Episode #149
The Power of Cognitive Behavioral Therapy
If you’re new to Cognitive Behavioral Therapy or even if you’ve used CBT tools before, CBT is an incredibly powerful therapy modality that can empower you to make real changes in your life.
What is Cognitive Behavioral Therapy?
What are some of the mental health struggles it can help with?
Is it a therapy modality that might help you?
Join me, Dr Julie Osborn, as I share with you the life-changing power of using CBT tools in your life.
Click to listen now!
Books & Resources
Find the books Dr Julie recommends in this episode by clicking here.
Full Episode Transcript
Hi, it's Dr. Julie from My CBT Podcast.
Today I want to share with you a special episode that I created for another great podcast.
THERAPY+ is a podcast dedicated to exploring a diverse range of therapies, tools, and practices for mental disorders and enhancing overall mental health, encompassing both conventional methods and complementary and alternative medicine.
Of course, I talk about CBT and why it can be so powerful in improving your life. I hope you enjoy this episode and don’t forget to check out Therapy + on Apple Podcasts!
Hi, my name is Dr. Julie Osborn. I'm a licensed clinical social I'm a nurse worker, and I have my doctorate in psychology. I specialize in cognitive behavioral therapy, which I'll be talking to you about today and educating you and hopefully helping you get interested in pursuing this type of therapy if struggling with any mental health issues that might be going on in your life. Just to share a little bit about myself, I've always wanted to be a therapist. I know I'm fortunate and unusual that I've known since I was a child what I wanted to do. I wasn't exactly sure what direction that would take, but I've always had an interest. I've always loved self-help books. I've always been so curious about human behavior, why people think the way they do and the choices that they make. As all therapists, We all have our own issues in our background that brought us into this profession, which helps us really empathize and understand what our clients are going through and can really support pursuing therapy.
I have a private practice, and then I have my own podcast, which is called My CBT Podcast, which I started March 2020, unintentionally, when the pandemic started as well. But I wanted to mix things up, and I wanted to give back to my community I've been very blessed with my practice, and I really believe in cognitive behavioral therapy. I thought, the more people that could learn this, the better world we would have. My kids really pushed me to start the podcast, knowing more about the world than myself. But I've been very blessed. It's been four and a half years now. I've heard from people all over the world, and many have shared that maybe they can't afford therapy or they never found the right therapy, or they thought they were, quote, crazy for certain thoughts they had, and listening to my podcast and how CBT can help them get better has been a life-changer. So it's been a life-changer. It's been very humbling for me. I'm excited to be able to share this with you as well. Hopefully, it'll make a difference for you. I know it's made a difference for me in my life.
Also to share this with anyone that you may feel a benefit from it. I always tell everyone, I practice what I preach. All the tools I teach my clients, I use every single day. First, let me tell you what is cognitive behavioral therapy. Cognitive behavioral therapy, which we call CBT, for short, is the most researched therapy out there and has some real concrete studies, which I'll share with you as well. But the word cognitive just means your thought process. Cbt teaches you that the way that you think creates your moods, which your behaviors and your physical reactions. Then you always want to look at the environment that you're in, home, work, social, whatever environment you're in, you always want to look and say, Is this a factor in my life in a good way? Is it negative? What do I need to do about the environment that I'm in? And can that be part of the problem? Going back to first the way that you think about things. Believe it or not, all of us have 80,000 to 90,000 thoughts per day. I know that sounds pretty overwhelming, but it's true. That's why we don't really know what we're thinking.
We have too many thoughts going on, and we're really focused more on our moods, our feelings, both the same. We tend to just react off our feelings, and that's the problem, that most people feel something and then they have a behavior. They feel anxious, so they avoid. They feel depressed, so they stay in bed all day. They feel worried, so maybe they're going to drink. Whatever the mood is, there's a behavior, there's a reaction. You don't want to make decisions based on how you feel because you will not make good decisions. That's the first place to get started is understanding I do have these feelings, but we don't have feelings for no reason. Our feelings are based on how we're thinking. Just because you think something doesn't mean it's true. With CBT, I teach people that your thoughts are either facts, they're 100% true, or they're hot thoughts. A hot thought is a thought that is not 100% true. That's the difference between CBT and say, positive thinking. At first, I think people start thinking Oh, this is just positive thinking. Change how your thoughts are. But it's not positive thinking because that doesn't work.
