Introduction to Emotions in CBT
Foundational CBTMany of our clients come in with an emotional disturbance. I feel depressed. I feel anxious. I feel angry. Those are all disturbances in the emotional system. And while they also are likely to have disturbances in the cognitive and behavioral system, it's important for us to understand the emotion and the role that that emotion plays in the maintenance of their pathology. Emotion has always been part of CBT. There's always been a recognition that our clients come in with problems of emotional disturbance.
But Historically, we would only get to those emotions indirectly through cognition and behavior increasingly in modern CBT there's an emphasis on dealing with those emotions in a direct fashion as well as indirectly through cognition and behavior. For a while, CBT theorists thought that there was a linear process between thought, emotion, and behavior. You think a certain way that leads you to feel a certain way, that leads you to act a certain way. And that may be true, but we're increasingly realizing that these relationships are bidirectional, that not only do thoughts cause emotions, but emotions can cause thoughts.
The worse you feel, the more negative your thinking becomes. Similarly, there's a bidirectional relationship between behaviors and thoughts and emotions. The worse your behavior becomes, the more negative your thoughts and emotions become as well. It's important to recognize that in CBT, we're not trying to eliminate emotions.
We recognize that emotions are good and important. The problem is just that the volume has gotten turned up a little too high so that the emotion has become maladaptive and it's leading the client down the wrong path. Our job then as CBT therapist is to help them find their sweet spot. What's the amount of emotion that is actually adaptive for me and works? Versus maladaptive and dysfunctional. From my perspective, bringing the problem into the room is critical.
It's really easy in CBT, especially if you're going the cognitive route to have a very cerebral abstract discussion about the client's anxiety. And you may get some traction doing that, but ultimately I think the outcome is going to be unsatisfying. You do much better if the client can be anxious in the session with you by doing something scary. And then practice with you tolerating that uncomfortable emotion and learning how to use appropriate coping strategies.
Finally, I would just encourage all CBT therapists to pay attention to emotion. Remember that that for most of our clients is the reason that they're in therapy in the first place. They don't wanna feel the way that they feel. Now, obviously, there are cognitive and behavioral elements that we do need to address in those but we don't ignore the emotion. To do so risks invalidating the client's experience, we wanna make sure then that we acknowledge and deal with the maladaptive emotions that they're experiencing in the session.