Week 13: Cognitive Behavioral Therapy to Improve Mental Health: 

This session demystifies Cognitive Behavioral Therapy (CBT) through the lens of modern neuroscience, offering a powerful, evidence-based approach for older adults to enhance mental well-being and cognitive vitality. We'll explore the concept of neuroplasticity—the brain's amazing ability to change and form new connections throughout life. Participants will learn how CBT helps identify and rewire unhelpful thought patterns and behaviors, such as avoidance and safety-seeking, that can arise from life transitions, health concerns, or worries about the future. We will break down practical, brain-based CBT techniques to address faulty beliefs, build resilience, and actively support a healthy, thriving mind. 

By the end of this session, participants will be able to: 

1. Define Cognitive Behavioral Therapy and its connection to neuroplasticity (the brain's ability to change). 

2. Identify at least three common cognitive distortions with examples relevant to aging. 

3. Recognize how avoidant and safety-seeking behaviors can limit independence and well-being. 

4. Apply a basic thought record to strengthen healthier neural pathways. 

5. Describe how behavioral activation and graded exposure can be used as "brain training" to stay active and engaged. 

6. Develop a personal action step for applying one CBT technique to support their brain health. 

Materials & Preparation 

• Handouts: 

• "My Brain Training Plan" worksheet (a modified Hierarchy of Fears). 

• https://www.choosingtherapy.com/wp-content/uploads/2024/07/Hierarchy-of-Fears-for-Anxiety-Worksheet.pdf
   

• Cognitive Trial Worksheet 

• https://depts.washington.edu/uwhatc/wp-content/uploads/2022/07/Cognitive-Triangle_Worksheet_Coping_and_Processing.pdf

Cognitive Behavioral Therapy was not created by a single individual but evolved over time through two major therapeutic waves: Behaviorism and Cognitive Therapy. Its history is a fascinating story of scientific and clinical innovation.  

First Wave: The Rise of Behaviorism (Early to Mid-20th Century) 

The roots of CBT lie in Behaviorism, a school of thought that emerged in the early 1900s. Behaviorists, like Ivan Pavlov and B.F. Skinner, argued that psychology should be the scientific study of observable behaviors, rather than internal mental states, which they believed were too subjective to measure. 

• Key Idea: Our behavior is learned through interaction with the environment. Maladaptive behaviors, like phobias or avoidance, are learned responses that can be "unlearned." 

• Therapeutic Innovations: This led to the development of Behavior Therapy. Techniques like Systematic Desensitization, developed by Joseph Wolpe in the 1950s, were highly effective for treating specific phobias and anxiety disorders. This technique involves gradually exposing a person to their fear in a controlled way until the fear response diminishes. 

 
Behavior therapy was revolutionary because it was short-term, goal-oriented, and scientifically testable, but it had a significant limitation: it largely ignored the role of thoughts and feelings. 

Second Wave: The Cognitive Revolution (1960s - 1970s) 

By the 1960s, many psychologists recognized that you couldn't fully understand human behavior without considering internal thought processes. This shift was known as the "Cognitive Revolution." 

Two key figures, both originally trained in psychoanalysis, became the pioneers of this new approach: 

1. Dr. Albert Ellis: In the 1950s, Ellis developed a technique he called Rational Emotive Behavior Therapy (REBT). He proposed that it's not the events in our lives that cause our emotional distress, but our irrational beliefs about those events. His famous "ABC" model illustrates this: 

• Activating Event (e.g., You get a poor performance review). 

• Belief (e.g., "I am a total failure and will get fired."). 

• Consequence (e.g., Feelings of depression and anxiety). 

Ellis argued that by challenging the irrational Belief (B), one could change the emotional Consequence (C). 

2. Dr. Aaron T. Beck: Often considered the "father" of modern CBT, Beck was conducting research in the 1960s to validate psychoanalytic concepts of depression. Instead, his findings led him to a different conclusion. He observed that his depressed patients consistently experienced a stream of negative, automatic thoughts that shaped their moods and behaviors. He called these "cognitive distortions." 

Beck developed a structured, present-focused therapy called Cognitive Therapy. Its central idea is that by identifying, evaluating, and changing these distorted thought patterns, patients could alleviate their symptoms. He developed key concepts like the Cognitive Triangle, which shows the interconnectedness of our thoughts, feelings, and behaviors. 

