你不想停止你紧张、焦虑的想法吗？事实证明你可以，而且当你在做的时候，你也可以让自己感觉更好，表现得更好。
这就是认知行为疗法的基础，它在 1960 年代突然出现在心理领域，并从那时起一直受到赞誉。
根据全国精神疾病联盟的说法，CBT 旨在“发现不健康的思维模式以及它们如何导致自我毁灭的行为和信念”。
它可能并不适合所有人。治疗师通常会布置“家庭作业”，因此它需要来访者的积极参与，并且不会解决诸如童年创伤或家庭系统性问题等潜在问题。
但对于那些愿意投入工作的人来说，认知行为疗法可能正是医生所要求的。 CBT 已在随机临床试验中显示可缓解抑郁、焦虑、强迫思维、饮食和睡眠障碍、药物滥用、创伤后应激障碍等。
在 CBT 期间会发生什么可以在如此广泛的条件下产生变化？
CNN 分别采访了该领域的两位专家：Jay Fournier，俄亥俄州立大学认知和行为脑成像中心情绪和焦虑项目的教授兼主任；以及俄亥俄州立大学韦克斯纳医学中心女性行为健康心理学家克里斯汀·卡彭特 (Kristen Carpenter)。
CNN：简而言之，什么是认知行为疗法？
Jay Fournier：这是一种结构化的心理治疗，与经常在电视或电影中描绘的治疗类型大不相同。重点是通过尽快减轻症状来帮助人们尽快康复。
CBT 往往更关注现在而不是过去，并且通常是一种短期治疗。与认知行为治疗师的前几次会议将关注您的目标：困扰您的是什么，您想改变什么？然后我们将制定一个治疗计划，旨在在一定时间内实现这些目标。
我作为认知行为治疗师的工作就是让自己失业。我试图训练一个人去做我知道如何在他们自己的生活中做的所有事情，这样当我们不再见面时，他们可以在没有我帮助的情况下继续做。
CNN：在 CBT 中，我们的想法如何影响我们的行为和感受？
Fournier：大多数人在一生中都认为他们的感受或他们最终做的事情会直接受到他们生活中发生的事情的影响。认知行为疗法的核心要素之一是有一个干预步骤：我们如何解释这些情况。正是我们对这些事件的解释导致我们感受到某些事物并以某些方式行事。
我们让人们做的第一件事就是注意他们的想法。如果你注意到自己的情绪发生了变化，试着问问自己，“在我感觉更糟之前，我脑子里在想什么？”
我们的目标不是去思考快乐的想法，因为快乐的想法很有趣。目标是帮助人们更仔细、更准确地思考他们的情况，特别是那些在事情变得更困难时倾向于消极思考的人。
让我们以某人称呼您的名字为例。你可能会想，“那个人看透了我，他们完全正确，我就是这样。”而且你很可能对自己感到非常糟糕。或者你可能会想，“哇，那个人真是个讨厌的人。我真的必须评估我是否希望他们出现在我的生活中。”
CNN：我们中的大多数人并没有非常清楚地想到这种消极的想法，只是感觉不好。 CBT 如何帮助人们变得更有洞察力？
克里斯汀·卡彭特：我们围绕识别自动思维及其背后的信念进行了大量培训。它从识别自我对话开始——字面意思是你在痛苦的时刻对自己说的话。
例如，我们通常在抑郁症患者身上看到的想法往往围绕着这些信念：“我不可爱；我不配；未来是暗淡的，我对此无能为力。”
对于那些焦虑的人来说，这些核心信念往往围绕着威胁：“这个世界很可怕；这个世界充满威胁；我没有能力面对这些挑战。”
作为治疗师，我们通过一系列问题帮助您分析您的自言自语：“这个想法有多真实？你有什么证据支持和反对这个想法？它有多现实？是否有我们可以识别的思维错误？它是不仅仅是那些在临床诊断上会犯思维错误的人——我们都这样做。
其中一些想法可能是逻辑谬误。其他是我们所说的“应该”陈述：“我应该能够全职工作，每天晚上还帮助我的孩子完成家庭作业，拥有丰富而积极的社交生活，阅读良好，并参加每一个有曾经发生过并烹饪健康的饭菜。”
我们帮助人们开始质疑其中的一些陈述，并评估它们的真实性。我们中的许多人对自己的标准比对其他人的标准要高：“为什么街区里的其他妈妈都休息一下，而你却没有？”
