People typically come to therapy because they want something to change in their lives. The depression or anxiety may feel like too much and they want to know what they can do to find relief. They may find themself stuck in a rut or caught up in unhealthy patterns and want help moving forward. The therapeutic approach of cognitive-behavioral therapy (CBT), can provide you with tools to do this by helping you to understand your automatic thoughts and personally held beliefs so that you can change them if they are inaccurate and no longer working for you.
This is because cognitive-behavioral therapy looks at how our cognition affects our behavior. Cognition refers to the ways we gain knowledge and understand information. It involves a variety of mental processes, including thinking, knowing, remembering, judging, and problem-solving.  Needless to say, there are a variety of cognitive processes, such as attention, language, learning, memory, perception, and thought. Cognitive-behavioral therapy suggests that the mental health symptoms people experience can be due to having a distorted view of themself, others, and the world.
As an evidence-based mental health approach, cognitive-behavioral therapy is often used to work in treating:
- Depression and other mood disorders
- Anxiety, including phobias, panic, Obsessive-Compulsive Disorder (OCD), Post-Traumatic Stress Disorder (PTSD), and Generalized Anxiety Disorder (GAD)
- Chronic pain and Somatization disorders
- Personality disorders
Some People May Benefit From a Different Approach to Cognitive-Behavioral Therapy
However, for some people, a strict talk therapy approach might not be a good fit. This could be due to a variety of reasons. For some people, this could be due to social anxiety which makes them feel uncomfortable talking about themselves or being with other people who want to know more about them. They may have difficulties gathering their thoughts. Or their nervous system needs time to regulate and calm so that they can feel safe. Additionally, some other people may need distance from their thoughts and feelings and instead externalize them in ways that allow them to explore them without it otherwise feeling too threatening. Still, other people may simply need other means for communicating and expressing their thoughts and feelings.
Reasons Why Music Therapy Can Be This Different Approach
Whatever the reason might be, as a counselor and music therapist, I believe that a music therapy-based approach to cognitive-behavioral therapy can be a meaningful way for engaging with your thoughts, feelings, and beliefs. Therapeutic musical experiences can encourage the expression and exploration of one’s automatic thoughts, along with their intermediate and core beliefs. While at the same time, these experiences can also bring up the cognitive distortions that are causing the person distress. These can then be examined and processed within therapy.
As well, one can intentionally listen to music at home and track their response as part of a thought journal that a person is typically asked to keep as a way of tracking their thoughts, feelings, and reactions. Adding music to their thought journal can lead to the conscious use of music as a coping tool and way of managing emotions. This can be especially meaningful for teenagers who are struggling with feelings of depression and anxiety. These teens may already be using music for these reasons, but they may not be doing so in healthy ways. 
What This Blog Post Will Cover
In this blog post, I’ll identify and define some core concepts of cognitive-behavioral therapy that I incorporate into my work as a counselor and music therapist. Following this, I’ll illustrate ways that music can support and enhance these concepts. I want to note that I’m an eclectic therapist at heart and don’t strictly adhere to the cognitive-behavioral therapy protocol, so I won’t be going into deep details around the structured treatment practices for cognitive-behavioral therapy.
If you’re reading this and are at a place where you’re considering therapy for yourself, I hope that this post serves two purposes. The first is that I hope it will help you better understand what cognitive-behavioral therapy is so that you can begin thinking about your own thought patterns, behaviors, and responses in life. The second is that I hope this post will effectively illustrate ways that a music therapy-based approach to cognitive-behavioral therapy may be for you.
So with that all now said, let’s dive a little deeper into this topic.
Overview of Cognitive-Behavioral Therapy
Like I mentioned earlier, cognitive-behavioral therapy involves looking at the relationship between the way you think, how you feel and how you behave. It does this by helping you to recognize your thought patterns. Are the majority of your thoughts positive, negative, neutral? Are they accurate or inaccurate and distorted? What about your emotional responses? Are the majority of your feelings positive, negative, or neutral? How do these patterns and responses influence your actions and behaviors?
