Cognitive Behavioral Therapy


CBT Therapists Chicago

CBT Therapist Chicago

Cognitive Behavioral Therapy (CBT) is a popular therapy for treating anxiety, depression and PTSD. It is an empirically supported treatment that usually yields results after a short few months.

​CBT explores the relationships between thoughts, feelings and behaviors. CBT is a very practical treatment aimed at helping individuals identify and alter dysfunctional thinking patterns and change their maladaptive behavioral patterns.

​If you struggle with some of the common “faulty” thinking patterns below, you will probably benefit from some CBT strategies such as cognitive restructuring.

What Principle Underlies Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) is an evidenced based treatment modality used to treat a wide variety of diagnoses. CBT posits that there is a powerful connection between thoughts, emotions, and behaviors, and encourages people to learn more about those connections to live the most fulfilling life possible. 

Often thoughts and emotions lead to behaviors that are not in alignment with the individual’s values or beliefs. Examples of this can include excessive substance use, self-injury or maladaptive interpersonal behaviors such as lying and manipulation. A primary underlying principle of CBT is that people can change their life by changing their behavior patterns that are not effective, and the way they do that is by first changing their thoughts. CBT suggests that mental health concerns are based in large part on unhelpful ways of thinking as well as unhelpful behavior patterns that are tied to those ways of thinking.  

For example, if a person is having the thought “I bet no one likes me”, they might feel insecure, and therefore isolate themselves. In this example, CBT would encourage the individual to target the thought “I bet no one likes me”, which will then shift the emotional state and open the door for that person to make friends and socialize. In turn, that person will gain evidence to counteract the original thought “I bet no one likes me”, which means the thought will lose its power and lessen in frequency. 

A significant underlying principle of CBT is the hope that people can change. It is possible for thought patterns to change, for behaviors patterns to change, and therefore for a person to live a more purposeful and fulfilling life. With the right awareness and the right support, anyone can improve their life. 

Common components of Cognitive Behavioral Therapy (CBT)

cognitive distortions

Catastrophizing: Immediately assuming the most catastrophic outcome. For example: You notice you have a headache and then immediately assume it must be a brain tumor.

Personalization: Taking full blame for a situation that in reality involved multiple factors: For example: Your parents get divorced and you are convinced it is entirely your fault when in reality there were likely many different factors leading to their divorce.

Polarized Thinking: Also known as “black and white” thinking or “all or nothing” thinking. For example: If you’re usually a straight A student and you receive a B on a test, you conclude that you are stupid.

Emotional Reasoning: Believing that feelings are facts. For example: I feel worthless therefore that must certainly mean that I am actually worthless.

Cognitive Restructuring

Cognitive restructuring is an intervention that comes from Cognitive Behavioral Therapy (CBT). It involves identifying ineffective thoughts and adjusting them to be more effective. At the end of the exercise, the goal is to restructure the thought to a point where it elicits less of an emotional response and is more in alignment with goals and values. Listed below are the steps and processes of cognitive restructuring:

  1. Identify the situation

Writing out the details of the situation (what is happening, what emotions are coming up, and what thoughts are present) is an important first step. Choose a situation that feels particularly activating or distressing. 

  1. Choose a thought to focus on

Based on the thoughts that came up in step 1, identify one thought that feels especially linked to distress. Often this thought will be an automatic thought, something that just comes to mind without intention. Examples can include “I’m not good enough”, “it’s all my fault” and “nobody cares what I have to say”. 

  1. Develop different perspectives

Consider evidence for and against the chosen thought. Consider the pros and cons of allowing this thought to dictate actions. CBT encourages people to use Socratic questions in this phase of the process, which are questions that are probing in nature and are aimed at getting to alternate viewpoints and deeper beliefs. Examples of these questions include:

  • Is this thought based on facts or my emotions or both?
  • Is there another way of looking at this situation?
  • What are the pros and cons of believing this thought?
  • What would change if I didn’t believe this thought?
  • What would I tell my friend who was in this situation?
  • What is the worst thing that could happen? Would I survive it?
  1. Establish an alternative response

The final step in this process is to actually shift the thought itself and create an alternative response. This is a thought to bring to mind whenever the previous automatic thought comes up and it should be much more in alignment with values and goals. Allowing an alternative thought to exist at the same time as the automatic thought promotes cognitive flexibility and can create separation between the person and the automatic thought so it doesn’t seem as factual. An example of an alternative response to the example above of “nobody cares what I have to say” could be “I have evidence to show that my friends and family are interested in what I have to say”.

