Cognitive Behavioral Therapy: Part Deux

By Carissa Weber

Photo by Pixabay on Pexels.com

Welcome back to part two of CBT! Cognitive behavioral therapy is such an important way to heal our brain that it warranted two posts. Seriously, even with two posts we may not even be able to go over all the CBT skills and how they work (but I will try).

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

  • Assists people struggling with mental health identify the automatic thoughts that contribute to our mental health
  • Gain awareness of our role in changing those automatic thoughts
  • Change the behavior to something more supportive of healing our mental health
  • Regular and consistent practice of identifying thoughts and challenging them can repair damage to the hippocampus and strengthen the communication between the prefrontal cortex and that darn amygdala

Having coping skills can change how your brain thinks. Learn more

Coping skills alert!

This post is going to be filled with tons of skills and how to use them. Remember, these skills only help with brain healing and effective communication from that darn amygdala if you practice them consistently! They work even better if you walk through them with your therapist. Lets dive in to some of those coping skills and why they help the brain so much.

One of my favorite skills is cognitive restructuring. Cognitive restructuring is a set of skills we can use when we find ourselves stuck in that never-ending spiral of negativity. If you find yourself using the cognitive distortions (especially catastrophizing and disqualifying the positives) this set of skills is right up your ally!

Cognitive restructuring works in the brain by allowing the prefrontal cortex to clearly produce facts to that darn amygdala in a way it not only will listen, but will see how much of a drama queen it is being. As it does this, your limbic system will release the neurotransmitters GABA and glutamate, which calms down any anxiety, fears, or depression you may be experiencing. Isn’t it amazing how our brain can adapt by changing how we react?

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Cognitive restructuring starts first with identifying the cognitive distortions that are being used when you identify that initial thought. Who would of thought the challenge from last week would come in handy for this week’s coping skills? In order to be able to cognitively restructure a thought, you have to be aware that it is happening! This initial step is something you are familiar with from last week’s post. When we talk about it in the terms of cognitive restructuring, it is known as self monitoring. Remember when I challenged you to keep your thought tracker? That is part of self monitoring. By bringing awareness to the cabinet if distortions we most often use, we are helping our prefrontal cortex build a case as to why that darn amygdala might be going overboard with it.

If you would like to learn more about identifying cognitive distortions, thought tracking (along with the benefits), and the science behind them, check out my previous post:

Cognitive Behavioral Therapy: Why it works

Once we are comfortable and aware of the cognitive distortions we are using, we can then use the skill known as putting thoughts on trial, or the Socratic questions (everyone calls them something different, but these are the 2 most common names). Named after the great philosopher (and conversationalist) Socratis, the socratic questions are ways we interact when we are trying to establish more facts about a situation (questioning is a skill? Who knew!), identify problems our darn amygdala is causing, and promoting healthy change in how we react.

Socratic questions are open ended questions that allow us to provide reflection on our current belief system. When we are able to gather facts outside of what we are initially seeing about a situation, it allows us to paint a full picture of the experience, not what that darn amygdala wants us to see. This means we are activating our prefrontal cortex, which in turn is activating our hippocampus to assist in pulling up memories of previously known situations and the facts of those situations. Once that is complete, the neurotransmitters glutamate and GABA are released to naturally calm down our body. As our body calms down, our stress goes down. If you remember from The Brain and Mental Health: A Basic Breakdown (Literally and Figuratively, lowering our stress allows our hippocampus to heal and return to a normal size.

Below you will find some examples of Socratic questions you can ask (or have a therapist) once you start to notice your thought patterns and cognitive distortions:

  • Is there a different way to look at this?
  • Am I making any assumptions about this situation?
  • what could the impact or outcomes be if I acted on this thought pattern?
  • What information am I missing to make a healthier choice?
  • Is this thought based on facts or emotions?
  • Can we validate all of the facts?
  • How would someone else respond to this situation?
  • What advice would you give a friend experiencing the same thing?
  • What has happened in the past when you acted on a similar situation? Was it helpful/hurtful to you?

These skills are awesome and help make a difference in our mental health, but work best with a trained professional helping you through them. Remember, I am a therapist by trade but I’m not YOUR therapist. If you need help finding a therapist locally, check out the link below:

Find a Therapist, Psychologist, Counselor – Psychology Today

If you notice, these questions all have something in common. They are clear, concise, fact-focus, challenge our assumptions, and are neutral in nature. There is a reason for that. By staying neutral and clear, decreases confusion (and the release of epinephrine and norepinephrine) that triggers that darn amygdala to signal the anxiety response. Remaining neutral allows the prefrontal cortex to keep the limbic system calm, cool, and collected. Another benefit to keeping the stress response low is it keeps the limbic system from feeling attacked. I don’t know about you, when I feel attacked, my darn amygdala throws up its arms and asks if I’m ready to put my dukes up.

