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5 Ways Cognitive Behavioral Therapy Surprised Me

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CBT stands for cognitive behavioral therapy and is commonly used to treat mental health conditions like anxiety and depression, but can also be helpful for lots of other conditions.

I had my own experience of CBT in 2019 for social anxiety, and I thought that I was as prepared as I could be after doing a fair amount of Googling — but there were still quite a few surprises along the way.

These surprises came about because my experience of CBT didn’t match all of my expectations, and they definitely weren’t things I’d read online. This made me want to share my experience so other people would have more realistic expectations of CBT than I did when heading into it for the first time!

I’ve had a good think back over everything I wasn’t expecting and have narrowed it down into this list of five things that surprised me about CBT. I hope you find it useful and interesting and as always, feel free to contact me about it!

1. It’s Not Counseling

The first thing that became clear to me when I went to my therapy sessions was that CBT is not counseling. I know this might seem obvious because the clue is in the name “therapy,” but this is something I definitely overlooked. I expected the sessions to mainly be focussed on what had happened to me in the past and how that was causing me to feel the way I did. The reality was that only a small amount of the sessions were focussed on this.

CBT is actually about learning practical methods and putting plans in place to help you overcome challenges in your life that present themselves because of your illness. It seemed to me that instead of ruminating over the possibilities of why you’ve ended up feeling the way you do, you and your therapist start from the point of just accepting it and working from there.

You then learn that the way you think and feel are reinforced by behaviors that you have learned to protect yourself from those feelings, and the focus shifts to recognizing and stopping these behaviors as a way of minimizing the negative impacts on your life, and in time improving the way you feel.

2. Have Examples Ready

A little prep work can go a long way, especially in your first couple of sessions. It can help your therapist understand your condition (and potentially make diagnosis easier) and might even make you feel less nervous knowing you have a good starting point.

A very helpful way of preparing for CBT would be to write a list of examples of what emotions you feel and in which situations you feel them. Include as much detail as you can, such as are you always alone when you have these feelings, or is it a significant other, friend or parent that triggers you?

Any specific examples, i.e. when you can tell the whole story of events, will also be really useful. Your therapist can use these to help you to unpack the underlying thoughts that caused the emotional reaction and which behaviors reinforced it.

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3. Learn How to Describe Your Feelings

I think a lot of us aren’t used to talking about our thoughts and feelings with others (I know I’m definitely not!) and that can make it difficult to describe them in an effective way to your therapist.

It came as a shock to me that when I had to describe the emotions I felt in certain scenarios, I really struggled. I would often opt for really simplistic adjectives, such as sad or angry, without even realizing there was a possibility of being much more specific.

Obviously the more specific you can be the better, and I highly recommend having a good think about what emotions you are feeling on a deeper level than you might initially do.

A fantastic resource to help is this colorful wheel separated into different emotions to help you describe how you’re feeling. I found it posted on The Mighty, and it works by finding the relevant emotion in the middle and working your way outwards. I was really surprised to find words that described how I felt so well without being able to think of them myself, such as exposed or vulnerable.

4. It’s Not Easy

Another thing that might seem obvious but surprised me is that CBT isn’t easy. I think I kind of expected to turn up to my therapy sessions, talk about myself a bit and then be magically cured. This definitely is not what CBT is like.

To be able to engage with CBT properly you have to be self-aware all the time and if this isn’t something you’re used to doing, it can be really tricky.

You have to be really tuned into your emotions, behaviors and surroundings outside of therapy to be able to make the most of the time you are in therapy. This allows you to identify triggers to work on and can demonstrate to yourself that it is your illness acting up in those situations and the emotions and behaviors you’re experiencing aren’t necessarily rational.

Another reason CBT can be difficult is you’re going to be put in uncomfortable situations. CBT is all about challenging your thoughts and behaviors in order to make you feel and function better, and you’re not going to achieve this sitting in your comfort zone. Your therapist will come up with ideas that scare the hell out of you, (in my case this was delivering a presentation to other therapists and being filmed doing role play) and you have no choice but to engage.

Please don’t let it put you off because it is a really effective way of encouraging you (or forcing you in my case) to tackle those scary situations in a safe environment, and letting you practice your new coping techniques to see if they really do work.

5. Be Prepared to Work

The last point ties in with the previous one about CBT not being easy, and that’s because CBT is a lot of work.

Again, I’m pretty sure I thought therapy would be more of a passive exercise that would magically make me better, but really you are the only person who can make you better, and your therapist is just there to give you the tools to work with.

For CBT to work properly you have to commit to the process and your therapist will likely give you things to do outside of the sessions nearly every week. Sometimes these will be easier things like keeping a thoughts diary, and sometimes they will be big challenges like speaking up in a meeting or asking a group of people if you can go to lunch with them. You will always discuss the big challenges with your therapist in advance, and you will have a clear plan of action for the week when leaving your session.

My therapist called this homework, and other therapists might have other words for it, but it boils down to the same stuff. Ultimately you have to be willing to put in the hard work outside of your sessions to see an improvement and for CBT to be effective.

Finally, I think it’s important to say try to be as open-minded as possible. These were just the five things that surprised me about CBT, and I’m sure you will have your own surprises along the way too. Don’t be put off by anything you come across (obviously if you’re extremely uncomfortable then let your therapist know) and try to go with the flow of the sessions. My therapist came up with a few wacky ideas to try in our sessions that initially I wasn’t sure about, but it the end they helped build my confidence.

Just trust the process, be honest and put in lots of hard work and things will be OK!

Thank you so much for reading and I hope my list of five things that surprised me about CBT helped you feel more prepared for what’s in store. As always feel free to reach out via email.

Best wishes, and stay calm! x

Getty image by Koldunov

Originally published: November 7, 2020
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