Cognitive restructuring is an intervention that can be very useful to gain awareness and shift perspectives when it comes to automatic thoughts. In turn, this can shift long-held beliefs about the self, improve mood and increase the ability to be present in a fulfilling life.

Behavioral Activation

One of the effects of depression, a common mental health concern treated by CBT, is feeling immobilized. It’s hard to push yourself to do normal self-care activities, and pleasure might seem all but absent from your life.

Feeling immobilized/stuck is not only a symptom of depression – it’s a cause. The fewer activities you engage in, the more depressed you feel; and the more depressed you feel, the less you do and want to do. It’s a negative spiral that maintains avoidance and prolongs depression.

The solution is to push yourself to higher levels of activity-even though you don’t feel like it. You can’t wait to feel motivated to get out of bed, or go to school, or go hang out with your friends, but rather, you need to act first (opposite action and behavioral activation) and in doing so, the motivation will eventually follow. Activity scheduling can help you identify what activities you can engage in to re-energize yourself and offer significant help in overcoming depression.

It’s important that you engage in a variety of activities that will bring you both a sense of enjoyment and a sense of mastery – feeling like you’ve accomplished something as this will raise your self-esteem and belief that engaging in activities can help to relieve your depression.

While the above paragraph discusses the use of CBT in the treatment of depression, CBT is a highly effective treatment for anxiety, OCD, trauma, eating disorders and various other mental health issues.

What is a Behavioral Therapist?

A behavioral therapist is a type of therapist who is going to focus on identifying and then changing the maladaptive behaviors of their clients with the goal of improving their overall wellbeing. The idea of behavioral therapy is that when a client engages in behaviors that are maladaptive, they accrue suffering, and will then likely continue to engage in those maladaptive behaviors. This in turn will result in some negative consequences for the client. A behavioral therapist will aim to assist the client with identifying these maladaptive behaviors, understanding the consequences of them, and then making changes so the client can act more in alignment with their goals and values. 

Unlike other types of therapy, like psychodynamic which focuses more on building insight and looking into a person’s past, behavioral therapy is driven by action. A behavioral therapist cares about the client’s past and emotions because they influence behavior. That information is assessed and explored with the purpose of understanding why the maladaptive behaviors are present, and then intervening with the goal of eliminating them. A primary strategy for accomplishing this is to identify the function that the maladaptive behavior is serving, and then find a way to serve that function in a more effective way. An example of this could be a client who is abusing alcohol with the purpose of lessening the intensity of their emotional experience. This is a maladaptive behavior because while it achieves the goal in the short term, it comes with many consequences in the long-term including financial, social, cognitive, and medical. A behavioral therapist would focus on the substance abuse itself and aim to help the client to reduce that behavior, therefore reducing the consequences, and replace it with more effective strategies. In this example that could include healthier forms of distraction when emotions feel too heightened, as well as some process and connection-oriented strategies including journaling, art or mindfulness that would aim to improve the client’s emotional tolerance, so they feel less of a need to avoid. 

Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Acceptance and Commitment Therapy (ACT) and Exposure Response Prevention (ERP) are all types of behavioral therapy that help a client become aware of the behaviors they are engaging in that are not serving them well, and then make more effective choices. These therapies are used to treat every mental health diagnosis and can be successfully adapted to meet the specific needs of each client.

Cognitive Behavioral Therapy (CBT) Books

Cognitive Behavioral Therapy (CBT) is a complex treatment modality, so utilizing books is an effective tool to learn more and deepen understanding. Listed below are the top 10 books about CBT and how it can be used to treat various mental health diagnoses.

  1. Cognitive Behavior Therapy – Basics and Beyond by Judith S Beck

This book provides a comprehensive look at CBT, diving deep into its principles and interventions. It has various exercises and case examples to offer that help to deepen understanding. 

  1. Culturally Responsive Cognitive Behavior Therapy: Practice and Supervision by Gayle Y Iwamasa and Pamela A Hays

This book is for therapists to better understand how CBT can intersect with various cultural backgrounds so they can most ethically serve their clients. 

  1. Deliberate Practice in Cognitive Behavioral Therapy by James F Boswell and Michael J Constantino

This is another book geared towards therapists and its purpose is to help therapists feel more confident bringing CBT into their practice. This book offers case examples so therapists reading can see how CBT principles are applied to real cases. 

  1. Cognitive Behavioral Therapy by Michelle G Craske

This book is geared toward therapists and provides a wealth of information that is broken down into a few sections which include assessment, case conceptualization and application. 

