Breathing Principle Series - Cognitive Behavioral Therapy Explained

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Essentially what you’re looking at when you use techniques like ‘AWARE’ to manage a panic attack is a form of cognitive behavioral therapy. This is a psychotherapeutic approach that we have already touched on lightly a couple of times and which you can use to not only combat severe anxiety but also to control any kind of stress response. Eventually, CBT can be used to completely control your reaction to stressful events and to help you tap into any emotion that you need at any given time.

Read on to find out how… Behaviorism and a Brief Psychology History Lesson Behaviorism is a school of psychology that was popular in the 50s but which has become largely defunct now. Still, it is a useful ‘inroad’ to the ideas that have succeed edit and a basic understanding is useful to lay the foundations for understanding CBT. The best-known experiment within behaviorism is ‘Pavlov’s Dogs’. Here, the psychologist Ivan Pavlov, held dog’s captive and rang a bell every day at the same time as feeding them. Eventually, he found that simply ringing the bell would result in the dogs salivating. In other words, the stimuli had become linked for the dogs, such that the bell triggered the same response as food on its own. This is ‘classic conditioning’ which occurs through repetition.

Another type of conditioning is operant, which relies on reinforcement (positive reinforcement for instance means rewarding a behavior immediately after). Also interesting is vicarious conditioning, whereby behaviors, habits and beliefs can be reinforced simply by watching others. We now know that Pavlov was likely forming and reinforcing connections in the brain between neurons the sound of the bell and then strengthening that connection with repetition. Reward, as with positive reinforcement, helps to enforce the idea that the association is useful and positive and may increase dopamine and BDNF (brain derived neurotrophic factor – a neurotransmitter that encourages learning). Vicarious conditioning on the other hand might work via the ‘mirror neurons’ – neurons which fire when we witness something happening to someone else (we’ll come back to these). Mirror neurons are the reason that emotions can be ‘contagious’ (along with something called facial feedback) and this could also contribute to a passive form of plasticity. Hardcore behaviorists believed that all human behavior could be boiled down to our conditioning. We reach for things as children and learn gestures for grabbing (via reward) and we learn our likes and dislikes through similar exposure and experience. When things went wrong in the brain, they could be described as maladaptive associations (a phobia could come from one serious bad experience or several smaller ones). The solution would be to desensitize the patient or to recondition them to create new, more positive associations, or to deconstruct the existing one. This form of treatment still proves useful for several phobias and other conditions. Introducing Cognitive Behavioral Therapy Behaviorism alone though paints an incomplete picture of our brain and development as apart from anything else, it leaves no space for internal thoughts, instead explaining the entire human experience as being based on impulses and learned responses. Cognitive behavioral therapy takes the basic idea of behaviorism then but layers a ‘cognitive’ aspect on top. CBT states that we can reinforce beliefs and behaviors through thought alone for instance – by rehearsing them in our brain or by being frustrated, scared or excited. According to CBT, a fear of heights isn’t just learned, it can also come from our thought processes and visualization. Negative beliefs and thought pat- terns for instance might lead us to think things to ourselves like ‘what if I fall?’ or ‘what if the railings give way?’. We might even imagine falling and this alone is enough to trigger the fight or flight response. And ironically, you can learn to associate heights with that panic response and thereby ‘reinforce’ the idea that heights are scary in your own head! Thus, CBT encourages us to change our thought patterns by rehearsing and enforcing thoughts like ‘thousands of people have been here and there’s never been an accident’ or ‘people don’t just fall over for no reason’.

By rehearsing much more positive thoughts you can essentially recondition yourself with no need to subject yourself to heights.

As we mentioned earlier in this book – it’s not the events that scare us but our perception of those events.

Likewise, by imagining something happening, or thinking about it, you can cause the very same neurons to fire in your brain as though it were happening. From our perspective, that means that you can trigger neural plasticity simply by thinking. Now we’re getting somewhere!

Cognitive behavioral therapy techniques have proven highly useful in treating several psychological disorders and for improving quality of life.

What’s more, they are very cheap and practical to implement – therapists can even provide their counseling over e-mail! They can be used to combat phobias like agoraphobia, but they can also be used to train ourselves to react better to different situations. You can change your thoughts so that you stay calmer in stressful situations or so that you give more attention and more focus to important events.

