INTRODUCTION TO COGNITIVE BEHAVIORAL THERAPY

 

"Cognitive Behavioral Therapy" is a collection of techniques that are effective for treating anxiety. There are three main techniques: Relaxation Training (which consists of different forms of self-guided meditation), Thought Restructuring (which is a type of journaling where you practice writing down your thoughts on paper and talking back to them), and Gradual Exposures (which teach you how to focus on anxiety in such a way that your brain burns through it).

A good analogy would be to think of anxiety as being an enemy that periodically comes up and messes with you. There are three styles of fighting against this enemy: The Yoga Style, The Logic Style, and The Berserker Style.

The Yoga Style of fighting against negative thoughts or feelings is to push them away by focusing on a distraction. American-style distractions would include focusing on work, TV, or exercise. That’s why if you take a week off of work or school with no plans at all, you will actually feel more anxious or depressed. More Buddhist forms of distraction would include focusing on your body, your breathing, or a mantra. This idea comes to our culture mainly through India - the idea of detaching from your thoughts by focusing on a distraction.

In the Logic Style of fighting against negative thoughts, instead of pushing the thoughts away, you engage the thoughts by using logic and reason. This idea basically comes to our culture through Greece - the idea that you can use logic and reason to manage all of your emotions.

The Yoga Style and the Logic Style are notorious for working well for mild and moderate anxiety, but then not working at all when you are really stressed. That’s because when you are really anxious, you can’t even focus on a distraction; and when you are really anxious, you can try talking back to your thoughts, but it just doesn’t seem believable in the moment. That is where the Berserker Style of fighting comes in (AKA Gradual Exposures). The Berserker Style typically works for even severe anxiety (although you should practice with mild forms of anxiety first).

The Berserkers were a tribe of Nordic warriors in the Middle Ages related to the Vikings. They used to go into battle just wearing a bear skin and holding a sword. This is back when people used to wear armor, so these guys were basically crazy. But their deal was that they wouldn’t stop fighting unless they were killed. They just wouldn’t stop. So they became the most feared warriors of the Middle Ages, because if you were a Berserker and you were about to attack a village, the people in the village would be like “Holy #$%! This person is coming that I literally have to kill to make them stop!”... It’s pretty intimidating. So from then on, the kings of the Middle Ages designated their best troops as being their “Berserker” troops and that’s where the word “berserk” comes from in the English language.

The Berserker Style of fighting against negative thoughts is, instead of pushing the thoughts away (as in the Yoga Style), or talking back to the thoughts (as in the Logic Style), you actually focus on the thoughts one-by-one until your brain gets bored of them. One example of the Berserker Style technique is a "Sentence Exposure". In a Sentence Exposure, you take a sentence that causes mild anxiety (for example, “I might not have a great time tonight”) and you repeat it over and over again in your head. "I might not have a great time. I might not have a great time. I might not have a great time..." When you do a Sentence Exposure what you are basically saying to the sentence is, “Screw you. I’m going to keep doing this until either I die or you die. But one of us is going to die right now.”... And the great thing is, no thought can kill you. The sentence always eventually starts to sound like a chant, or a song, or a mantra. If you keep repeating it long enough, your brain either gets distracted or it starts rebelling by talking back to it spontaneously. You then go on to the next sentence and the next sentence until you are back in the moment. The key with exposures is to pick something with a low intensity at first, until you get the hang of it. You can then use the same technique to deal with intense anxiety, physical discomfort (such as pain, nausea, or muscle tightness) and social activities (such as saying hello to strangers, calling friends, and dating). The Berserker Style is almost always the most effective style for intense anxiety. It’s also the one that people usually haven’t tried yet. Detailed description of several Berserker Style techniques are contained on this website.

Teaching all the Cognitive Behavioral Techniques usually takes me 5 weeks when I'm working with patients. So, in 5 weeks my patients usually know whether or not the techniques are working. We then start focusing on social skills, assertiveness, and/or relationship skills (which are also covered extensively on this web site).

Although self-help is not the same as one-on-one treatment, I'd still like to provide you with the timing of how I teach these techniques to my patients. Hopefully, this will help prevent you from getting overwhelmed by trying "all the techniques at once."

Week 1 : Yoga Style (11-Muscle Relaxation, Sensation Focusing)

Week 2 : Yoga Style (Permission Breath Counting, Reciprocal Inhibition)

Week 3 : Berserker Style (Sentence Exposures)

Week 4 : Berserker Style (Sensation Exposures, Real-Life Exposures)

Week 5 : Logic Style (Dysfunctional Thought Records)

Weeks 6-9: Social Skills, Assertiveness Training, Relationship Skills

 

Although the Berserker Style (Gradual Exposures) is usually the most effective, as you can see above I've actually found it best to start with the Yoga Style (Relaxation Training). This allows you to ease your way into the treatment techniques.