If everybody could use positive thinking, we'd all be well because everybody can come up with a positive thought. But positive thinking doesn't give you any evidence for why it's true. Cbt, we're looking to balance out your thoughts, and what part of my thought is true and what part of my thought is not true. Now, to go back to the research a little bit before I give you guys specific tools to start using, is that decades ago, and this has been replicated over and over, there was some research where people with depression all got a PET scan. That's the test where you see your brain and you can see the blue, the yellow, the red. Then half of the group got CBT for 10 weeks, and the other half of the group didn't get any therapy. Then they came back together after, again, just 10 weeks. It's not long at all. They all had another PET scan. In the group that had the CBT therapy, there was actually a change for the better in what they could see in the PET and that based on changing your thoughts and balancing them out, their brain was calmer, would be a way to describe it, and that they felt better.
It was the first time in therapy that they actually could see like, Oh, this works. Every time, again, they've replicated, they've always got the same outcome. It's a type of therapy that they say if you have mild or moderate symptoms of whatever you're struggling with, say depression their anxiety, that it works just as well as medication. Medication has its place. I want to say that for sure. But sometimes I have clients come in and like, I don't really want to go on medicine. I don't know if I need it. I say, Well, you know what? But based on my assessment, I don't think it's something you have to do right away. Let's do the CBT, put the time in, do the work. At the end of, say, 10 sessions, we can reassess. If there's some areas you're really struggling, then maybe you can go see a psychiatrist and get educated and decide if that's for you. But many, many times the CBT is enough if you're willing to put the time and energy into learning it because there's always homework with good CBT. That's something to remember. When you go look for a therapist yourself and they say there's CBT, ask them if there's homework.
That's one reason people get better quicker is because you're working on your stuff in between sessions. It's not just once a week. I see my therapist for maybe an hour, and then that's all I do? That's not going to fix anything because if you're struggling, it's going to be a daily basis. It's really exciting, and I love it. I love this therapy because I can see people get better, quicker, and be able to move on with their lives. Since I've been in this profession, I've been doing... I was trained in CBT in 1997, so I've been doing a long time. I know people are getting more educated and based on what therapy they want. People don't want to spend years in therapy hoping to feel better. It's like, What's going on in my life right now? Help me think differently. Help me balance out my thoughts, and I want to be able to move on. I think people really appreciate that and are more motivated when they know I'm going to feel some relief pretty soon. It can happen pretty quick. I can tell you, I've had some clients where they got better faster than I even think they would, but they really embraced what I was teaching them, did the homework, showed up for their sessions, were willing to push themselves in places that might have felt uncomfortable and really could see a difference.
You can look up Cognitive Averal Therapy. Again, you're going to find lots of research and some fabulous resources out there. There's workbooks that I'll tell you about. You can even just work on those by yourself if you're not in a place to go to therapy for whatever reason, and you can still get a lot of benefit out of it just by working on it on your own if you're really that motivated. I think with going to a therapist, a lot of times you can get deeper because as a therapist, I can see things, notice things. My training helps me help my clients see things that maybe they weren't really looking for or realizing, and so we can really get deeper. But I do want to say you can do a lot on your own as well. One of the main tools that I want to share with you today, so you can feel like you're walking away with something, is what we call a thought record. A thought record is where we're going to figure out what was the situation that got you upset, identifying all your moods, figuring out what your thoughts are, and then looking for evidence to support or not support it, and come up with more balanced thinking.
Let's get started. Again, the first column in the fall record is I want you to identify a situation, basically who would, when, and where. I'm going to give you an example. This is someone coming to therapy. It's Tuesday morning, say at 9:30 AM, and they're in their therapist's office looking at the fall record, trying to figure out how am I going to do this and what do I write down? I'm not even sure what to do. The person coming in is feeling overwhelmed, they're feeling depressed, maybe Maybe feeling anxious, maybe feeling insecure. We have hundreds of moods, and we really want to identify as many as we can. What are some of the thoughts that are making this client feel overwhelmed and depressed and anxious and insecure? One is there's a thought that this is too complicated for me to learn. I'll never understand this. I'll never get better. Nothing else can help me. The therapy won't work, and I'm doomed to be depressed. Based on that, her thoughts, she might as well get up and leave, right? And this is what happens to most of us. We think something, we think it's true, and we make a decision based on that.
