Cognitive Behavioral Therapy: A Basic Introduction

Cognitive Behavioral Therapy, or CBT, is one of the better-known therapeutic approaches. For a while now I have referred to the basics of CBT as the “flat-headed screwdriver of coping strategies.” Translation: it may not be the only tool in the box, but it is one of the ones we find ourselves grabbing most often.

But what is it? Without getting into the academic history or foundations of the discipline, which could be gleaned through Wikipedia or a Google search, I am hoping in this article to just explain some applicable basics of the approach, as well as what intersection this approach has with Christianity.

To summarize at the start, cognitive behavioral therapy focuses on increasing mental and emotional wellbeing by helping the client to identify thought distortions and replace them with less-distorted thoughts. This may sound like simple “positive thinking” or having a “positive attitude.” Some of that is included, but Cognitive Behavioral Therapy is more than that.

Here is one way of going a little deeper. We have all uttered the sentence, at one point or another “He made me mad,” or “she made me upset.” This is a basic sentence that hardly anyone would pause to analyze.

But that’s just what we’re going to do, here, by asking: what does this sentence imply? Simply put, the sentence “He made me mad” implies that events cause feelings. It implies that a person can cause feelings to happen with me and that it is somehow possible to place feelings inside of another person. It implies that I can cause feelings to happen in the other person and that they, in turn, can cause feelings in me.

But is this true? Of course, it is possible to contribute to someone feeling better or worse. We are either helping or we are not, with the things we choose to say and do. So of course, it is possible to contribute to another person’s negative feeling state.

But to say we cause feelings, or that others cause them in me? I’m implying that there is a problem here, and there is. Something is missing.

Here is a way of getting at this. Imagine the letter A on a whiteboard. This stands for any event, such as what a person does or says. Now imagine an arrow drawn from the A pointing right to the letter B, which is the feeling that results. Let’s say someone just “cut me off” while driving. That would be letter A. The resulting feeling, if you’re anything like me, is anger. That would be letter B, which is the resulting emotion.

Cognitive Behavioral Therapy works on a foundation of assuming that this picture is incomplete. There is something that happens between the letter A (Event) and letter B (Feeling). The resulting feeling is better labeled C instead of B.

So, what comes between an event and a feeling? Thoughts. Meaning. Interpretation. Something must be done by me with the event, for it to mean something so that it results in any feeling at all.

Go back to the example of being cut off on the road. I am most likely to find myself saying “what a jerk” (or, let’s be honest, something worse) when someone pulls in front of my car without a signal and then slows down. I am thinking certain things about this: how rude, that guy is crazy, how inconsiderate. I am thinking he should know better, because he is putting me (and my family!) in danger.

I mean, maybe that’s all there is to it. Or maybe not. What if this particular driver has a family member in the ICU, has been up for days by their bedside, and is driving quickly home from the hospital to pick up some extra things before returning to the hospital?

Imagine you can somehow know this. How different is the resulting feeling? You may still be upset, but not in the same way. The personal offense is probably not there anymore. If anything, you may find yourself feeling something more like compassion than anger.

But notice this: the event doesn’t have to change for the feeling to change. The event is exactly the same: a car pulled in front of me without a signal and slowed down. But the feeling is different because the interpretation is different.

When I started working with conflicted relationships in a multi-day intensive setting, I was struck by how often this kind of exercise proved helpful to the conflicted couple by going about resolving conflict differently. So often, in my experience, someone is mad at another person because their interpretation drives that strong emotion, even when the event has more than one possible interpretation, even when they are wrong!

When I coach this skill today, I encourage my clients to start by simply practicing becoming more aware of the thoughts that play through the mind. It is as if there is a radio station inside of our head. Most of us, when beginning this kind of practice, might have a tough time “tuning in” to what is playing beneath the static.

But increasing awareness is the first step. In a sense, CBT practice begins with mindfulness practice, simply becoming more aware of the thoughts that are playing, especially when we are feeling the worst.

It’s those moments in a relationship where everything was going okay until something happens, and the mood turns. I find myself feeling alone, negative, afraid, angry, for reasons that I can’t quite explain. But one thing we are often sure of in moments like this is that if the other person would just do (or stop doing) fill-in-the-blank, I would feel better. But again, we tend to assume that events cause feelings.

But if we can tune in, and practice this for a while, and get better at paying attention to the thought patterns we tend to run with on a day-to-day basis, we might be surprised how much negativity and assumption we find there.

At this point, many may respond by saying “well, yes, I know I think negatively. But that’s because my partner refuses to change!” Maybe they do, but this work can still be done with benefit.

Psalm 139 is one of my favorite passages for providing context for this kind of work. In this Psalm, David is talking to God about how much more God knows David than David knows him. David speaks to God about God’s vastness, how God’s knowledge is so much beyond his own, even of himself. At the close of the Psalm, David writes:

Search me oh God and know my heart; test me and know my anxious thoughts. See if there is any offensive way within me and lead me in the way everlasting. – Psalm 139:23-24

When we do this, I believe God is faithful to answer. He gives wisdom to those who seek it.

Romans 1:21 gives a striking picture of the effects of sin on the human ability to think clearly and love in a way that pleases God:

For although they knew God, they neither glorified him as God nor gave thanks to him, but their thinking became futile, and their foolish hearts were darkened. – Romans 1:21

So, in short, we think we know ourselves fully when we don’t. And, at the same time, thinking the other person is an idiot and at the same time responsible for my negative feelings. Reality is likely so much more complex than we assume.

I want to be clear: I am not saying that responsibility for negative feelings is the same in all situations. For instance, in the context of domestic violence or emotional abuse, I believe we should be careful about assigning equal responsibility to the abuser and the abused. Abuse is wrong and must be stopped before we get into the subtleties of identifying and changing thought distortions.

At the same time, I can’t imagine a context where becoming more aware of my thought habits, identifying thought distortions, and correcting those distortions with a more logical and more scripturally-sound interpretation of the event wouldn’t be helpful, at least on some level.

Unfortunately, there are also situations where a person’s ability to look inward is being hindered by the effects of unresolved trauma, or some other mental or cognitive impairment. So doing this work presupposes some level of stability. Sometimes it is necessary to stabilize a situation before we can explore and correct it.

Romans 12:2 says, “Do not conform to the pattern of this world but be transformed by the renewing of your mind.” CBT provides a “screwdriver” for doing so. It can be a powerful approach to treating anxious thoughts, depressive emotions, and relational conflict, especially when coupled with Scriptural wisdom.

What am I thinking? How true are my thoughts? How do I know? Is what I find myself thinking in line with what God says is true of Himself? Of the world? Of me? Of his creatures, which all of us are?

How different would relationships be if we all started with something like this approach?

As stated above, the purpose of this article is to provide a basic introduction to Cognitive Behavioral Therapy. I hope I have achieved that purpose. If you or someone you know could benefit from more in-depth work like the work described here, please reach out!