但这并没有将消极思维转变为“玫瑰色眼镜”方法，因为这也无济于事。太远了。你想要做的是向中间拉，向那种对自己有同情心的思维方式，更现实，不受可能是错误的假设的束缚。
归根结底，我们在 CBT 中所做的是帮助修正错误的、夸大的信念，以便人们学习克服消极的自我对话所需的技能。
CNN：我知道CBT经常有家庭作业。你分配什么类型的家庭作业？
Fournier：认知行为疗法确实涉及家庭作业，很多家庭作业是以一种新的、不同的方式关注你正在做的事情、你的感受以及你的想法。
在治疗过程中，我们会有特定的工作表可以分发给人们，他们可以下载应用程序来做同样的事情。最终，我们希望人们学会自己使用这些工具。我们将 CBT 视为一种协作关系，我们共同努力为人们的生活带来他们希望看到的改变。
我们使用的一个主要工具称为自动思维记录，人们可以在此记录他们在两次会议之间的日子里所做的事情、思考的事情和感受。他们会把它带回会议，我们将一起回顾并评估想法。什么没有多大意义？思考或处理情况的替代方法是什么？
我们还要求人们跟踪他们的压力和焦虑程度。然后我们一起寻找峰值：“你什么时候感到压力最大？压力最小？你在做什么和在想什么？”然后这些将是我们在治疗中开始关注的事情。
CNN：我们已经谈了很多关于 CBT 的认知方面的问题。行为方面呢？
Carpenter：CBT 的前提是思想、行为和情绪交织在一起：“我的思想影响我的感受，我的情绪影响我的行为，而且这一切都是相互关联的。”
作为一名治疗师，这为我提供了三种途径，我可以与个人一起使用来帮助改变——通过思想、情绪和行为。
以抑郁症为例。抑郁的人退出这个世界，不再做他们曾经觉得愉快和愉快的事情。对于有这些挑战的人，我们会鼓励他们安排积极的活动，与朋友和家人联系，并尝试做一些能给他们带来归属感或成就感的事情。
CNN：这些行为变化是否适用于压力，例如大流行造成的压力和焦虑？
Fournier：当人们与焦虑作斗争时，他们往往会避开他们焦虑的事情。这是很自然的行为。但是回避会干扰生活，干扰他们为自己设定的目标，最终会使焦虑变得更糟。因此，在焦虑中，治疗正在帮助他们逐渐重新处理他们以前一直避免的情况。
对于承受高度压力的人来说，其中一些事情在人们的生活中会发生变化，但其中一些则不会，尤其是在大流行期间。根据情况，我们可能会鼓励人们做出他们可以做出的改变。
但即使对于他们无法改变的导致焦虑的生活时刻，我们也可以看看他们是如何经历这些情况的。
有时生活中会发生不好的事情，这只是其中的一部分。但有时人们会经历比情况所要求的更多的抑郁或更多的焦虑。我们可以帮助他们查看他们在这些时期的想法和行为，看看是否有办法改变这些想法以减轻他们的压力。
虽然我不是创伤后应激障碍方面的专家，但 CBT 已被证明对缓解症状非常有帮助。当然，我们无法改变过去；我们无法改变发生在这个人身上的事情。但是我们可以帮助他们做的是改变他们与发生在他们身上的事情的关系，通过改变他们对创伤经历的看法。通过这样做，我们希望帮助他们减少与创伤相关的生活干扰症状。
CNN：一个人如何找到训练有素的 CBT 辅导员？
Carpenter：我总是推荐行为和认知疗法协会。 他们有一个受过 CBT 培训的治疗师列表，您可以通过邮政编码在当地查看。 美国心理学会还在他们的“寻找心理学家”机制中将接受过 CBT 培训的治疗师列为“治疗方法”。
坚持。 在您确定一位治疗师之前，请尝试几位治疗师。 你想找到最适合你的人。
CBT: A way to reshape your negative thinking and reduce stress
(CNN)Wouldn't you like to stop your stressful, anxious thinking in its tracks? Turns out you can, and while you're at it, you can make yourself feel and act better too.
