been there, when something just like this happens and sabotages our day (maybe even our week). Many times, we don’t even notice the initial thought that really started the whole shebang.

The CBT model is one that requires active participation to identify what is known as automatic thoughts. Those are the thoughts that first pop up into your head and start the cascade of emotions and actions based on those emotions and thoughts. When it comes to therapy, one of the first things a therapist might assign (if they are a cognitive behavioral therapist) is completing something known as a thought tracker. A thought tracker is a tool use to help the brain (more specifically, the prefrontal cortex) learn to identify any patterns in our thoughts that impact our moods and actions. By taking time each day to record the thoughts you are having, it helps the prefrontal cortex develop a stronger connection to that darn amygdala. What have we learned about that stronger connection in previous posts (like in What Anxiety Really is: A Map of Distress to Nowhere)? Stronger connections between that darn amygdala and the prefrontal cortex equal a decrease in distress and an increase in the control over our feelings. Plus, actively journaling (there I go again with the journaling and follow through) your thoughts, feelings, and actions related to those two, results in the release of the feel good neurotransmitters.

“Success-came from wanting a little better tomorrow at the expense of today.

– Chelsey VanHulle-Schaal: friend, equestrian lover, and insightful quote maker

How do we use a thought tracker to get the maximum benefit out of it? Many clients find benefit in maintaining their thought tracker throughout the day. This means keeping your thought tracker close so you can write down what triggered the thought, the label of the thoughts, the emotion that was provoked by the thought, and how you reacted to it, as it is happening in real time. The benefits to maintaining your thought tracker in this manner include: giving your prefrontal cortex time to process all the facts, identifying the thoughts more quickly, and being able to apply a healthy coping skill to change your reaction immediately. Some people dislike this method as it can increase anxiety and make you preoccupied with what you are feeling versus what is happening during your day.

Remember, every brain is different and will react differently than another to a coping skill. You will not know what works for you unless you experiment with it.

The second way (and more common way) people use their thought tracker is by sitting down at the end of their busy day and reflecting on what thoughts they encountered and how those thoughts shaped their experience of the day. This way has many benefits, too. For one, this daily reflection allows your thalamus to retrieve positive memories from your hypothalamus and your hippocampus to release calming neurotransmitters. This translates into your darn amygdala actually calming down, which can result in improved sleep, a decrease in digestive upset, and a strengthening connection between your prefrontal cortex and that darn amygdala. How long do you practice thought tracking? What a great question! If you recall from my previous post, The “Feel Good” Neurotransmitters and How to Release Them, it takes approximately 66 days to form a new habit. By using this number (and actually practicing the thought tracking) this skill alone can assist in decreasing symptoms of anxiety and/or depression just because it brings awareness to the thought patterns that darn amygdala is using (at least that is what Hoffman and his research team found in 2014). Some people struggle with this because they forget about what all happened during their day, causing some stress and decrease in motivation to use the thought tracker.

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Credit to Colton Nieman at #the_natural_perspective

There are several benefits to using a thought tracker. One benefit is shedding light on your core beliefs. Core beliefs are filters we develop over time that shape how we think. These core beliefs can be both positive and negative, and can develop from our experiences in life (like childhood experiences, messages sent to us through media, even bullying events). Just like a pair of sunglasses, core beliefs allow that darn amygdala and the thalamus to see what information they want to see and pass it around the limbic system as much (or as little) as they like. In turn, these are the messages we say about ourselves to ourselves. If we use the example from above, and a friend doesn’t immediately return a message to us, the core belief that could pop up might be “I’m not important” or “I am a disappointment.” That core belief is what filters our thought process and our emotional response (example: I’m a disappointment therefore my friend didn’t want to talk to me). These core beliefs are stored in the hippocampus and come out when the amygdala feels an event warrants it. Can you change your core beliefs? You most certainly can! Just like our self-esteem, our core beliefs can be challenged and changed for the better as we actively practice our healthy coping skills (and kindness to ourselves).

Interested in reading more on core beliefs? Check out Gary Van Warmerdam’s book on the right

Coping skill alert!

Changing a core belief requires a skill called examining the evidence. In the skill, we are using our prefrontal cortex to challenge the instant (and impulsive, might I add) thoughts that our amygdala decides to pull from our hippocampus. Believe it or not, the skill starts off by first examining the information that supports your core belief. Whether that evidence is information that has been said to you for years, letter grades, or even a simple interaction with a cashier at a store, the prefrontal cortex helps identify the objective facts it needs to support this core belief. In doing so, the limbic system starts to trigger the release of glutamate as a way to recall facts.

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The next step in examining the evidence is exploring the information that does not support the core belief. If you’re struggling with your self-esteem, anxiety, and depression, this is where it gets tricky. Why? The filter that the core belief provides makes it hard for us to see ALL of the facts. Do not be surprised if it takes time to identify and locate these facts that challenge the core belief. These facts might initially include facts that have been rejected (for example, being invited out for drinks with coworkers, having someone pay for your coffee, or even that surprise dinner). As tough as it may be, you have to include these facts as they are evidence. Another set of facts that might be hard to add are what are called modified facts. These are facts that you understand are true, however they come with a “but” at the end of them (Examples include “I’m close with my parents BUT they are my parents and have to love me” and “I got an A on the test BUT there was this deep grading curve). As we consider all of the evidence and facts, our serotonin is activated and released. Do you remember what serotonin does? It helps us feel good! Who knew by looking at the facts we could start to feel better?

By practicing this daily (there I go with the whole practicing thing again), you can challenge that core belief and rewire the brain to make it, well, a bit more realistic.

