CBT is often used when a client wants to create a tangible change in her life. This change could be directed at broad topics like anxiety, depression, or OCD symptoms, or the targeted change could be something more specific.
The concept that drives CBT is the theory that cognition (our thoughts), behaviors (what we do), and emotions (how we feel), all impact each other. For example, if someone feels happy (emotion), then she might think positive thoughts about others (cognition) and go out of her way to do something kind (behavior).
Conversely, if someone wants to change a feeling, thought, or behavior, she can first adjust one of the other two sensations which will in turn affect the challenge that she is facing. If a person panics every time she hears a loud noise at night, she can restructure her thoughts to recognize that likely the rustling sound is just wind, not a robber. With this new thought, her feelings of fear can decrease.
But that is easier said than done.
To understand where in the triangle (cognition-emotion-behavior) to implement change, CBT utilizes a tool called functional analysis. Through functional analysis, the CBT therapist helps the client mentally walk through the challenging phenomenon in question to pinpoint its function. Meaning, instead of focusing on what triggers a particular behavior, a CBT therapist explores the function that the behavior serves and why that need exists.
The ABCs of Functional Analysis
A functional analysis can be divided into three sections: antecedents, behavior, and consequence.
Antecedents - When a CBT therapist and the client assess for antecedents, they look for anything that preceded the client’s behavior that could have contributed to that behavior. More than just a “trigger,” this is a wider view of what going on for the client before the questionable action occurred. Antecedents include things like medical symptoms, fatigue, stressors, interpersonal conflicts, location, and context.
Behavior – This is typically what the client wants to change. A behavior could include an overt behavior, any behavior that is physical in appearance to others, or a covert behavior, a thought or feeling. The therapist and client will try to record in as much detail as possible what the behavior looks like including facial expressions, physical actions, involuntary physical actions, sounds, sensations, etc.
Consequence – Consequences are what happened for the person after the behavior. Most consequences are reinforcements and are what is motivating the person to continue the behavior. For example, if a consequence of eating ice cream is that you are happy, then you will be reinforced to eat more ice cream because of that positive reinforcement.
When the therapist and client map out these ABCs, they have a fuller understanding of why the behavior may be happening and what is causing it to continue occurring. Armed with that information, they can make changes, usually to an antecedent or consequence, which, in turn, affect the behavior.
For example, if a consequence of the woman panicking when she hears a noise at night is that she gets attention from her family for feeling that way, the therapist might suggest a way for her not to receive such warm attention. Without that positive reinforcement, the urge to panic might begin to dissipate. Or, if an antecedent of panicking is that she turns off all the lights in the house, the therapist might suggest keeping a light on.
CBT is vast in both application and tools. While a functional analysis is tremendously telling about a person’s actions, it is the beginning of the treatment process. Every behavior has a purpose and once we understand what that purpose is then we can determine how to approach and treat it.