That's the basis of cognitive behavioral therapy, which burst onto the psychological scene in the 1960s and has been gathering accolades ever since.
According to the National Alliance on Mental Illness, CBT, as is it called, is designed to "uncover unhealthy patterns of thought and how they may be causing self-destructive behaviors and beliefs."
It may not be for everyone. Therapists typically assign "homework," so it takes active participation on the part of the client, and it doesn't address underlying issues such as childhood trauma or systemic problems in families.
But for those willing to put in the work, cognitive behavioral therapy can be just what the doctor ordered. CBT has been shown in randomized clinical trials to ease depression, anxiety, obsessive thinking, eating and sleep disorders, substance abuse, post-traumatic stress disorder and more.
Just what happens during CBT that can produce change in such a wide variety of conditions?
CNN spoke separately with two experts in the field: Jay Fournier, a professor and director of the Mood and Anxiety Program at The Ohio State University's Center for Cognitive and Behavioral Brain Imaging; and Kristen Carpenter, a psychologist in women's behavioral health at The Ohio State University Wexner Medical Center.
CNN: In a nutshell, what is cognitive behavioral therapy?
Jay Fournier: It's a structured kind of psychotherapy, much different than the type of therapy often portrayed on TV or in the movies. The focus is on trying to help people get well as quickly as possible by reducing their symptoms as quickly as possible.
CBT tends to focus more on the present than the past, and is typically a shorter-term treatment. The first few sessions with a cognitive behavioral therapist will home in on your goals: What is bothering you and what do you want to change? Then we will set up a treatment plan designed to address those goals within a certain period of time.
My job as a cognitive behavioral therapist is to put myself out of work. I'm trying to train a person to do all the things that I know how to do in their own lives, so that when we stop meeting they can continue doing it without my help.
CNN: In CBT, how do our thoughts affect our actions and feelings?
Fournier: Most folks go through life thinking that the way that they feel or the things that they wind up doing are directly influenced by what has happened to them in their lives. One of the core elements of cognitive behavioral therapy is that there's an intervening step: How we interpret those situations. It's our interpretations of those events that lead us to feel certain things and behave in certain ways.
One of the first things we would have people do is just notice their thinking. If you notice your mood changing, try to ask yourself, "What was going through my mind right before I felt worse?"
The goal isn't to think happy thoughts because happy thoughts are fun. The goal is to help people think more carefully and accurately about their circumstances, particularly folks who have a tendency to think more negatively when things get harder.
Let's use the example of someone calling you a name. You might think, "That person saw right through me, they're exactly right, I am just that." And you're likely to feel pretty terrible about yourself. Or you could think, "Wow, that person is such a nasty person. I really have to evaluate whether I want them to be in my life."
CNN: Most of us aren't terribly aware of thinking such negative thoughts, just the bad feelings. How does CBT help people become more insightful?
Kristen Carpenter: We do a lot of training around identification of automatic thoughts and the beliefs that underlie them. It starts with identifying self-talk -- literally the things you say to yourself in a moment of distress.
The thoughts that we typically see in those who are depressed, for instance, tend to be around these beliefs: "I'm unlovable; I'm unworthy; the future is dim, and there's very little I can do about it."
For those who are anxious, those core beliefs tend to be around threat: "The world is scary; the world is threatening; I am not equipped to face these challenges."
As therapists we help you analyze your self-talk with a series of questions: "How true is that thought? What evidence do you have for and against that thought? How realistic is it? Are there thinking errors that we can identify? And it's not just people with a clinical diagnosis that make errors in thinking -- we all do that.
