What you can expect in a typical CBT session
CBT believes in “socializing” a client to therapy since many clients come to therapy thinking they are there to just “talk”. CBT therapists will help the person see in the very first session that therapy will involve “work” which includes setting an agenda for the session, summarize discussions of important problems, provide feedback, remember session content, and consistently do daily homework. In the first session the therapist will usually administer a brief screening tool such as the BDI (Beck’s Depression Inventory). Your therapist needs to assess if you meet the current diagnostic criteria for any mental illness and therefore assessments are an important part of CBT sessions.
The therapist will then check your activity and daily schedule. Most people with mental health issues spend their day cramming in too much or doing too little activity. CBT therapists will help you to monitor your daily schedule using a chart as below.
Worksheet reprinted with permission of Judith S. Beck, Ph.D., © 1993. From Cognitive Therapy: Basics and Beyond, (1995), Guilford Press.
In the next session (usually a week later) your therapist will evaluate this schedule and together you will draw certain conclusions. Eg:
- Watching too much T.V.
- No physical exercise
- Few pleasurable activities
You will then discuss with your therapist to add activities that can give you a higher sense of pleasure and accomplishment.
- Walking at least 10 min a day in sunlight
- Meeting friend on Saturday
- Reading a novel by favourite author
- Completing blog article on business stress
Maintaining the activity log, then discussing activities and finally completing those activities is easier said than done. Negative thinking is the biggest challenge that a person with depression needs to work with. So now your therapist will introduce to you the concept of monitoring your thoughts… a concept called Cognitive Restructuring based on the Cognitive model. The cognitive model suggests that how we perceive a situation influences our emotional, behavioral (and often physiological) reactions. Our perceptions are often distorted when we are distressed. In therapy, you will learn to identify and evaluate “automatic thoughts” (spontaneously occurring verbal or imaginal cognitions), and to correct your thinking so that it more closely resembles reality. Evaluating Automatic thoughts usually decreases emotional upsetness and increases the likelihood of behaving more functionally.
Once you start monitoring and evaluating your thoughts, slowly you will see your mood improve. In a few weeks, you may see significant improvement in your mood. You may start feeling like you earlier self and return to many of the activities you had stopped doing.
You will also use the above thought record sheet and other tools to start modifying your more persistent and underlying core beliefs (the “root” of your depressed thinking). Eg: (“I am worthless, unlovable, failure”). Your therapist may also ask you if you would like more comprehensive treatment which involves working on adverse childhood experiences using a form of therapy called EMDR (Eye Movement Desensitization and Reprocessing).