Now, all the thoughts I shared with you are all hot thoughts, the thoughts that aren't 100% true. This happens all the time that we don't have any facts going on. People are making life decisions based on thoughts that aren't even true, which I always found very profound. Very profound. That's why we want to learn to say, Okay, I have this negative mood going on. What am I thinking? You want to get into the habit of ask yourself, What am I thinking? What am I thinking? Make that a habit. Then you can say, Well, that's not really 100% true. I might have to really analyze this a little more. Let's go off the thaw where the client says that doing the thaw record, doing the work here, is going to be too complicated for her to learn. I'm going to ask you to say, Okay, can you give me some evidence? I want some facts that maybe this is true. Because, again, our thoughts have some truth in them. The client said that she looks at the fall record and she doesn't know what to do. She said she was never very good in school, and she doesn't know what you mean by evidence.
Based on that, she may struggle and causes her to think that it's too complicated. Then I would ask her, What evidence do you have that doesn't support that thought? She shared that it works. She learned that computer filing system, which is complicated. Some of the early worksheets seemed hard. With my help, it helped her do them quicker and it seemed easier. We practiced a few times. She said that I told her, I should say, that she only needed to know how to do the first two columns now. She realized she could get help from me until she know how to do it on her own. That's some evidence that she's going to be okay and be able to use the therapy to benefit her. Based on the evidence, we want to come up with a new thought. Her new thoughts were that, even though this seems complicated now, I've learned other complicated things in the past. Another thought was, my therapist will help show me how to do this. And the third one was with practice, it might make sense and get easier. What we do with the thought record as well is we want to focus on what CBT is about is that you want to feel better by changing the way you think.
When I first asked her how she was feeling, and a couple of the moods, she said overwhelmed, she was 95%, which is super high, and she was 85% depressed. It's hard to do much when your emotions are that strong. But after coming up with new thoughts, she felt only 40% overwhelmed, and her depression started to go down to 80. That was great. 40% overwhelmed is manageable. I can do things, I can read things, I can figure out what I'm thinking. That is a thought record. I know I'm going I'm going to go through this a little fast, and it's not as easy as it sounds, but that is the premise of CBT. Change how you feel by changing the way you think and challenging your thoughts. It teaches you to also be more present, that I'm having this angry feeling. What am I thinking about? I talk to a lot of people about road rage. I'm driving someone's too slow or they cut me off by accident. In the thoughts, they don't care about me. They could have killed me. I got a family. They're not even thinking about me. I mean, these are all thoughts.
This is where this road rage comes from. We all have to just stop and be more present and figure out, what am I thinking? To remember that just because they think something doesn't mean it's true. My mantra I share with my clients every day, all day long, is you want to make decisions based on what's best for you, not how you feel. What is best for me? If you're in bed one morning and you're having a hard time getting up because you're feeling depressed or anxious or overwhelmed, and you say, I don't feel like getting up. You want to say, What is best for me? I've had clients get out of bed, get dressed, take a shower, get something to eat, doing things that are just difficult on a daily basis because it can be a real struggle when you're feeling that overwhelmed and that depressed. If you can ask yourself, there's another tool, Okay, what's best for me? That's how I'm going to make my decision today, not how I feel. I never tell anybody what's best for them because when you ask yourself, you're going to know it, and then it's going to be a choice you make if you're going to follow through.
So CBT has been around since the 1960s, and it's grown with new specialists, new tools, lots and lots of research and finding more in interesting ways on how our brain works in the human behavior and how For all of us, when it comes down to the nitty-gritty of everything in our lives, I can always figure out what's going on and I can get to people's thoughts and help you learn and develop how to do that. So CBT also includes teaching good communication skills, problem solving skills. We talk about acceptance. We talk about forgiveness. We talk about a lot where you're in anger, guilt, and shame, depression, anxiety. The workbook I mostly use is called Mind Over Mood, and it's written by Dr. Dennis Greenberger and Dr. Christine Podesky. I was fortunate enough, back in 1997, when I started working at the University of California, Irvine, to be trained by Dr. Dennis Greenberger, and I had to take over a group, CBT group, and I also thought the psychiatry residents would come in to help me run the group. It was, again, what a gift in my life. I didn't know back then as a therapist, I really needed a specialty.