Interested in learning more about cognitive restructuring? Check out Dennis Greenberger’s book Mind Over Mood. click the link to the right

Part of the questions you may have noticed is that they are assisting in collecting evidence (all of the evidence, not just the ones that support your way of thinking) as part of finding reasons for changing our behavior. Collecting the evidence, and writing it down, can really help your brain challenge the cognitive distortions (especially personalization) in several ways. First, it gives your prefrontal cortex the one to three minutes it needs to catch up with what that darn amygdala is trying to pull. Second, it activates your hippocampus to pull out all the information it already has to support the prefrontal cortex. Third, by writing down the facts, you are allowing your brain to process the information through action (essentially, this builds a bigger case to prove that darn amygdala is being a drama queen).

Some ways to challenge the negative thoughts is by asking questions! Along with the list above, here are some other Socratic Questions that you can use to help gather evidence to disprove that cognitive distortion:

  • How does calling yourself a (insert insensitive self-talk insult) impact you?
  • Does this thought pattern cost you anything emotionally?
  • Does this thought pattern impact people around you?
  • How does this thought pattern promote your dreams?
  • what are the long term effects of this thought pattern?
  • Is the evidence painting a different story?

These questions really make you slow down and think (that’s the point!). Some of them may be hard to answer, but by doing so, you are gaining knowledge about yourself and building that case to reel in your darn amygdala.

Another skill within the cognitive restructuring skillset is decastrophizing. Just like the name implies, decastrophizing helps us with cognitive distortions (especially catastrophizing) to help our darn amygdala to stop focusing on all the bad things that could happen, just what is happening in the here and now.

How many times have you went down the rabbit hole of despair when a friend didn’t return a message right away? Does your thought go to “what if my text sounded weird?” or “what if they really don’t like me?” Maybe it is more like “I knew people see me as a screw up.” Using the questions below can help you identify the irrational thoughts driving your anxiety (and desire to control every ounce of things outside of your control):

  • What are you the most worried about in this situation?
  • How likely is it (percentage wise) for this worry to come true?
  • What would happen if that worry came true?
  • What is the worst thing that could happen if your worry comes true?
  • Is there evidence to prove your worry would come true?
  • Will this impact you one week from now? How about in a month? Will it still impact you in a year?

Take a moment and look at the pattern here. Catastrophizing (and fortune telling) tend to start with the statement “what if.” Decatastrophizing tends to follow a similar pattern by asking if that “what if” comes true. These questions give the prefrontal cortex a script to use that darn amygdala’s medicine against itself. The hippocampus starts in with supplying the prefrontal cortex with memories that support the prefrontal cortex’s case.

Now that we have done some cognitive restructuring, we are ready for identifying alternate thoughts! If you look at your thought tracker, you are able to reflect on what negative thoughts have been fueling that darn amygdala. Pretty crazy how much we feed that thing, huh? I know I feed that darn amygdala often (and I’m a therapist for crying out loud!), and I have to actively use my cognitive restructuring to identify alternative ways to think about the event that triggered the negative thought.

If we go back to the example of our friend not returning a message for a minute, we remember from Cognitive Behavioral Therapy: Why it Works thinking we weren’t important. Looking at the situation with all the facts, what other ways can you see it? Maybe our friend got super busy? Are they anxious and just too overwhelmed to respond (not that I’m calling myself out or anything)? Could it be they are taking a social media break for a couple of days? The possibilities are endless! How does it feel to know there are other reasons why our friend didn’t message us back right away?

We made it! We got through how to counter negative thoughts through the power of questioning. Thank you for taking the time to learn more about ways to strengthen your prefrontal cortex’s voice and confidence in telling that darn amygdala to kindly shut the fuck up.

To recap this post:

– cognitive restructuring helps challenge the natural assumptions our darn amygdala makes that may increase mental health symptoms

– Using the Socratic and decatastrophizing questions put the irrational thought on trial and helps the prefrontal cortex develop a stronger voice

– collecting evidence to support/disprove your thought helps the hippocampus heal and slow down mental health reactions

– Practice, practice, practice these skills will ensure they turn into an automatic process

Bonus Material!

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With your purchase of the worksheet bundle , you get fun (and helpful) handouts. These handouts are designed for your personal use and to help you remember the facts of each post. This week’s handouts (that’s right, handouts!) goes over the questions associated with cognitive restructuring and decatastrophizing. Enjoy!

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