Some of those thoughts might be logical fallacies. Others are what we call "should" statements: "I should be able to work full-time and also help my kid with their homework every night and have a rich and engaged social life and be well read, and get to every event that has ever occurred and cook healthy meals."
We help the person begin to question some of those statements, and evaluate how realistic they are. Many of us hold ourselves to higher standards than we would hold others to: "Why does every other mom in the block get a break but you don't?"
But it's not shifting negative thinking to a "rose-colored glasses" approach, because that doesn't really help either. It's too far. What you want to do is pull toward the middle, toward the kind of thinking that is compassionate to the self, that is more realistic and is not bound by assumptions that might be false.
At the end of the day what we're doing in CBT is helping modify false, exaggerated beliefs, so that people learn the skills they need to overcome negative self-talk.
CNN: I understand that CBT often has homework. What type of homework do you assign?
Fournier: Cognitive behavioral therapy does involve homework, and a lot of that homework is paying attention in a new and different way to what you're doing, how you're feeling and what's going on in your mind.
In the course of therapy, we would have specific worksheets that we might hand out to folks, and there are apps they can download to do the same. Eventually, we want people learn to use these tools on their own. We think of CBT as a collaborative relationship, where we're working together to bring about the changes in the person's life that they want to see.
One major tool we use is called an automatic thought record, where people keep track of what they are doing, thinking and feeling during the days between sessions. They'll bring it back to the session, and we'll go over it together and evaluate the thinking. What doesn't make much sense? What are alternatives ways of thinking or handling the situation?
We also ask people to keep track of their stress and anxiety levels. And then together we look for spikes: "When were you feeling the most stressed? The least stressed? What were you doing and thinking?" And then those would be the things that we would start to focus on in treatment.
CNN: We've talked a lot about the cognitive side of CBT. What about the behavioral side?
Carpenter: CBT is predicated on the assumption that thoughts, behaviors and emotions are intertwined: "My thoughts influence my feelings, my emotions influence my behaviors, and it's all interrelated."
As a therapist, that gives me three pathways I can use with individuals to help effect change -- via thoughts, emotions and behaviors.
Take depression, for example. Depressed people withdraw from the world, no longer doing things they once found pleasurable and enjoyable. For somebody with those kinds of challenges, we would encourage them to schedule positive activities, reach out to friends and family, and try to do things that will give them a sense of belonging or a sense of accomplishment.
CNN: Can these behavioral changes apply to stress, such as the stress and anxiety that the pandemic has caused?
Fournier: When folks struggle with anxiety they tend to avoid the things that they're anxious about. It's pretty natural behavior. But avoidance can interfere with life, can interfere with their goals for themselves, and they can ultimately wind up making the anxiety worse. And so in anxiety, the treatment is helping them gradually reapproach the situations they've previously been avoiding.
For people experiencing high levels of stress, well, some of those things are changeable in people's lives, but some of them aren't, especially during the pandemic. Depending on the circumstance, we might encourage folks to make the changes that they could make.
But even for the anxiety-causing life moments they cannot change, we can look at how they're experiencing those situations.
Sometimes bad things happen in life, and that's just part of it. But sometimes people experience more depression or more anxiety than the situation necessarily calls for. We can help them take a look at their thoughts and behaviors during those periods to see if there are ways to change those thoughts to reduce their stress.
While I'm not an expert in post-traumatic stress disorder, CBT has been shown to be very helpful with symptoms. Of course, we can't change the past; we can't change what happened to the person. But what we can help them do is change their relationship to what happened to them, by changing their thinking about the traumatic experience. By doing that, we hopefully help them experience fewer life-interfering symptoms associated with the trauma.
CNN: How can a person find a trained CBT counselor?
Carpenter: I always recommend the Association for Behavioral and Cognitive Therapies. They have a listing of therapists who are CBT-trained and you can look locally by zip code. The American Psychological Association also lists CBT-trained therapists under "treatment methods" in their "Find a Psychologist" mechanism.
Be persistent. Try several therapists out before you settle on one. You want to find the person who is the best fit for you.
