The Behavior Therapy Element of CBT

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

Cognitive behavioral therapy consists of two components: the cognitive part (our thoughts) and the behavioral part (our actions and behavior). CBT focuses on how changing the way we think and changing the way we act can change the way we feel and help us feel better. I have a number of videos that look at the cognitive aspect of CBT that I’ll link to in the description and that you’ll find in my free CBT self-help course. In this video, we’re going to focus on the behavioral part.

The most common behavioral technique in CBT is the original type of behavior therapy, exposure therapy, developed in the 1950s based on Pavlov’s work on classical conditioning. Exposure therapy was conceived as a treatment for what’s known as specific phobias: fear or anxiety about a specific object or situation, like flying, heights, or animals, as well as agoraphobia, which is a fear or anxiety about being in a situation in public where you feel trapped or unable to escape in the event that you start to feel panicky. I describe exposure therapy and how it works in detail in another video that I’ll link to in the description, but the basics are: we usually try to avoid the things that we fear or that make us anxious, which tends to make us fear them even more and increases our anxiety about them.

With exposure therapy, we gradually expose ourselves to our fears and anxieties in a controlled manner, which helps reduce our fear and anxiety, and eventually, we can extinguish our fear, and these things no longer cause us anxiety or distress. Even though it dates back to the 1950s, exposure therapy is still the most effective treatment for phobias.

The most effective treatment for obsessive-compulsive disorder is a type of exposure therapy called exposure and response prevention, in which we gradually expose ourselves to situations that trigger our obsessive thoughts that lead to compulsive behaviors while preventing ourselves from engaging in these compulsive behaviors until we learn that the situations we’re obsessing over are generally safe and not something we need to be concerned about. We don’t need to engage in these compulsive behaviors or rituals to prevent the consequences we fear or to manage our anxiety and worries about them.

One of the most effective treatments for PTSD is a type of exposure therapy called prolonged exposure, in which we gradually expose ourselves to memories of the traumatic event until these memories no longer cause us stress and expose ourselves to real-life situations related to the trauma until these no longer cause us anxiety or distress.

There’s also interceptive exposure for panic attacks, which involves exposing ourselves to the physical symptoms associated with our panic attacks to learn that these symptoms aren’t dangerous or anything to fear. We may spin around until we’re dizzy, exposing ourselves to this feeling of dizziness until we learn that this feeling is nothing to panic over – it doesn’t mean we’re having a stroke or about to pass out. Or we might induce a racing heart with some rigorous exercise until we learn that symptoms like a pounding heart and gasping for breath don’t mean that we’re having a heart attack. By exposing ourselves to the physical symptoms we experience during a panic attack, we learn that we can have these feelings without anything bad happening, which makes it less likely that they trigger a panic attack.

The other main type of behavioral therapy in CBT is behavioral activation for depression. When we’re depressed, we tend to withdraw from the world and lose interest in activities we used to engage in and enjoy and can really limit how much we do. Behavioral activation involves gradually increasing our levels of activity and starting to do more and taking part in activities that can give us a sense of pleasure or enjoyment, a sense of achievement or accomplishment, and a sense of social connection and closeness to others.

So even though when we’re depressed, we might not have the desire to do anything or feel like we have the energy to do anything, and just want to lie in bed or lie around on the couch all day, once we change our behavior, get up, and start doing something no matter how small, we generally start to feel better, and our depression starts to lift, and we start to have more energy and are able to continue increasing our levels of activity until they’re close to back to what they used to be, and we no longer feel depressed.

Other behavioral interventions in CBT include things like relaxation exercises and breathing training, role-playing and assertiveness training, so learning how to behave differently in certain situations, sleep hygiene, and so on.

So how do we get from behavioral therapy to cognitive-behavioral therapy? Well, while exposure therapy is primarily a behavioral technique, it now usually incorporates a cognitive element as well to help consolidate the learning that takes place during an exposure exercise, in which we assess what we learned as a result of the feared outcome not arising, and the discrepancy between what we feared was going to happen and what actually occurred.

And the most common intervention in cognitive therapy, cognitive restructuring, is often used in combination with behavioral experiments in which we expose ourselves to real-life situations to see what actually happens in order to test the accuracy of our thoughts. So if we’re having thoughts like “I’m such a loser, I don’t have any friends,” a behavioral experiment could involve asking some people we know if they want to do something with us, and if anyone says yes, that’s evidence that our thought “I don’t have any friends” may not be that accurate, and I have a whole video about behavioral experiments that I’ll link to in the description.

Now let’s look at some cognitive-behavioral therapies for specific disorders to see how they combine cognitive and behavioral elements.

So CBT for panic disorder can include behavioral approaches like exposure to situations in which we tend to feel panicky, as well as interoceptive exposure to physical symptoms that cause us to panic, and breathing exercises to help slow down our breathing when we do start to feel panicky, and it also includes the cognitive technique, cognitive restructuring, to help counter the catastrophic thoughts we have during a panic attack.

CBT for depression combines behavioral activation with cognitive restructuring to help us recognize cognitive distortions and modify negative patterns of thinking, and so we improve our moods both by changing our behavior and how we act, as well as changing our thoughts and how we think.

CBT for insomnia involves cognitive restructuring to counter negative thoughts about difficulty sleeping, as well as behavioral techniques such as relaxation exercises, scheduling sleep into a regular routine, and sleep hygiene strategies, and I talk more about CBT for insomnia in a couple of other videos that I’ll link to in the description.

CBT for social anxiety disorder combines graded exposure to fear and anxiety-provoking social situations with cognitive restructuring of negative thoughts and cognitive distortions related to social interactions, as well as attentional retraining and attention training.

Social anxiety is associated with what’s known as attentional bias, and during social interactions, we tend to focus a lot of our attention on ourselves, on our thoughts about our performance, and on our emotions and body sensations, as well as on looking for social threats in our environments, which could involve scanning the room for cues about what other people are thinking about us, or focusing our attention on the person we’re talking to is facial expressions or behaviors for signs that we might be boring them or that we’ve said something to offend them.

Attentional retraining and attention training involves learning to shift our attention away from our own thoughts, emotions, and body sensations, and away from looking for social threats in our environments related to what other people may be thinking about us. Instead, keeping our attention focused on our actual social interactions and our conversations with other people. I’ll have a video that looks at how to treat social anxiety disorder in more detail coming out soon, so please subscribe so you don’t miss it, and I’ll put a link in the description once it’s out.

Attention training is related to mindfulness, and elements of mindfulness are now often incorporated into CBT either as an additional component to CBT, or integrated with CBT on a fundamental theoretical level, as in the case of mindfulness-based cognitive therapy, dialectical behavior therapy, and acceptance and commitment therapy. To learn about a behavioral technique that plays an important role in managing and regulating emotions in dialectical behavior therapy, please check out my video on opposite action.

In these therapies that incorporate mindfulness with CBT, they are often referred to as the third wave of CBT. The first wave being behavioral therapy, the second wave involving the addition of cognitive therapy to behavioral therapy to form cognitive behavioral therapy, and then this third wave that also integrates mindfulness with CBT. I’ll talk more about the third wave of CBT in an upcoming video.