For you to answer these questions, curiosity and acceptance are needed. Yet, that can be hard to do depending on your background and early life experiences. After all, if you grew up with a distorted view of yourself, others, and the world, you may feel closed off to these concepts. Your early childhood experiences may have taught you distorted or unhealthy emotional and behavioral responses which no longer serve you now that you’re older.
Cognitive-behavioral therapy suggests that we learn most of our emotional and behavioral responses early on in our lives.  Fortunately, however, the emotional and behavioral reactions we develop can be changed. Cognitive-behavioral therapy believes that these reactions and beliefs are learned, and because of this, they can also be unlearned. This is good news for those whose childhoods were less than ideal.
To change these reactions, though, we need to understand them and ourselves, as well as how we perceive others and the world around us. We need to understand how we think and behave, as well as be able to recognize when our thoughts aren’t accurate and are instead cognitive distortions that are causing us needless distress. Below are some key concepts to cognitive-behavioral therapy that can be explored through the use of music, which I will describe further below.
Three Levels of Cognition in Cognitive-Behavioral Therapy
Cognition-behavioral therapy looks at three levels of cognition where dysfunction can exist. They are:
- Core Beliefs
- Intermediate Beliefs
- Automatic Thoughts
Core Beliefs are those early beliefs we form in childhood. And similar to our attachment style, they develop early on through our interactions with our parents. As such, they influence how we understand ourselves based on the care we received from others. These core beliefs are the drivers behind our intermediate beliefs and automatic thoughts. These core beliefs also form the basis for our general coping strategies for dealing with major life issues, which is another reason why an attuned and secure attachment with our caregivers is so important.
For those whose early experiences led to negative core beliefs, these negative core beliefs can lead to problems. Again, though, I want to stress that core beliefs can change. However, if they don’t, a person thinking and behavior, can becoming rigid and inflexible. This can ultimately lead to the development of a personality disorder, which tend to begin in adolescence and early adulthood. And this is another reason why access to adolescent mental health is important.
Intermediate Beliefs or Conditional Beliefs are the attitudes or rules a person adopts about life and how the world operates. They’re the general beliefs about life that help a person make sense of how to behave in the world. They take the form of assumptions, such as “If… then”, rules and expectations, attitudes, and values. These rules guide thoughts, and as a result, influence behaviors. Our core beliefs also help shape them.
Automatic Thoughts are those thoughts about ourselves and others that immediately come up in a situation. We may be unaware of these thoughts, but the emotions they bring with them are very familiar. They are also influenced by our intermediate and core beliefs. Our automatic thoughts lead to reactions that can help us or hinder us. The image to the right illustrates how this happens.
Cognitive distortions are exaggerated patterns of thought that aren’t based on facts.  They are negative thought patterns that can lead you to believe things about yourself and the world that aren’t true. Reversing these cognitive distortions is a key goal of cognitive-behavioral therapy.
Common Cognitive Distortions
Below are fifteen common cognitive distortions. Click underneath each to read a brief description of what they are.  How many do you recognize yourself doing?
Discounting the Positive
Jumping to Conclusions
Fallacy of Fairness
Fallacy of Change
Always Being Right
Using Music to Address Cognitive-Behavioral Therapy Concepts
So now let’s look at music. Music is a versatile therapeutic tool. Because of this, I believe it can be helpful to use for teaching and exploring concepts from cognitive-behavioral therapy. As Hakvoort and Bogarets put it about their work in the forensic setting: “Cognitive-behavioral music therapy stimulates patients to learn and practice new skills, confronts them with old habits and cognitions, and offers the opportunity to develop new behavior. Music is implemented to trigger neurological processes in the brain to support these behavioral modifications” (p. 198) 
So now let’s take a closer look at some ways that music can do this.
The first is through active music-making. Whether improvised or pre-composed songs, music-making can bring up thoughts and feelings about yourself and your situation. For example, when presented with the invitation to make music, you may automatically refuse to give it a go. This could be because of a core belief that you have of yourself not being “creative” or “musical enough.” You may have an intermediate belief that “therapy shouldn’t be fun.”