Cognitive Behavioral Therapy Techniques

The techniques for changing your thought patterns via CBT are known collectively as ‘cognitive restructuring’. Essentially, this is like reprogramming your brain to think and react the way you want it to.

Here are just a few of the techniques used in CBT.

Mindfulness

Mindfulness is a form of meditation used in CBT where the objective isn’t to ‘silence’ your thoughts but rather to reflect on them without reacting to them. In other words, you are aiming to objectively survey the contents of your thoughts to see ‘where your mind takes you’. This can also be used with journaling or just a little self-reflection.

In other words, you need to somehow identify what thoughts are having a negative impact on your performance in order to be able to undo them.

You’ll learn more about mindfulness and how to use it in the chapter on meditation.

Thought Recording

You don’t have to do any mindfulness meditation necessarily though in or-der to identify what thoughts you have running through your head. Just as effective is to simply be a bit more aware of your thoughts and to record them as they happen.

You can do this for example by keeping a diary by the side of your bed, or just by noting down the thoughts you have when you note them.

Thought Challenging

Thought challenging is the process of taking an idea and then deconstructing it (this lies at the heart of Tim Ferriss ’‘Fear Setting’ from The Four-Hour Workweek).

So, if you are currently afraid of public speaking, then you would use mind-fulness in order to identify why you’re afraid and what ruminations are pre-venting you from performing your best. You might identify

thoughts like ‘everyone will laugh at me if I choke’ or ‘what if I forget my lines?’.

Thought challenging means taking these ideas and then thinking about them critically. So, for instance, let’s ask how likely it really is that an audience might laugh you off stage. Isn’t it true that most people are more polite than that? Wouldn’t they be more likely to sympathize with your situation? And moreover, why would it even matter? You probably won’t need to see these people again!

Thought challenging can be even more useful if you write it down and if you revisit the thoughts regularly (to reinforce the ideas in your brain). Eventually, you can this way rewire yourself and find that you no longer have the same fear holding you back when talking in public.

Hypothesis Testing

The issue with thought challenging is that you must really, truly believe what you’re saying. Essentially it boils down to a ‘self-placebo’ where you’re changing your belief in order to change your behavior and mental state.

Sometimes thought alone isn’t enough to genuinely transform your beliefs and in this case, you might want to get ‘proof’. One way to do this is with ‘hypothesis testing’ which essentially means proving to yourself that your fear is unfounded. One example of how you might do this would be to go up on stage to do some public speaking and then purposefully choke and stutter. In other words –purposefully make an idiot of yourself.

What you’ll find is that people don’t laugh, jeer or boo. More likely, they’ll wait patiently and there will be no negative consequences. What you’ve learned here is that the worst-case scenario really isn’t all that bad!

Hypothesis testing can be used in conjunction with thought challenging and exposure therapy – which is a form of behavioral therapy!

The blanket term for using these different techniques together is ‘cognitive restructuring’.

How to be Socially Fearless with Hypothesis Testing?

To demonstrate just how you can employ these principles in practice and use them to achieve a healthier mindset, consider how you can use hypothesis testing and exposure therapy to become ‘socially fearless.” Let’s say you’re not phobic but that you experience a ‘normal’ amount of anxiety when talking in public. This isn’t a crippling problem, but it is enough to prevent you from being quite as confident, charming and persuasive as you could be. So, what do you do? One answer is to simply prove to yourself that there’s nothing to be afraid of (hypothesis testing)and then to train yourself not to be afraid of it (exposure therapy). So go into a shop that’s not too near to your home and take some items to the counter to buy. Now, when you go to buy those items, put on a silly voice. As you do this, you’ll find yourself experiencing all those normal signs of the stress response. Instead of getting anxious about that though, just let it happen and use the breathing techniques discussed in the next blogs, or just make it into a ‘fun challenge’. Do this a few times and what you’ll find is that there’s no repercussion. You can be absolutely ridiculous and nothing bad will come of it.

The lesson? When you talk normally you really don’t have anything to worry about! As a result, you’ll start to feel much more relaxed and you’ll find it much easier to be confident, assertive and charismatic!