What is Cognitive Behavioural Therapy (CBT)?

figure 1: cbt model

figure 1: cbt model

Cognitive Behavioural Therapy (CBT) emphasizes the inter-relationships between our thoughts, behaviours, and feelings (both emotions and physical sensations).  More specifically, CBT assumes that our thoughts, behaviour, and feelings mutually influence each other.  CBT also assumes that how we interpret or evaluate situations in daily life can influence how we feel and behave.  For instance, if a student is faced with a math test next week and thinks, "I have no time to study, I'm going to fail," there is a good chance that he or she would feel anxious, and have a hard time focusing on studying or avoid it altogether.  Alternatively, if he or she thinks, "I have little time to study, how do I make the most of what little time I have?," she still might feel tense and nervous, but she will likely experience better concentration and better quality study time.  

The beauty of the CBT approach is that when we become aware of how our thoughts, actions and feelings fit together, we introduce opportunity: to either carry on as usual with our reactions or make a conscious choice and shift our reactions.  Once we decide to modify any one of these three components, we can create change in the other components. 

In a nutshell, CBT focuses on helping people identify and change unhelpful thoughts and behaviors, which can trigger and maintain anxiety, depression, insomnia, and stress, to improve quality of life.  It is also an evidence-based approach, meaning that there are numerous studies that support its effectiveness in the treatment of anxiety, depression, stress, insomnia, and health-related concerns (e.g., chronic pain).  

Some CBT Basics:

1.       CBT can provide a new or different way of understanding problems, as well as emotional or behavioural reactions.

2.       CBT can help clients develop new coping skills to address their problems.

3.       CBT homework exercises are an essential part of therapy.

4.       CBT relies on active collaboration between the client and therapist.

5.       CBT aims to help the client become his or her own therapist.

6.       CBT focuses on the present.

8 Tips for Stress Relief

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My last article focused on increasing awareness about the signs and symptoms of stress, as well as how to determine when stress becomes problematic.  As mentioned in the previous article, be sure to consult your doctor to rule out any physical causes or medical reasons for stress-like symptoms.  Of course, stress can often make a medical issue more difficult to manage and patients often find that their symptoms are worse when life gets stressful.

Tips for Stress Relief

  1. Learn, then regularly practice a breathing or relaxation exercise to dial down your nervous system's response to stress.  There are many forms of breathing and relaxation exercises, ranging from visualization and imagery exercises, progressive muscle relaxation, Qi Gong, yoga, tai chi, autogenic relaxation, etc.  Find something that works for you, then carve out time to practice on a regular basis.
  2. Learn about mindfulness.  Mindfulness hails from Eastern traditions and it involves paying attention to the present moment, on purpose and nonjudgmentally.  If you are interested in learning more about mindfulness, consider the writings of Jon Kabat-Zinn and Mark Williams.  The site, http://www.franticworld.com is a good starting point as it has free guided meditations that will provide a taste of what mindfulness is about.
  3. Make time for exercise every day.  Exercise is a powerful way to dampen your body's stress response.  Research has shown that even a brisk 10 minute walk can boost your mood.
  4. Reduce alcohol, tobacco and caffeine use.  Alcohol, tobacco, and caffeine use can often escalate during times of stress.  Many people find that these strategies may feel helpful in the short-term, but given the risks to physical and emotional health over time with prolonged and excessive use, it's best to find other, healthier ways to cope with stress.
  5. Maintain a healthy diet.  Appetite may increase or decrease during times of stress.  It is also not uncommon to crave certain high fat, high sugar foods when feeling stressed.  Consult your physician or a dietitian regarding healthy eating habits and a dietary plan that is right for you.
  6. Share your concerns with a friend or loved one.  The stress buffering effects of social support have been well documented in scientific studies (for a recent review, click here).  If you are unable to access emotional supports within your personal network, consider seeking professional support from a mental health professional.  
  7. Learn to say "no" to unnecessary or unfulfilling activities.  People often feel obliged to say "yes" to all requests, large or small, necessary or not.  This is especially true of those of us who are by nature, "people pleasers."  During times of stress, energy conservation is key, thus learn to suppress that inner "pleaser" and be selective about the requests, favors, or new projects that you take on and say "yes" only to activities or tasks that are fulfilling, necessary, or meaningful to you.
  8. Make time for hobbies and leisure interests.  Work-life balance can be sorely missing or off-kilter during times of stress.  Life can start to look like it's composed strictly of work, deadlines, responsibilities, errands, and obligations.  Reintroduce balance by deliberately scheduling leisure or fun activities into your calendar.  Scheduling the activity will make it more likely to happen and will provide something fun to look forward to.    

Consult a psychologist or other health professional if you are having difficulty managing stress on your own.

When does Stress become a Problem?

(c) jtanki

(c) jtanki

The word, "stress" seems pretty ubiquitous in our everyday language.  It's not uncommon to hear people say, "I'm so stressed out!" or "there's just too much stress!"  Based on the findings of the Canadian Community Health Survey (2011),  23.6% of  Canadians aged 15 and older reported that most days were 'extremely or quite a  bit stressful.'  Gender differences were noted, such that 25% of females reported that most days were 'quite a bit' or 'extremely stressful,' compared with 22% of males. 

There can be countless of sources of stress; it can arise from positive events (e.g., getting married, having a baby), negative life events (e.g., a health-related crisis, death of a loved one), daily hassles (e.g., argument with your spouse, being stuck in traffic), or major life events/milestones (e.g., promotion, retirement).   

Is all stress bad for you? The fact is, stress is a normal and unavoidable aspect of our daily living, and without the stress of overcoming challenges, changes, and hardships in our lives, we would not grow to develop resilience or "grit."  So the old adage, what doesn't kill you, makes you stronger, rings true where stress is concerned.  

What are some common symptoms of stress?  Due to the non-specific nature of some of these symptoms, prior to concluding that a symptom you have is stress-related, especially if it is a new symptom, please consult your doctor.  Of course, people often find that stress can makes an existing physical or emotional concern worse or more difficult to manage.  Here are some common signs and symptoms of stress:   

  • Feeling tense, restless, on edge
  • Feeling irritable
  • Feeling tired most of the time
  • Concentration difficulty
  • Uncontrollable worry
  • Increased muscle tension
  • Inability to fall asleep or stay asleep
  • Loss of appetite or overeating
  • Drinking too much caffeine or alcohol
  • Smoking more than usual

When does stress become a problem? Stress becomes a problem when it significantly affects your emotional well-being, self-care, or your ability to function at home, work, or in your personal relationships.  

What to do when stress is taking a toll? In the next article, strategies for managing stress better will be shared.  However, for additional support, consult a health care professional with expertise in stress reduction.