A few years ago, pre-pandemic, I scheduled an in-person meeting with a client in Brooklyn. It was an opportunity to meet the team and nurture a relationship that, until then, had been purely long-distance. I’d been to New York City countless times (occasionally venturing into Brooklyn on foot), but I’d either taken the train or my husband had driven. I confess, the prospect of driving to Brooklyn from Philadelphia had my stomach in knots.
Like many people, I carry some limiting beliefs about myself that stem from childhood, and I knew I’d feel an enormous sense of accomplishment once I’d proven I could drive myself. I also knew that to stay calm, I needed to feel in control. So the day before my meeting, I went to Google Maps, entered my client’s address, and navigating in street-view mode, “drove” there virtually.
Seeing an image of my destination on screen and noting in advance which streets were one-way and where I’d need to park took away the element of surprise. The next morning, I drove there with confidence and chalked it up as a win. I now have that memory to draw strength from the next time I’m feeling anxious about traveling to an unfamiliar place.
I was reminded of this experience after speaking with Laura Braider, PhD, a psychologist and AVP of College Mental Health at Northwell Health, about cognitive behavioral therapy (CBT), a type of mental health therapy backed by years of studies.
Challenging and reframing thoughts and breaking an overwhelming task into smaller steps are just two of the tools that therapists, including Braider, use to help patients change behaviors and overcome negative thoughts. Given that CBT is considered a talk-based therapy, I was surprised to learn how action-oriented it can be.
Here are five takeaways from our conversation that may surprise you, too:
CBT comprises different therapeutic approaches
“The term CBT can be misleading because there are many different types of CBT,” explains Braider. Cognitive behavioral therapy refers to an umbrella of evidence-based treatments, including exposure and response prevention (ERP or EX/RP) for obsessive-compulsive disorder (OCD), CBT for anxiety and depression, and dialectical behavior therapy (DBT) for regulating emotions and interpersonal relationships, to name a few.
The CBT playbook is often nuanced and creative
All forms of CBT share a structural foundation and protocols that follow a specific order. But within that structure, there’s room for personalization. “There can be activities involved that provide a sense of pleasure and mastery of certain skills. It’s not a rote, paint-by-numbers treatment,” Braider says.
She gives the example of a young patient she is helping overcome social anxiety. “As a project, I have him going into a bakery and ordering macarons, so that weaves in fun but is also a challenge.”
CBT therapists prioritize problem solving
“The first thing to understand about CBT is that it really focuses on the present and understanding what’s contributing to the problem or making the patient more functional and less uncomfortable,” notes Braider. “Some therapies delve more into the past and history of the patient’s family. This therapy is more focused on understanding what the problem is and correcting it.”
She adds that with CBT, it’s assumed that problems have more than one cause, usually both biological and environmental (nature and nurture). “CBT recognizes that it’s a combination of thoughts, feelings, behaviors, social interactions, and the environment that contribute to a presenting problem,” says Braider.
CBT calls out unhelpful thinking patterns
Braider points out that many CBT treatments are centered around irrational thoughts that go through our heads that we may not even notice in the moment. “We do notice that we feel bad after having those thoughts,” she says.
“I don’t tend to be phenomenal with technology,” Braider explains. “Sometimes when I’m typing, I’ll notice my kids looking over my shoulder and sighing because they just want to type for me. I’ll catch myself saying, ‘I’m such a stupid idiot,’ which is a knee-jerk, irrational cognition that I’m verbalizing. What I’m really thinking is, I don’t feel competent in technology, but I’m blowing it out of proportion by calling myself names.”
Braider says those types of thoughts can impact how we feel in a day, and that CBT helps her reframe her response. “Instead, I’ll say, ‘You know what? I’m a busy mom, I’ve got a job, I’m not great at technology, and I’m rushing right now,’” she adds.
CBT is typically goal-oriented, involving a progression of tasks
CBT most often centers around a specific challenge the patient is facing, such as overwhelming anxiety in social situations or self-destructive behaviors in relationships. “We’ll address the problem and see how pervasive it is in their lives. Usually, we find patterns of thoughts people default to that are less than optimal for mental health,” Braider says.
She describes treatments as collaborative, with the therapist and patient developing a plan for dealing with specific situations. The patient then takes a series of gradual steps to gain a sense of control and predictability.
For instance, someone who struggles to interact with other people may start by initiating a conversation with the barista when they buy a coffee and eventually move up to higher-stakes situations, like a party or networking event.
In CBT, patients are encouraged to recognize their accomplishments. “You’re being taught new skills, such as how to communicate more effectively, how to be more assertive, or how to deal with intense emotions that can’t be avoided,” Braider says. “Even if someone is genetically predisposed to a disorder, we can still intervene and help that patient identify what might be triggering it and how to respond in a more productive way.”