I do recommend that, that if you're searching for a therapist, find someone who has the specialty for what you need. You're going to get a lot more out of it when people are very focused and honed in to therapy You may use a little bit of this and that, the therapist, but I had so many clients that have come to me that said, I went to someone that said, Oh, yeah, I do CBT, and they're like, They really didn't. I really want someone, a specialist for me. There's so many articles out there, and usually Usually, they say CBT is the one that's recommended. I don't want it to sound like it's the only answer for all mental health, but there isn't a mental health diagnosis that I couldn't treat using CBT tools. That's the other thing I want to focus on is tools. That's what it's about. It's really great to come in and to be able to vent to someone and get some empathy and support and be able to maybe cry and just be in a safe place with somebody. But in the long run, or the bigger picture, good therapy is going to help you get better.
To get better, you have to have tools. Just sharing your feelings, you're not going to make changes because you still don't know how to. Felt great sharing everything, but I still don't know what to do next time I have a panic attack. I still don't know what to do next time I have an argument with my partner. I still don't know what to do when I'm so depressed, I can barely get out of bed. I don't know what to do when I have to give that presentation work and I'm having a panic attack and sweating in in my office and I got to go out there in five minutes. I need tools. What can I do right now to start feeling better? We talk about mindfulness, relaxation, breathing, CBT is used a lot for people that struggle with insomnia. There's all different areas because it still comes down to how am I thinking that's causing me to have these negative feelings, which then affects my behavior and my physical reactions. Physical reactions, I haven't spoken much about yet, but that's like, that would be crying, that would be difficulty, focusing, concentrating. That would be any of the symptoms you're having, especially with anxiety, increased heart rate if you're short of breath, muscle tension, upset stomach.
Those are all physical reactions that can happen. Then going back to the environment, as I was saying earlier, I always ask everybody, is your environment impeding you in any way? I appreciate that most people or many people will say, Oh, I'm the problem. I'm the problem. Sometimes you might be the problem, but you also want to look at your environment and say, Is that the problem? Am I in a hostile work environment? Am I in a relationship where I'm being abused? Am I in a relationship where I'm being manipulated? I don't always have to leave every relationship that isn't 100% healthy. Maybe it's family members that I still want to have in my life, but I'm going to set healthier boundaries. Maybe I do need to leave my job and find something else. Maybe Maybe I just need to leave the department and find another boss to work under. We really want to look at shades of gray versus black and white. The black and white is where people get into trouble. It's either this way or that way. They don't stop and think about what they're thinking about what's going to be the best decision, and they're very reactive.
Again, with the CBT, we can pause and breathe. I tell people, Pause and breathe. Let's figure out what you're thinking. If you tend to say, I don't know a lot, which a lot of people do, when you say, What are you thinking? I don't know what I'm thinking. You got to take a minute and slow down. A little trick I use is I will ask my clients, I say, Take a guess. What do you think your thought is? Probably nine out of 10 times, they nailed it within a minute. Because when we take a little time and we can be honest and authentic with ourselves, we can usually figure out what we're really thinking, but maybe it's too painful or I don't want to bother, I don't want to do the work, whatever. That's okay. But when you do the I don't know's, you're not going to get anywhere. I don't know. Okay, I don't know. Another little trick you could start to use is noticing if you say what if all the time. People with anxiety tend to be what if thinkers, and what if leaves us in this perpetual state of anxiety because we don't get the answers to what if.
I don't know. What if this happens? What if that happens? Instead, we want to say, Okay, let's be present and focus on What do you think might happen? Is that really true? Do you have evidence that could happen? What could you do now to maybe take better care of yourself so that when somebody's saying, What if I get sick in the future? Who's going to take care of me? That can be a concern, but what are you going to do now to take good care of yourself and maybe set up a good plan if that happens in the future. People are just stuck in this anxiety. It's where a lot of addictions start. I'm anxious, so I'm going to drink a beer. Oh, that made me feel better. I'm going to smoke some weed. That made me I go calmer. When I come home tomorrow, I'm going to do the same thing. I'm not dealing with why am I stressed in the first place. I'm just putting that bandaid on, that mood to behavior I talked about. We don't want band aids. Band aids don't fix things. People start doing that behavior, food addiction. They eat all the time these comforting foods, and then their weight becomes an issue.
That's where, again, nobody plans to become an addict, of course, but it's a perpetual behavior, usually trying to numb out these uncomfortable feelings that that people just don't even know what to do with. Again, it can be overwhelming. I'm not wanting to speak too broadly, but I don't want to get too specific because there's so many different mental health issues out there. But I'm telling you that if you take the time, learn CBT, get a workbook, find a therapist, you will really see the benefit. I find so much joy watching my clients get better and also being able to use these tools myself on a daily basis. My relationships, being a parent, being a professional, being a person of the world, what I want to give back to the world, how do I want to be, how do I think about the world. All of this is based on how am I thinking about things? Then being able to also identify my core beliefs, which is really important I want to share with you, is our core beliefs are underlying everything. We have negative and positive core beliefs, but negative core beliefs are like, I'm not good enough.