In the 1970s and 1980s, the field began to merge the action-oriented techniques of behavior therapy with the thought-challenging strategies of cognitive therapy. This powerful combination became known as Cognitive Behavioral Therapy (CBT). CBT acknowledged that to create lasting change, a person must address both maladaptive behaviors (like avoidance) and the faulty underlying beliefs that fuel them. It has since become one of the most researched and widely practiced forms of psychotherapy in the world, continuously evolving with new developments like Mindfulness-Based CBT. 

CBT is a versatile and effective treatment for a wide range of psychological and even physical health issues. It is considered a "gold standard" treatment for many conditions because its effectiveness is backed by thousands of scientific studies.

It is commonly used to treat: 

• Anxiety Disorders: This is one of the most successful areas for CBT. It includes: 

• Panic Disorder, Social Anxiety Disorder, Generalized Anxiety Disorder (GAD) 

• Phobias (e.g., fear of flying, needles, heights) 

• Obsessive-Compulsive Disorder (OCD) 

• Mood Disorders: 

• Major Depressive Disorder 

• Bipolar Disorder (as an adjunct to medication) 

• Dysthymia (persistent depressive disorder) 

• Trauma-Related Disorders: 

• Post-Traumatic Stress Disorder (PTSD) 

• Eating Disorders: 

• Bulimia Nervosa 

• Anorexia Nervosa 

• Binge-eating disorder 

• Sleep Disorders: 

• Insomnia (CBT-I is the first-line treatment for chronic insomnia) 

• Substance Use Disorders: 

• Alcohol and drug addiction (by addressing triggers and coping mechanisms) 

• General Life Challenges and Behavioral Issues: 

• Anger Management: Identifying triggers and restructuring hostile thoughts. 

• Procrastination: Breaking down avoidant behaviors and challenging self-defeating beliefs. 

• Stress Management: Developing better coping skills for work, family, and life pressures. 

• Relationship Problems: Improving communication by changing distorted thoughts about partners or others. 

• Chronic Pain and Chronic Illness: Helping patients manage the emotional distress and unhelpful thinking patterns associated with their conditions to improve quality of life.

The core principle of CBT's broad applicability is that our ingrained patterns of thinking and behaving play a critical role in our mental and emotional well-being, regardless of the specific problem we face. 

Think of one new thing, big or small, they've learned in the past year. How were you able to learn this new task? Neuroplasticity. The purpose of this lecture is to learn how neuroplasticity allows our brains to keep learning and growing. Secondly, we'll practice a technique called CBT to actively guide that growth.  

"Your brain is not fixed. The thoughts you repeat create strong neural pathways, like well-walked paths in a forest. CBT helps us create new, more helpful paths." 

Linking the Cognitive Triangle to Your Brain  

"To understand how this works, let's look at the core of CBT, the Cognitive Triangle, and connect it to what's happening inside our skulls. 

2. FEELINGS/EMOTIONS: The Brain's 'Alarm System' 

• What it is: On one corner, we have our Feelings or Emotions—anxiety, joy, frustration, etc. 

• The Brain Connection: Our emotions are generated deep inside the brain in a set of structures called the limbic system. A key player here is the amygdala, which acts as our brain's sensitive 'alarm system' or 'threat detector.' It's incredibly fast. It can trigger a feeling of anxiety before your thinking brain has even had a chance to assess the situation. But here's the key: while the alarm might be automatic, our prefrontal cortex (our thoughts) can send a signal back to the amygdala to say, 'It's okay, stand down. This is not a real threat.' We can use our thoughts to regulate our feelings. 

3. BEHAVIORS: The Brain's 'Sculptor' 

• What it is: On the final corner, we have our Behaviors—the actions we take. 

• The Brain Connection: Actions are what turn our thoughts and intentions into reality. When we decide to do something, signals go to our motor cortex to get our bodies moving. Crucially, every action we take creates a new experience. It sends a flood of new information back into our brain. Actions are the sculptor of the brain. Avoiding a situation strengthens the pathway that says, 'This is dangerous.' Approaching a situation, even a little nervously, provides the brain with new evidence and begins to build a new pathway that says, 'I can handle this.'" 

"Let's make this real. Imagine you're at a community event, and someone you know walks up to you, smiling. You know you know them, but their name has vanished. This is a common experience for people of all ages. How you respond in that moment can either reinforce a negative 'deficit' pathway or build a new, positive 'resilience' pathway."  

Negative Cycle: Reinforcing the "Deficit" Pathway 

1. SITUATION: You can't recall the person's name. 

2. THOUGHT: Your automatic thought is, "My memory is getting so bad. This is probably a sign of serious decline." 

• What's happening in the brain: This catastrophic thought immediately triggers your amygdala (the alarm system). Stress hormones like cortisol are released. Ironically, cortisol can interfere with the function of the hippocampus, your brain's memory center, making it even harder to recall the name. Your thought has created a self-fulfilling prophecy. 