At the same time, however, making music can help you to shift those beliefs. Being able to play a song or an instrument that you wanted to play can feel good. You might be able to start seeing yourself as a creative person. Through making music you might discover new ways of being with others. These new ways of engaging and presenting yourself to others are more aligned with what you want.
Making music and talking about the experience can also lead to the exploration of cognitive distortions. For example, filtering, polarization, overgeneralization, and discounting the positive are some cognitive distortions that I see come up for clients when making music. It may take the form of ruminating on a wrong note that a person plays leading them to think that they’ll “never be able to play.” It may also take the form of dismissing what they can do well through the music. Talking about your experience after making music can be a way to reflect upon and restructure these beliefs.
Likewise, talking about your relationship with music can open the door for exploring messages you received as a child and the type of self-talk you currently engage in. Were some of your early messages as a child that you “couldn’t carry a tune” or that you were “tone-deaf?” If so, those early messages may have contributed to your core beliefs.
As well, depending on your identity, you may have picked up messages from society that it isn’t “appropriate” for you to play a certain kind of instrument or play a certain kind of music. Is that really true? Does it have to be true? We can explore that through this kind of conversation.
Lyric analysis is a type of music-based discussion that uses song lyrics as the basis for discussion. Song lyrics can help illustrate examples of dysfunctional thoughts and beliefs. This can then lead to further exploring these thoughts and beliefs. Some songs that capture this idea of dysfunctional thoughts and beliefs include “Creep” by Radiohead and “Bohemian Rhapsody” by Queen.
Lyric analysis can also be useful for exploring more accurate and helpful thoughts and beliefs. Song lyrics can bring up new insights and awareness of who we are and who we want to be. For example, Lady Gaga’s “Born This Way” illustrates core beliefs worth embracing and adopting.
Using the lyrics of pre-composed songs is also a way for a person to become acquainted with cognitive distortions. Using song lyrics to explore cognitive distortions provides a person with some distance between themself and the distortions which can make it feel easier to engage with. For example, emotional reasoning can be seen in the lyrics for Radiohead’s “Creep,” while blaming and control fallacies can be seen in NF’s “Let You Down.” This can then lead to talking about times they witness or experience the same things in their lives.
Song-Writing To Promote Cognitive Restructuring
Cognitive restructuring works with one’s automatic thoughts. Cognitive-behavioral therapy uses cognitive restructuring to work with depression. Song-writing can be useful in promoting cognitive restructuring because it can help create and reinforce alternative thoughts that better serve a person. Thoughts and ideas brought up in therapy can be used to create personally-composed songs. These songs can affirm who they are and how they’ve grown or changed from therapy.
Experiencing This For Yourself
To live more of the life we want it is important to understand why we think and behave the way we do. Yet, it can sometimes be hard to figure out on your own. If this describes your situation and you’re thinking about therapy for yourself, but would like to experience a music-based cognitive-behavioral therapy approach, contact me. I offer a free 15-minute online or phone consultation that you can schedule here.
References What is Cognition? – VeryWell Mind  Cherry Hense, PhD, Michael J Silverman, PhD, MT-BC, Katrina Skewes McFerran, PhD, RMT, Using the Healthy-Unhealthy Uses of Music Scale as a Single-Session Music Therapy Intervention on an Acute Youth Mental Health Inpatient Unit, Music Therapy Perspectives, Volume 36, Issue 2, Fall 2018, Pages 267–276, https://doi.org/10.1093/mtp/miy013  All About Cognitive Behavioral Therapy (CBT) – PsychCentral  Stuck in the Negatives? 15 Cognitive Distortions to Blame – PsychCentral  Hakvoort, L., & Bogaerts, S. (2013). Theoretical foundations and workable assumptions for cognitive behavioral music therapy in forensic psychiatry. The Arts in Psychotherapy, 40(2), 192–200. https://doi.org/10.1016/J.AIP.2013.01.001