I'm not lovable. I'm bound to be abandoned. Others can't be trusted. The world's a dangerous place. None of us are born with negative core beliefs. We learn them based on maybe a one-time situation where we've been harmed or we're in a long-term negative situation. We don't walk around saying, I'm not good enough, am I lovable? But it's there. That's where all of these half thoughts that I'm talking about stem from. Once you to therapy and you can really work on some things you can really get down to the core. When you can change that, the whole world will open up to you. A few resources I want to share with you is, again, the book that I use mostly is called Mind Over Mood by Dr. Dennis Greenberger, Dr. Christine Podesky. Another really excellent book. I've had a lot of training with Dr. David Burns, and he has many books, but his latest CBT book I would recommend is called Feeling Great. All of these books are workbooks. You're not just reading and learning something, but you're doing the work, you're learning the tools. I tell everybody that, they're like, Oh, I got to do this homework.
They say, You know what? It's just for now, because once you learn the tools, they are just automatic. I say, the thought record I shared with you earlier, like thought records forever. I'm going to use thought records for the rest of my life. It's not just like, Oh, I feel better. No, I don't need to practice any of my tools anymore. The workbook helps you really get a little deeper and understand things in a way that's really going to benefit you. Then it's just automatic. You're going to be in a situation, maybe feel some stress, anxiety, and right then and there, you're going to be in your thoughts a whole lot quicker and be like, Okay, what am I thinking? Is this a half thought? What's a more balanced way for me to think about it? What are some actions I can take to start feeling better, to set those boundaries, to have different balanced thoughts, an alternative way to look at things. That's what it all is about. When you can do that on a regular basis, you're going to change your brain chemistry for the better. Some ways to find me, if you're interested in what I'm sharing.
Again, my podcast, which is free, is called My CBT Podcast. You can find it on all different platforms. I make most of my podcast about 30 minutes, so you can pick a topic, and then you're going to walk away with some tools. I keep them short because I want you to be able to hear them from beginning to end. Also, my website is called mycognitivebehavioraltherapy. Com. On there, you can find lots of resources, some videos, there's newsletters, there's suggestions on just how to get started. If you want to work with me, you can reach out. But if you're also looking for a CBT therapist anywhere in the world, if you look up feelinggoodinstitute. Com, everyone on that website is CBT trained. We have therapists all over the world. So wherever you're at, you can find somebody, and they can teach you the CBT tools because the foundation is the same for all of us, and we can make it specialized for what you need. So remember, again, it's not just these major mental health issues. I don't want you to think it's just for that. It's life adjustments. It's moving to a new city. It's maybe going through a breakup or a divorce.
It's having your children leave the house. It's making a career change. I mean, anything in your life that's causing some distress, it's important enough for you to find some help, find a different way to look at it, create an action plan. What can I do so I can handle it well, so I can be happier in my life? I don't to carry all my childhood things for the rest of my life. So don't minimize what you're going through because you compare yourself to someone else who's struggling more. If you're like, I just want some help to get through this time in my life, don't judge yourself and go find somebody and know that you deserve it, and that you're lovable and that you're good enough, and that there's no reason why any of us should really know how to handle things if we weren't taught, and most of us were not taught in our childhood, how to identify what you're thinking, or sometimes even problem solving or good communication skills. Sometimes as adults, we got to go figure that out and get a new perspective and live our lives differently than what we've learned along the way.
Again, CBT, it is the most research therapy out there, most successful. It's considered short term, and it's giving you tools. That's what makes the difference for me. Again, it really fell on my lap. I wasn't even seeking it out, but it was just one of the greatest gifts I ever had. I love working with my clients. Again, I believe the reason I really did my podcast was that the more people that can have these tools, the better our world is going to be because our world is run on everybody else's feelings. Everyone's running off their feelings and making decisions instead of breathing, pausing and saying, What am I thinking that's causing me to feel this way? And is it really true?
Again, I hope this is helpful. If you have any questions, please reach out. I always like being available to anyone out there to answer questions or give you resources or help you get hooked up with a really good therapist to make a difference.
As I said earlier, my mantra is make decisions based on what's best for you, not how you feel.