3. FEELING: You feel a rush of anxiety, embarrassment, and frustration. 

• What's happening in the brain: This is the physical sensation of your amygdala taking charge. Your heart rate might increase, and you may feel flustered as your body goes into a mild 'fight-or-flight' mode. 

4. BEHAVIOR: You withdraw from the conversation, maybe mumbling a quick hello and moving away. You decide to skip the next social event. 

• What's happening in the brain: By avoiding, you've taught your brain a simple but dangerous lesson: "That situation was uncomfortable, and leaving made the discomfort go away." The pathway that links socializing with anxiety gets a little stronger. You've also starved your brain of the positive stimulation and connection it needs to stay healthy. 

Positive Cycle: Building the "Resilience" Pathway 

1. SITUATION: You can't recall the person's name. 

2. THOUGHT: You consciously choose a different thought: "It happens to everyone. Forgetting a name is normal. I'll just be upfront and ask them politely." 

• What's happening in the brain: This calm, rational thought engages your prefrontal cortex (the 'control tower'). It sends a powerful calming signal down to the amygdala, saying, "There is no threat here. We can handle this." This prevents the flood of stress hormones. 

3. FEELING: You feel calm, accepting, and in control. 

• What's happening in the brain: This is the feeling of your prefrontal cortex successfully managing your automatic emotional response. You've stayed in the driver's seat. 

4. BEHAVIOR: You smile, make eye contact, and say, "It's so good to see you! Please tell me your name again." You re-engage in the conversation. 

• What's happening in the brain: This is the most important step! Your action provides your brain with a new piece of data: "I forgot a name, I used a simple strategy to fix it, and the social outcome was positive." You are actively carving out a new neural pathway for resilience and social confidence. The next time this happens, this new, helpful path will be a little easier to take. You've just completed a successful workout for your brain."

Earlier this semester, we talked about building good habits. Now, we’re going to focus on identifying the sneaky mental and behavioral habits that can actually work against us. Awareness is the biggest step toward strengthening your mental health and enjoying life fully.  

Our brains love routine, but sometimes they fall into "thinking traps"—automatic ways of interpreting events that don't actually serve our brain health or happiness. Think of them as mental shortcuts that lead us in the wrong direction. Learning to spot them is the key to challenging them. Below are five common distortions. We’ll look at how they might show up in later life and how to reframe them. 

1. All-or-Nothing Thinking (Black and White) 

When you see things in absolutes, with no middle ground. If something isn’t perfect, it’s a total failure. 

• The Trap: "If I can't walk for a full hour like I used to, there's no point in exercising at all." 

• The Reframe: Any activity is better than none! A 15-minute walk or a few stretching exercises is a victory, not a failure. Focus on incremental progress. 

2. Catastrophizing (Jumping to the Worst) 

When you instantly jump to the absolute worst-case scenario, blowing a small problem completely out of proportion. 

• The Trap: "I have a new ache. This must be a serious, undiagnosed illness." 

• The Reframe: Take a deep breath. Acknowledge the ache, but stick to the facts. It’s okay to consult a doctor, but don't assume the worst before you have information. 

3. Mind Reading (Assuming Negative Intent) 

Assuming you know what other people are thinking, and that it's always negative, without any proof. 

• The Trap: "The younger people in this group think my stories are boring." 

• The Reframe: You can’t read minds. Focus on the value of sharing your experiences and connecting with others, regardless of what you imagine they might be thinking. 

4. Emotional Reasoning (Feelings as Facts) 

Believing that something is true simply because you feel it strongly. 

• The Trap: "I feel overwhelmed by this new technology, which proves I'm too old to learn it." 

• The Reframe: Your feeling of overwhelm just means the task is challenging right now. It is not proof of inability. Feelings are temporary; learning ability is not limited by age. 

5. "Should" Statements (Rigid Rules) 

Holding yourself (or others) to rigid rules or expectations that are often unrealistic or unhelpful. 

• The Trap: "I should be able to manage my own finances without any help." 

• The Reframe: It takes strength to ask for help, especially with complex tasks. Allow for flexibility and recognize that seeking support is a sign of wisdom, not weakness. 

If "thinking traps" happen in our heads, "behavioral roadblocks" are the actions we take (or don't take) that result from those traps. These are often actions meant to keep us safe or comfortable, but they end up shrinking our world and reducing the opportunities our brain needs to stay stimulated and engaged. 

