CBT in Speech Therapy
Written by: Kendra Wormald / Treatment / January 18, 2023 / 7 minutes read
Updated: January 17, 2024
One of the most surprising aspects of speech therapy that I hear from my clients is that they would never have thought that emotions and thoughts had any relevance to their communication skills and habits. They were even more surprised that counseling was part of an SLP’s scope of practice. However, it’s quite the contrary.
Imagine having to give a presentation in front of your team and company stakeholders. Now picture how your body would likely respond and how you would communicate. Do you have an increased heart rate, reduced and shallow breaths, increased tension in your chest or throat, stumbling over your words or stuttering, speaking quickly, not being able to think clearly, or remember what you or they had been saying? Often, a combination of these can be a direct correlation with feelings of nervousness, anxiety, and panic, as well as relate to automatic negative thoughts such as, “I don’t belong here”, “ What I have to say doesn’t matter, “I’m not an effective communicator”.
Emotions, thoughts, and behaviors are all related to some degree, including what we think about ourselves as communicators, which is why Cognitive Behavioural Therapy (CBT) can be used as a framework to ultimately target communication skills.
… the goal of CBT is not to ‘think happy thoughts’ but is instead to think accurately. Our thinking can become biased, but it is within our power to change the way we think.” (Psychology Tools, 2023)
Table of Contents
Examples Of How Emotions Can Impact Communication Behaviors
What Is CBT?
What Emotions And Thoughts Can I Talk About In Sessions?
Do I HAVE To Talk About My Feelings?
What Does CBT For Communication Look Like?
Examples of how emotions can impact communication behaviors:
When you are feeling small, insecure or afraid, you tend to: Talk quietly, avoid eye contact and avoid speaking “too much”.
When you are feeling angry, unheard and disrespected, you tend to: Respond and speak quickly, use aggressive communication and accusatory language and tone
When you are feeling happy and excited, you tend to: Use a lot of body language and hand gestures, hold eye contact, add word stress, and use variety in your pitch.
When you are feeling hopeless and helpless, you tend to: Withdrawn from social situations, put yourself down, use a lot of filler words
Reflect on your own life and picture how you responded to circumstances. Now focus on how you felt in that moment, did it to some level dictate how you behaved?
What is CBT?
Cognitive Behavioural Therapy focuses on identifying, evaluating and responding to dysfunctional thoughts and beliefs. CBT’s key message is that the way we think (cognition), and what we do (our behaviors) affects the way we feel. Examining these thoughts and emotions may help explain why a reaction occurred to a specific situation. The result of successful intervention depends on the restructuring of negative thought patterns and subsequent behaviors.
“We can’t always control our emotions, but we can choose how we respond to those feelings when we write and speak” (Graham, 2023).
What emotions and thoughts can I talk about in sessions?
Counseling is in the SLPs scope of practice: “counseling for individuals, families, co-workers, educators, and other persons in the community regarding acceptance, adaptation, and decision-making about communication and swallowing” (ASHA, 2007). Notably, if the client mentions topics that are outside the scope of practice for an SLP, i.e things outside of communication, the SLP will refer you to a psychotherapist to further investigate those experiences.
Evaluating and deconstructing thoughts and emotions isn’t always the easiest conversations to have. It may take a few sessions to build rapport with your therapist before trying this approach. It’s common to feel uncomfortable speaking about these things. If it’s unmanageable, be sure to ask for a break or to possibly come back to the conversation another day.
Cognitive Behavioural Therapy focuses on identifying, evaluating and responding to dysfunctional thoughts and beliefs.
Do I HAVE to talk about my feelings?
The simple answer is, no. You will never have to do anything in sessions. Therapy should create a safe space for you to investigate these thoughts and emotions. This investigation could lead to a better understanding of yourself and your communication habits. However, if you are not in a place where you feel ready to do so, that’s an important part of the journey too. Recognizing your level of readiness for change is a valuable skill in itself. You and your clinician are a team and will work towards your goals at your pace.
An important practice that complements this approach is breath work. Look into this Masterclass course on Breathing for Communication.
What does CBT for communication look like?
There are several techniques that can be used to approach CBT. I find a lot of my clients like working with a ‘Thought Record’, a type of structured journal. This record is organized into columns with the headings:
Framework:
Situation: Where were you, what time of day was it, who were you with, what happened
Emotions: What did you feel?
Negative Automatic Thoughts: What thoughts or images went through your mind?
Evidence for Negative Thought: What evidence is there that supports this?
Evidence against Negative Thought: What evidence is there that does not support the negative thought?
Alternative, Balanced Thought: Weight up the evidence, is there a different, more balanced thought?
Example:
Situation: I went on a tangent when giving a proposal at work and lost my train of thought.
Emotions: Embarrassed, nervous, frustrated
Negative Automatic Thoughts: I’m a terrible communicator, I always mess up important conversations, I don’t belong in this role
Evidence for Negative Thoughts: I stumbled over my words the last three meetings
Evidence against Negative Thought: I received positive feedback the other day when I was facilitating a discussion with my team, my colleagues often come to me to explain new concepts
Alternative, Balanced Thought: At times I lose track of my communication intent, but I know how to take back control, take a breath, then keep moving forward.
A thought record can be made for nearly any situation and doesn't need to be written down every time. Getting in the habit of intentionally reflecting on experience and your reactions and emotions actively throughout the day, will help contribute to successful communication engagement and development.
How we think and feel about ourselves as communicators has a significant impact on how we communicate. There is substantial value in spending time reflecting and evaluating how your emotions, thoughts and actions are connected and how these impact who you are as a communicator.
To speak with a psychotherapist or one of the speech-language pathologists at Well Said: Toronto Speech Therapy, schedule an initial consultation by clicking the link below or calling (647) 795-5277.
