CBT: A Primer

bigstock-creative-concept-of-the-brain-37447483Before 2003 I’d never heard of cognitive behaviour therapy, CBT, but it had fancy sciency words in the name and I like fancy sciency words, they comfort me. The social worker/therapist facilitating it, however, never explained what it was or the basis of its efficacy. I think I was expected to know by instinct, or simply follow along and reap the benefits by rote use of what I thought were silly schoolboy exercises from a book with cartoon illustrations like a first-grade speller. In retrospect, I probably could’ve figured it out, but my brain was not functioning at its best back then (still isn’t) so the exploration of abstracts was not so easy. It wasn’t until after this frightened hermit stepped out of his cave not long ago, and forced himself to attend a series of small, intimate, group sessions, that he finally got it.

What is it they say about people who talk about themselves in the third person?

Anyway, at the risk of raising the ire of those more educated than I, I’m going to give you my take on CBT, and a quick introduction to how I started making practical use of it. I do use it together with mindfulness quite often, however to avoid overwhelming anybody, and because I’m lazy and don’t care to write 2000 words today, let’s save that one for later.

During one of these group meetings, probably one when I was still wearing my winter coat as armour and had my hands tucked under my legs ready to bolt, the therapist casually tossed out a term that pinged my appreciation for fancy sciency words: neuroplasticity. That is, the brain’s ability to rewrite itself, to form new neural connections, and retrain at a subconscious, cellular level. At its most fundamental, this is what happens with post-traumatic stress disorder, and why I call PTSD an injury rather than an illness; it rewires your upstairs room. That is actual, really real, physical damage caused by an outside force.

Neuroplasticity is also why you never forget how to ride a bicycle, tread water, or walk upright.

According to the Canadian Mental Health Association, cognitive behaviour therapy “teaches you how your thoughts, feelings, and behaviours work together and how to deal with problems and stress.” The repetition of what seem like silly exercises is basically a learning technique that takes advantage of the principles of neuroplasticity, like doing your multiplication tables (for the millennials and their new math, that’s how we rocked it back in the olden days). There’s a conscious effect to be sure, but it was only when I understood a bit of how these things worked in the underlying magical wizarding world of the brain, that I had my epiphany and started to really use it.

The first time I did was a week later, ready to go to the next session and standing at my apartment door, coat on, keys in hand, too frightened to leave. I examined the fear as logically as I could. Sure, I’d tried to do that before and how many of us get sick of the question, “What are you afraid of?” because we already know it’s fucking irrational so just shut up. The difference this time was that I made a very conscious effort to examine the effects of that fear, not just the cause, as well as the most likely outcome of both options: go to therapy with people I had come to really like and appreciate and get something out of, or stay home feeling self-pity, guilt, and shame about my inability to man up. Also irrational, but just as debilitating.

Something in my Harry Potter cerebrum ticked over then, and I wasn’t so afraid. I stopped thinking at that point, because over-thinking can be just as dangerous as not thinking at all, and grabbed the opportunity to walk out the door feeling quite pleased with myself.

This is a more advanced and directed form of CBT than writing down what you feel and how you might feel differently (one of those simple exercises). I remember talking about it at the session, and seeing a bit of surprise on the therapist’s face that I’d made practical use of it so quickly, and I felt pretty darn pleased with myself at that, too.

I still get overwhelmed quite easily, but these tools allow me to do the mundane tasks of a normal person’s life, like going outside to get groceries or do the laundry or talk to strangers face to face (for a short time) without losing my shit. It helps me not drink.

CBT has so much more to it than this little tidbit of my own experience, but if you’ve got one of those silly exercise books sitting under your couch, dig it out and give it another shot. It’s worth the effort.

Think of it as training wheels for that cranky lizard inside your head.

4 thoughts on “CBT: A Primer

    • Thanks, Andy. I really dig the whole brain-changing thing, and it’s not just CBT apparently that uses it. I’ve received a bit of feedback pointing to other therapies that has it at their base. I may explore those a bit later.

      I honestly don’t believe PTSD is ever cured, but, as you say, managed. I liken it to a deep wound of a major limb – a shark bite, for example, that can heal up but only to a point. Full function will never come back. There will always be some pain and disability, and the limb will never be as it was before. That’s an entire other blog post 🙂


  1. Pingback: Mindfulness: A Primer | Patrick Riley

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