Avoidance (Actively Stepping Back) 

These are noticeable decisions to retreat from opportunities that could benefit you. 

• Declining social invitations due to low energy levels or the fear of feeling like a burden. (This reduces social stimulation, which is vital for brain health.) 

• Avoiding physical activities (like walking outside) because of an intense fear of falling. (This reduces exercise and leads to physical and mental deconditioning.) 

• Putting off important appointments (doctor, dentist, financial planner). (This creates unnecessary stress and risk down the line.) 

Safety-Seeking Behaviors (Subtle Restrictions) 

These are often more subtle actions taken to minimize perceived risk, even if the risk is low. While a little caution is good, too much restriction leads to boredom and isolation. 

• Only going to familiar places, avoiding new routes, new stores, or new restaurants. (This limits sensory input and novel experiences that stimulate the brain.) 

• Relying on a family member to make all phone calls or handle basic paperwork. (This erodes your sense of competence and autonomy.) 

• Restricting activities to what feels "safe," even when it results in chronic boredom or disengagement. (This tells the brain it doesn't need to work hard or adapt.) 

The key takeaway is that when you notice yourself saying "I can't," try reframing it to, "I can try." Challenging these traps and roadblocks helps you maintain independence and keep your brain sharp! 

Now that we’ve identified the "Thinking Traps" and "Behavioral Roadblocks" that can hold us bac, let’s talk about the tools you can use every day to build new, healthier mental habits. The techniques below are based on a powerful and proven approach called Cognitive Behavioral Therapy (CBT). We’re going to use these tools to literally change the structure of your brain for the better. 

Tool 1: Cognitive Restructuring with a Thought Record 

The goal of this exercise is simple: to stop reacting immediately to an Automatic Negative Thought (ANT) and instead, treat it like a hypothesis that needs to be tested. 

A Thought Record is your "workout sheet" for building flexible thinking pathways. It helps you slow down, check the facts, and create a more Balanced Thought. 

Tool 2: Behavioral Change for a Stimulated Mind 

The antidote to Avoidance is Action. We often wait to feel motivated before we act, but the science shows it works the other way around: Action creates motivation. 

The brain thrives on novelty, engagement, and movement—remember the motto: "Use it or lose it." 

A. Graded Exposure (Brain Training in Small Steps) 

When a task feels too big, or you've been avoiding something out of fear (e.g., fear of falling, fear of technology), we use Graded Exposure. This means breaking the activity down into tiny, manageable steps and practicing them one at a time. This builds confidence and new neural connections slowly. 

Goal: Learning to use a new tablet or smartphone. 

Step 1 (Low Anxiety): Watch someone else use it for 10 minutes. 

Step 2 (Slightly Higher): Practice turning it on and off, and adjust the volume. 

Step 3 (Building Confidence): Open one specific, low-stakes app (e.g., Photos, Weather, or the Calendar). 

Step 4 (Engaging): Try a simple, pre-installed game (like solitaire) or browse a news website you know well. 

Step 5 (Independence): Successfully send one simple email or text message without help. 

B. Behavioral Activation (Scheduling Health) 

Behavioral Activation means scheduling activities that involve Movement, Social Connection, or Learning—the three pillars of a healthy brain—even if you don't initially feel like doing them. We’re acting against the urge to retreat or do nothing. 

The Rule: Choose an activity, schedule it, and do it. 

• Movement: Schedule a 10-minute walk down the street and back, or 5 minutes of chair exercises. 

• Learning/Mastery: Schedule 15 minutes of working on a crossword puzzle, reading a new book, or practicing a new card game. 

• Social Connection: Schedule a 5-minute phone call to a friend or family member. 

By committing to these small actions, you send a powerful message to your brain: "I am capable, and the world is still an engaging place." 

Which of these two tools—The Thought Record or Behavioral Activation—feels easier for you to try out this week? 

CBT is one of the most common and effective forms of psychotherapy used in addiction treatment and is widely implemented in rehab settings. It is a structured, goal-oriented approach that focuses on identifying and changing the thoughts, feelings, and behaviors that lead to substance use. Here are examples of CBT techniques and concepts as they are applied in rehabs for addiction:  

1. Functional Analysis of Substance Use 

This involves a detailed examination of the circumstances surrounding substance use to identify the patterns and triggers. 

• Example: A client documents a recent situation where they used substances by recording: 

• Antecedent/Trigger: Being alone on a Friday night and feeling anxious. 

• Thought/Feeling: "I can't relax or have fun without a drink. I'm bored and stressed." 