  1. Overcoming Unwanted Intrusive Thoughts by Sally M Winston and Martin N Seif

Intrusive thoughts can be very distressing and are present in several mental health conditions. This book provides a practical and compassionate guide for how to find relief from intrusive thoughts and gain more cognitive peace. 

  1. The CBT Journal for Mental Health: Evidence-Based Prompts to Improve Your Well-Being by Jordan A Madison

This is a journal for anyone to use and provides a wide variety of journal prompts, affirmations and exercises rooted in CBT principles. 

  1. The CBT Workbook for Mental Health: Evidence-Based Exercises to Transform Negative Thoughts and Manage Your Wellbeing by Simon Rego and Sarah Fader

This workbook is meant to accompany the journal listed above. It helps readers to navigate CBT exercises aimed at reducing cognitive distress. 

  1. The Generalized Anxiety Disorder Workbook: A Comprehensive CBT Guide for Coping with Uncertainty, Worry and Fear by Melisa Robichaud and Michel J Dugas

Generalized Anxiety Disorder (GAD) is a diagnosis that comes with symptoms of excessive worry, restlessness, fatigue, difficulty concentrating, irritability and sleep disturbance. This workbook guides the reader thought CBT focused exercises to help them learn to reduce these symptoms and cope effectively. 

  1. The CBT Workbook for Perfectionism: Evidence-Based Skills to Help You Let Go of Self-Criticism, Build Self-Esteem, and Find Balance by Sharon Martin

This workbook uses CBT principles to help the reader find strategies for reducing perfectionism tendencies and gain more flexibility. 

  1. The CBT Couples Toolbox: Over 45 Exercises to Improve Communication, Navigate Problems and Build Strong Relationships by John Ludgate and Tereza Grubr

CBT is a great treatment modality to utilize in couple’s therapy. This book can be utilized by therapists or couples and offers exercises that will help couples to learn effective communication skills to strengthen their relationship.

CBT for Depression

Cognitive Behavioral Therapy (CBT) is a popular and evidence-based treatment for depression. The priority in CBT is to focus on the connection between thoughts, emotions, and behaviors. A common pattern with depression is that it is fueled by isolation, avoidance, and disengagement, which can in themselves be symptoms of the disorder. When a person is depressed, they are not as likely to reach out, engage and connect with meaningful people or activities, which in turn is likely to exacerbate the depression. This connection is important to lay out when treating depression so the points of intervention can be highlighted. By targeting the thoughts and behaviors of the individual, their mood can improve. 

Cognitive restructuring is a CBT tool that involves becoming aware of ineffective thought patterns (known as cognitive distortions) and shifting them to be more effective. Catastrophizing is a common example of a cognitive distortion that CBT would say is ineffective. It involves jumping to the worst-case scenario, believing that will be the outcome, and having no confidence that the individual can cope with the situation. Cognitive restructuring provides an opportunity for the individual to notice the pattern of catastrophizing, notice how it makes them feel (hopeless, sad, defeated) and then change those thought patterns to be more neutral and effective over time. An example of a catastrophic thought might be “if I fail this test I won’t get into college and my whole future is ruined.” Cognitive restructuring would encourage the individual to assess the evidence of that thought, examine it, challenge it, and come up with an alternative such as “if I fail this test, I can speak to my teacher about concepts I am struggling to grasp. It’s still possible that I can succeed in my academic ambitions.”

Behavioral activation is another technique used in CBT to treat depression. It involves engaging in meaningful activities even when there is no motivation to do so. Behavioral activation aims to harness the individual’s agency and choice to encourage them to act in ways that will positively impact their mood, thus giving them more of a chance to have positive experiences and mood states. In the short term, movement, being with loved ones and being outside often lift the mood. Longer term, building mastery with a skill or working towards a goal can provide a sense of purpose, meaning and fulfillment that is opposite to depression. This intervention is especially hard because there is no motivation to engage in the moment, so scheduling activities and seeking accountability if needed can be helpful.

Depression can lift and there is relief in sight. CBT puts some agency back in the hands of the individual who is suffering, and while they cannot simply wish their depression away, they do have the power to influence the trajectory of their mood by utilizing the interventions discussed above. 

CBT for Anxiety

Cognitive Behavioral Therapy (CBT) is a treatment modality that is well researched and highly effective for the treatment of anxiety disorders. CBT primarily focuses on targeting the individual’s ineffective thought patterns with the goal of changing their emotions and behaviors to be more in line with the individual’s goals. 

