How to use cognitive and behavioural strategies to address different emotional issues

Cognitive behavioural therapy (CBT) is a research-based form of treatment which focus on helping clients make changes in their cognitions (thoughts) and in their behaviours to address their issues. Often the issues which the client seeks to address using CBT involve the experience of intense emotions which are having a negative impact on major areas of one’s life such as work, school, relationships and leisure activities. Among the problematic emotions in these issues are sadness or depressed mood, anxiety, anger, frustration and guilt.

CBT focuses on lowering the intensity of these and other emotions to manageable levels by making changes in cognitions and behaviours. However, the kinds of cognitions and behaviours which are targeted varies depending on which emotion is being addressed. I will discuss this in the following sections.

Sadness/Depressed Mood

Cognitions to be targeted

The cognitions to be targeted for change when sadness or depressed mood is the issue comprise the ‘negative cognitive triad’. These include negative thoughts about yourself and pessimistic or hopeless thoughts about your current life and your future.

Because these cognitions are typically negatively skewed beliefs called ‘hot thoughts’, targeting them involves accurately assessing them. This entails looking at both the evidence which supports and does not support these hot thoughts.

Doing so leads to the hot thoughts about yourself, your current life and your future shifting toward more accurate ‘balanced thoughts’. In turn, this lower the intensity of your sadness or depressed mood to manageable levels.

The thought record is an effective tool which can be used for this purpose.  A psychologist who specializes in CBT can teach you how to use this skill.

Behaviours to be targeted

The behaviours to be targeted for change when sadness or depressed mood is the issue focus on doing more activities which have a positive effect on your mood. This can include engaging in pleasurable activities by yourself and with others as well as by scheduling mastery activities. These are activities such as sports or hobbies and interests in which you are accomplishing something, using your talents and skills or are working toward a goal.  Regularly scheduling a combination of pleasure and mastery activities has been found to have a reliable positive effect on mood.

Targeting behaviours to improve mood can also include implementing action plans to address problems in major areas of your life such as work or school and relationships.  Making positive changes in these major areas of life has also been found to have a significant positive effect on mood.

Anxiety

Cognitions to be targeted

The cognitions to be targeted for change when anxiety is the issue focus on worries and ‘catastrophizing’. In general, these worries focus on ‘overestimating danger’—thinking that negative events are likely to occur when the evidence indicates otherwise—and ‘underestimating coping’—assuming that you will be unable to cope with adversity if it occurs.

The kinds of hot thoughts which drive intense anxiety varies depending on the particular anxiety issue including:

(1) Social anxiety disorder features negative thoughts focusing on being negatively evaluated and criticized or embarrassing oneself in front of others;

(2) Obsessive-compulsive disorder (OCD) often involves negative thoughts focusing on themes of contamination and harming others as well as being unable to function unless you perform time-consuming behavioural or cognitive rituals;

(3) Panic disorder entails catastrophic misinterpretations of physical or mental sensations such as believing you’re having a heart attack when your heart rate increases;

(4) Phobias feature hot thoughts in which you overestimate danger and/or underestimate coping in a specific situation such as driving;

(5) Health anxiety disorder involves negative thoughts in which you overestimate the danger to your health based on observing physical symptoms or ‘oddities’.

In a similar manner to the cognitive approach to addressing sadness and depressed mood, lowering the intensity of anxiety can be done by critically evaluating hot thoughts regarding overestimating danger and underestimating coping. Behavioural experiments are the preferred method of gathering and assessing this evidence with anxiety issues. I will discuss details of these experiments in the next section.

Behaviours to be targeted

The behaviours to be targeted for change when anxiety is the issue focus on regularly exposing yourself to the situations which lead you to experience strong anxiety along with the negative cognitions which drive it. Such exposure overcomes the tendency to avoid these situations. Whereas avoidance provides a temporary reduction in anxiety levels, consistent exposure leads to a lasting reduction in anxiety to manageable levels which is known as desensitization.

Exposure which facilitates desensitization is achieved by planning and performing behavioural experiments.  Behavioural experiments allow you to gather data which demonstrates that you can cope with anxiety and perform effectively while experiencing it. As such, this behavioural strategy helps you to change hot thoughts to balanced thoughts and thereby lower the intensity of the anxiety you experience to manageable levels.

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Anger

Cognitions to be targeted

The cognitions to be targeted for change when anger is the issue focus on negative thoughts about other people. These include negative thoughts about someone’s character (e.g. ‘He is selfish’) as well as negative cognitions regarding how someone feels about you or others (e.g., ‘She doesn’t respect me’).

These cognitions are often accompanied by thoughts which focus on the other person behaving unfairly or violating rules and expectations. ‘Should’ statements often show up in people’s thoughts when their anger is strong. That is, when you believe that others should behave in certain ways and they do not behave in those ways, strong anger is often the result.

In a similar manner to the cognitive approach to addressing sadness and depressed mood, lowering the intensity of anger can be done by critically evaluating hot thoughts regarding other people’s character and how they feel about you as well as by being more accepting and flexible when they do not consistently adhere to your rules and expectations.

Behaviours to be targeted

The behaviours to be targeted for change when anger is the issue focus on managing your reactions toward others while you are experiencing anger. The goal is to behave constructively and assertively rather than aggressively when expressing your concerns. This entails focusing on expressing your feelings about the behaviour of the other person while avoiding negative or insulting references their character and steering clear of aggressive and abusive language and actions.

Frustration

Cognitions to be targeted

The cognitions to be targeted for change when frustration is the issue focus on negative thoughts about not making any progress or of being blocked from achieving your goals. Thoughts of this kind can fuel frustration at work (e.g., ‘l’m not getting anywhere in my career’) and in relationships (‘Our son never does what we ask him to do’).

In a similar manner to the cognitive approach to addressing sadness and depressed mood as well as anger, lowering the intensity of frustration can be done by critically evaluating hot thoughts regarding not making progress.

Behaviours to be targeted

The behaviours to be targeted for change when frustration is the issue focus on taking actions which will lead you to make more progress in those areas in which you feel stuck.  For example, you could implement an action plan with the goal of making progress in your career or meet with a psychologist to explore strategies to make it more likely that your child will do what you ask them to do.

Guilt/Shame

Cognitions to be targeted

The cognitions to be targeted for change when guilt/shame is the issue focus on negative thoughts about about yourself for having done something which has led to negative consequences such as causing harm to someone.

In a similar manner to the cognitive approach to addressing sadness and depressed mood as well as anger and frustration, lowering the intensity of guilt/shame can be done by critically evaluating hot thoughts regarding your level of responsibility for the negative consequences.

Behaviours to be targeted

The behaviours to be targeted for change when guilt/shame is the issue focus on taking responsibility for your actions. This includes sincerely apologizing when appropriate, making amends and reparations to those you have harmed, striving to learn from your mistakes and improving your behaviour in the future.

May you target the correct cognitions and behaviours to address your emotional issues,

-Dr. Pat