• Behavior (Substance Use): Deciding to go to the liquor store and buying alcohol. 

• Consequence: Initial temporary relief, followed by regret, worse anxiety the next day, and loss of productivity. 

The therapist and client then analyze this chain to identify key intervention points. 

2. Identifying and Challenging Negative Thought Patterns (Cognitive Restructuring) 

This technique helps clients recognize and dispute "automatic negative thoughts" or irrational beliefs that drive their behavior. 

• Example: 

• Automatic Negative Thought (ANT): "I messed up one time in my recovery, so I'm a total failure, and I might as well go back to using." 

• Challenging the Thought: The therapist guides the client to look for evidence against the thought. "Does one mistake erase all the days you've been sober? What concrete evidence do you have that you are a total failure?" 

• Developing a Balanced/Realistic Thought: "I had a lapse, which is a setback, but it's not a failure of my entire recovery. I can learn from this moment and get back on track right now." 

3. Developing and Practicing Coping Skills 

CBT provides practical, healthy alternatives to using substances to manage difficult situations, feelings, or cravings. 

• Examples of Skills Training: 

• Craving Management: Practicing a structured coping plan when a craving hits (e.g., "Surf the urge" by waiting 15 minutes, using deep breathing, calling a sponsor or support person). 

• Stress Management: Learning and using relaxation techniques like Progressive Muscle Relaxation (PMR) or guided imagery instead of reaching for a substance when feeling overwhelmed. 

• Assertiveness/Refusal Skills: Role-playing how to firmly say "No" to friends or family who offer drugs or alcohol, or how to leave a high-risk situation without feeling guilty or awkward. 

4. Relapse Prevention Planning 

This is a core element of CBT in rehab, often involving a detailed plan for maintaining sobriety after leaving the facility. 

• Examples: 

• "Fire Escape" Plans: Creating a written, step-by-step plan for what to do if the client experiences intense cravings or finds themselves in a high-risk situation. This includes who to call (support network) and what self-care behaviors to engage in. 

• Identifying High-Risk Situations: Listing people, places, and emotions (e.g., loneliness, anger, certain social events) that pose the highest risk of relapse and developing specific avoidance or management strategies for each. 

5. Homework Assignments (Generalization of Skills) 

CBT is practical, and therapists often assign tasks to be completed between sessions to practice new skills in real-life situations. 

• Example: 

• Thought Records/Journaling: The client is asked to track their negative thoughts and the subsequent feelings and behaviors (similar to the functional analysis) for a week and bring the records to the next session for review. 

• Behavioral Experiments/Pleasant Activity Scheduling: A client who uses substances due to boredom might be asked to schedule and complete one non-substance-related enjoyable activity each day (e.g., reading, walking, hobby) and report on how they felt afterward.

You've learned how your thoughts influence your actions, and you've acquired specific techniques—like the Thought Record and Graded Exposure—to take control of your brain health journey.  

1. Your Personal Action Plan 

The most effective plan is one you can stick to. Now, let’s use the "My Brain Training Plan" handout (or a note card) to choose ONE small, actionable step you can commit to starting this week. 

Remember the principles: keep it small, specific, and measurable. This is not about making massive changes, but about creating tiny, consistent wins that build momentum and rewire your brain.

Commitment 

Write your chosen step down and put it somewhere you will see it every day. Your brain is ready to change, but it needs clear instructions! 

2. Summary and Resources 

Recap: The Power of Change 

The biggest takeaway from this class is the concept of Neuroplasticity. No matter your age, your brain has the ability to adapt, learn, and change its structure. We don't have to be slaves to our old habits or thinking patterns.Cognitive Behavioral Therapy (CBT) gives us a structured way to harness that neuroplasticity. It's a method for directing your brain’s natural ability to change toward better mental health, greater independence, and a more fulfilling, engaged life. By challenging those "Thinking Traps" and actively working against "Behavioral Roadblocks," you are strengthening your mind and preserving your independence for the long run. 

Recommended Resources for Continued Learning: 

• National Institute on Aging (NIA): Excellent free resources on cognitive health, exercise guidelines, and aging gracefully. 

• AARP Mental Health & Wellness: Reliable articles and guides on managing stress, loneliness, and finding local support. 

• Library Resources: Ask your local librarian for books on "Cognitive Behavioral Therapy," "Mindfulness," or "Neuroplasticity." 

Disclaimer: Please remember that this class is for educational purposes only. The techniques discussed here are not a substitute for professional medical advice, diagnosis, or therapy. If you are experiencing persistent distress, anxiety, or depression, please consult your doctor or a licensed mental health professional.