The other benefit to using your thought tracker would be identifying your cognitive distortions (we talked about these guys briefly in Amped up or Shut Down: The Many Faces of Anxiety). Similar to core beliefs, cognitive distortions are filters created by the beliefs we hold. Overtime, we reinforce them with our day-to-day life experiences. This is why they are so subtle and hard to recognize. Soon, cognitive distortions become an irrational way of thinking as that darn amygdala uses false information to create a belief about a situation. In turn, we react to that false information.

“I suspect you will find that a great many of your negative feelings are in fact based on such thinking errors.”

– David Burns, researcher and amazing psychiatrist

Often, we have no clue we are using these distortions in our thinking. How do these impact the brain? That darn amygdala takes the information our senses are providing us, makes an impulsive thinking choice (really thinking to itself “I’m totally interpreting this information right!”), and tells the thalamus to alert the rest of the limbic system accordingly. Sometimes, the prefrontal cortex is involved and can offer some sort of validation to that darn amygdala (“you’re right, this is an accurate way of looking at the situation”), other times, the prefrontal cortex has been left out of the loop (nice going thalamus!) and doesn’t have the ability to respond. By keeping a thought tracker, you are building up information, and the confidence might I add, to allow the prefrontal cortex to identify the pattern and use it as objective facts to kindly tell that darn amygdala to stop being a drama queen.

Drs. Aaron Beck and David Burns have taken a lot of time to study the cognitive distortions that impacts mental health. In their research, they have come up with 11 common cognitive distortions that we all use today. Even if you think you are healthy, mental health wise, you may find yourself using these cognitive distortions on any given occasion. Below, you will find a list and definition of the 12 most common cognitive distortions. Which ones have you use the most often?

  • Catastrophizing​
    • Seeing the worst possible version of a mistake, no matter how small
  • Minimizing​
    • Believing experiences (good or bad) aren’t important​
  • Overgeneralizing​
    • Taking a single experience and generalizing it to an entire pattern​
  • Magical Thinking​
    • Our acts influence unrelated situations​
  • Personalization​
    • Blaming yourself for things outside of your control​
  • All-or-Nothing​
    • Also known as black and white thinking, you think in extremes and ignore the middle ground
  • Mind Reading​
    • Interpreting what people are thinking​ without knowing all the facts
  • Fortune Telling​
    • Predicting the future as the gospel without all the facts​
  • Emotional Reasoning​
    • Thinking emotions are facts “I feel like (insert statement), so it must be true”
  • Disqualifying the positive​
    • Only focusing on the negative​ information provided and discounting the positive facts
  • “Should” statements​
    • Statements you make to yourself about what you “should” do/feel/act
  • Fallacy of Fairness
    • Perceiving the world is a fair place when it isn’t

Hopefully this gives you a good basic understanding of the beginnings of cognitive behavioral therapy, thought tracking, and discoveries from thought checking. In next week’s post, I will go over more about how we start to challenge our thoughts in order to change them. This means we will learn more about how to challenge our depressive and anxious thoughts! I am very excited about this upcoming post, as I am sure many of you are. Thank you for taking time today to read about cognitive behavioral therapy and how it can assist people in changing their depression and anxiety.

To recap this week’s post:

– Cognitive Behavioral Therapy (CBT) is a therapy technique used to challenge negative thoughts

-Negative thoughts can shape how we feel and react to a situation

– Core beliefs are the sunglasses that filter how we take in information

– Cognitive distortions are reinforced beliefs that impact our view on situations

– Consistant practice and identification of thoughts allows the prefrontal cortex to gain strength to tell that darn amygdala to “shut up”

Bonus Material!

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11 responses to “Cognitive Behavioral Therapy: Why it Works”

  1. […] Let’s take a moment to quickly recap the main points of CBT from my last post, Cognitive Behavioral Therapy: Why it works: […]

  2. […] skills we have talked about (like in Mindfulness: The Art of Becoming Calm, Cool, and Collected or Cognitive Behavioral Therapy: Why it Works). Why? We are essentially putting that darn amygdala in a time-out and allowing the prefrontal […]

  3. […] to explore all the facts of that scary change. We can also use the information we gathered from Cognitive Behavioral Therapy: Why it Works and Cognitive Behavioral Therapy: Part Deux how challenging our own thoughts in a logical way can […]

  4. […] store information about what we need to do in the future to feel good. Heck, even in my post, Cognitive Behavioral Therapy: Why it Works we talk about how practice rewires the brain. There is a purpose to my […]

  5. […] other made you dessert). These tell-tales (along with the whole thought tracking we talked about in Cognitive Behavioral Therapy: Why it Works) help you identify what your emotional brain is striving […]

  6. […] Cognitive Behavioral Therapy: Why it Works […]

  7. […] and cognitive distortions can filter how we interact with […]

  8. […] (Quintero and Long, 2021). That is a mouthful. To shorten it up: toxic positivity is a form of the cognitive distortion, […]

  9. […] in turn, initiates the process of creating negative core beliefs about ourselves. The more our darn amygdala feels rejection, avoidance, or even conflict from […]

  10. […] decreases symptoms of anxiety. Third, the prefrontal cortex can use these items of self-care to check the facts to prove to that darn amygdala that the world is not coming to the end. Fourth, the insula […]

  11. […] to look at what healthy coping skills we need to use. Learn more about these coping skills in Cognitive Behavioral Therapy: Why it Works or in Distress Tolerance and how Wise Mind Helps us Accept What is Going on) to help create a […]

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