A first step in CBT for the treatment of anxiety disorders is to provide education about anxiety itself as well as how CBT can help alleviate anxiety symptoms. CBT encourages the use of logs to aid in the process of understanding the connection between thoughts, emotions, and behaviors, which builds insight and clarity for the individual. The logs can also highlight patterns of thinking that are common for the individual, which indicates an area of need if those patterns of thought are ineffective and leading to emotions or behaviors that are undesirable. Examples of the types of thoughts that are ineffective are mind reading (projecting thoughts or emotions onto other people), all or nothing thinking (seeing a situation in absolutes, all good or all bad), and discounting the positives (when a person acknowledges the positives about a particular situation but excuses them and rejects them for a variety of reasons). 

Once the ineffective thoughts are identified, the individual is encouraged to challenge and restructure them. This process involves questioning ineffective thoughts and creating a more balanced and effective thought to take its place. 

In CBT, the process of challenging ineffective thoughts is done by using socratic questions to break down the thought more deeply and begin to broaden the perspective. A few examples of socratic questions are:

What is the assumption being made in this situation?

Is there a different perspective to consider?

What evidence supports this idea? What evidence challenges it?

Will this matter in 5 years?

The answers to the socratic questions are what helps in developing a new thought, one that is more aligned with the desired outcome. 

Let’s take the example of giving a presentation at work. An example of how a thought can contribute to anxiety about giving a presentation is:

Thought: I bet I’m going to stutter, I’ll be so embarrassed 

Emotion: Anxious, dread

Behavior: Procrastinating practicing the presentation, which leads to stuttering and tripping over words

An example of how CBT would restructure the thought is:

Thought: With some practice I can be a confident presenter

Emotion: Anticipatory, confident

Behavior: Practicing the presentation in advance leads to a presentation that is calmy and clearly delivered

By targeting the ineffective thought patterns that are linked with symptoms of anxiety, the individual gains tools to shift their thoughts as needed, as well as an overall improved quality of life.

Who benefits from CBT?

Cognitive Behavioral Therapy (CBT) is a well-established and versatile therapeutic approach used to treat a wide range of mental health diagnoses and symptoms. Additionally, CBT has led to the development of several other therapeutic approaches that are well suited for the treatment of many mental health diagnoses and symptoms. CBT can be so broadly applied because of its focus on the connection between thoughts, emotions, and behaviors, which are impacted by every mental health condition. 

In the instance of anxiety and depression, it’s common for thoughts to feel distracting and disempowering, keeping the sufferer from the life they want to live. CBT is excellent at targeting those unhelpful thought patterns and reframing them to be more effective. By targeting the thought patterns to make them more effective, it positively changes the emotions which then has a positive impact on behaviors. 

CBT has also expanded into specific treatment modalities for a variety of disorders including trauma-focused cognitive behavioral therapy (TF-CBT), cognitive behavioral therapy for insomnia (CBT-I), cognitive behavioral therapy for eating disorders (CBT-E) and inference-based cognitive behavioral therapy (I-CBT) for the treatment of obsessive-compulsive disorder. These treatment modalities are all evidence based and are proven to be effective, taking the core principles of CBT and adapting them to treat the symptoms of a particular disorder more specifically. 

In addition to all of the diagnoses listed above, CBT is an excellent tool for treating addiction, relationship conflict, ADHD, and some personality disorders. In fact, dialectical behavioral therapy (DBT) was created from CBT specifically to treat borderline personality disorder and has since been shown to be a very effective treatment option to many other mental health concerns. 

CBT is not as effective in the treatment of severe psychotic disorders, especially if the individual is experiencing active delusions or hallucinations. The same can be said for bipolar disorder when the individual is experiencing an acute manic episode. For CBT to be most effective the individual needs to be grounded in reality and functioning well cognitively.

CBT is a widely used therapeutic approach for good reason. It’s effective at treating most mental health diagnoses and provides tools for any person to improve their mental well-being. That being said, treatment is always most effective when it is tailored to the individual and their specific needs. This might include a variety of treatment approaches and possibly medication. 

Cognitive behavioral therapy (CBT) chicago

​Our CBT therapists at Cityscape Counseling in Chicago incorporate cognitive behavioral treatment interventions to address classic depression and anxiety symptoms. CBT for anxiety, CBT for depression, and other interventions such as CBT for OCD and CBT for insomnia, are aimed at helping individuals identify unhelpful thought patterns, evaluate data for and against the conclusions your mind has drawn, monitor how these thought patterns are influencing your moods and behaviors, and reconstruct more helpful thinking patterns.

if you’re looking for a CBT therapist in chicago, Cityscape counseling would love to work with you.

We know that seeking out therapy can be a daunting endeavor so we’re dedicated to helping you each step of the way. Start by calling or emailing us to set up your first appointment.