Cognitive Behaviour Therapy – Or I think, I think!

‘Cogito Ergo Sum’ or, ‘I think therefore I am’ is probably one of the only Latin phrases that I remember from my high school days.  It was taught to us as the philosophers’ phrase of describing self awareness to differentiate us from the lower animals.

But what if what we are thinking does not coincide with other’s view of reality?  Do we do what Adam Savage does on that fabulous show ‘Mythbusters’ and – ‘I reject your reality and substitute my own’?  Or do we look at our thought processes and reexamine them?

When our moods and emotions are out of balance our worldview also changes and we often fall into irrational thinking patterns, which in turn create feedback to our moods and the circle continues.

Cognitive Behaviour Therapy is designed to help us recognize the irrational thinking patterns and learn strategies to challenge those thoughts and thereby have a positive feedback effect on our moods.  In essence we are trying to retrain our thinking patterns back into more of a rational pattern.

The therapy is based on the idea that how we think (cognition), how we feel (our emotions) and how we behave (behaviour), are all interconnected.  Basically the view that emotions cause our thought patterns is reversed by this therapy which maintains that irrational thoughts lead to negative emotions and moods, and thus behaviour.

Dr Aaron T Beck was the forerunner of this type of therapy - a professor emeritus at the department of psychiatry at the University of Pennsylvania and also serves as the director of the Center for the Treatment and Prevention of Suicide. He is noted for his research on psychotherapy, psychopathology, suicide, and psychometrics, which led to his creation of cognitive therapy and the Beck Depression Inventory (BDI), one of the most widely used instruments for measuring depression severity. [1]  although his work has been continued in other modifications to better suit other disorders, atlthough the basic schemes remain.

Other well known authors of books or articles dealing with this therapy are Dr Jim Phelps of Bipolar World fame and Dr David Burns who wrote the best selling book, Feeling Good: The New Mood Therapy. And of course Dr Beck’s book, Cognitive Therapy and the Emotional Disorders.

The classic example of where irrational thought can alter are moods is where we make a mistake and think, “I am useless – I never get things right”,  then our moods tend to become depressed and then our behaviour changes to avoid other situations where we feel we will fail again and this tends to reinforce our belief in our uselesness. Soon we have a self-fulfilling prophecy feeding on itself.  Sound familiar?

The  way our thoughts become irrational is based on what is often described as ,’The Ten Cognitive Distortions’ and they are common in life for everyone at some point.  The difference is that those of us with bipolar or depression tend to have had them become almost a way of life.

Once we have become familiar with these irrational thought patterns, we then have to learn strategies to challenge and confront them so that over time we can change how we feel about ourselves and situations and thus are enabled to also change our behaviour to reinforce the positive cycle.

This is often done in a four step process so that we can see the rational versus the irrational thoughts side by side in line with the situation and then look at what steps we can take.

But first a description of the Cognitive Distortions:

1.       All or nothing thinking – the tendency to think in absolute terms, like ‘always’, ‘never’ and every.

2.       Overgeneralisation – taking isolated situations and applying them in a wide generalised way.

3.       Mental filter – focussing exclusively on one, usually negative aspect and ignoring the larger, more positive picture.

4.       Discounting the positive – continually ignoring positive aspects for arbitrary reasons.

5.       Jumping to conclusions - assuming something negative where there is actually no evidence to support it. Two specific subtypes are also identified:

a.       Mind reading - assuming the intentions of others

b.       Fortune telling - guessing that things will turn out badly

6.       Magnification – usually magnifying the negatives and minimising the positives – my psychiatrist nicknames it ‘Awfulisation’.

7.       Emotional reasoning – making decisions on how you feel not based on objective reality.

8.       Should statements – when you concentrate on what you feel you should do or ought to be rather than the reality of the situation. (Often called ‘wishful thinking’).

9.       Labeling – related to overgeneralisation, where you assign labels to someone rather than specific behaviour.  One example could be rather than saying – I made a mistake, you say I am a loser because of the mistake.

10.   Personalization and blame – assuming yourself or others are the cause of things when that may not have been the case.

 

Now I am absolutely sure that some, if not many, of those are familiar to you as they were to me as I went through them with my psychiatrist and through Dr Burns’ book, ‘Feeling Good’.   In fact I was a bit depressed at just the number that I was familiar with at first!

So, remembering that I am doing this just as a person who tries to use CBT in my life, and not an expert, here are the steps that I take to challenge an irrational thought.

Situation:

You've have had a bad day, feel fed up, so go out shopping. As you walk down the road, someone you know walks by and, apparently, ignores you.

 

Irrational

Rational

Thoughts:

He/she ignored me - they don't like me

He/she looks a bit wrapped up in themselves - I wonder if there's something wrong?

Cognitive distortions

Fortune telling, Mind reading, Labelling, Overgeneralisation, Emotional Reasoning

Emotional:
Feelings

Low, sad and rejected

Concerned for the other person

Physical:

Stomach cramps, low energy, feel sick

None - feel comfortable

Behaviour:

Go home - avoid them

Get in touch to make sure they're OK

[2]

You will note that the process is basically a four step procedure – one we clearly look at what actually happened not what we think happened.  Two – we identify our irrational thought and it is a good idea to see what one, or ones of the cognitive distortions is involved.  Three we look at what a rational thought could be for the situation and then look at what action we can take do  something concrete and positive about it.

It is a really great idea to write down our reasoning and not just do it mentally as if forces us to confront our irrational thoughts and actions in a much more effective way.

Do I do well at this?  To be perfectly honest, it requires hard work and commitment to make it work but the longer we work at it the easier it becomes. I have to remind myself that the times that I am really down and not feeling very good about myself and life in particular, these are the times when I most need to do it.

When those irrational thoughts start to hang around and my moods alter, I need to remember Adam Savages’ wise saying, “I reject your reality and substitute my own”.

References and further reading:

In chronological order:

·               Beck, Aaron T. Cognitive Therapy and the Emotional Disorders. International Universities Press Inc., 1975. ISBN 0-82-360990-1

·               Ellis, Albert. A Guide to Rational Living. Prentice Hall, 1975. ISBN 0-13-370650-8

·               Abramson, L., Seligman, M.E.P. & Teasdale, J. (1978). Learned Helplessness in Humans: Critique and Reformulation. Journal of Abnormal Psychology, 87 pp49-74

·               Dryden, Windy. "Ten Steps to Positive Living." Sheldon Press, 1994.

·               Burns, David D. Feeling Good: The New Mood Therapy. Revised Edition. Avon, 1999. ISBN 0-38-081033-6

·               Keller, M. et al. A Comparison of Nefazodone, the Cognitive Behavioral-Analysis System of Psychotherapy, and Their Combination for the Treatment of Chronic Depression. New England Journal of Medicine Volume 342:1462-1470 May 18, 2000.

·               Tanner, Susan and Ball, Jillian. Beating the Blues: a Self-help Approach to Overcoming Depression. 1989/2001. ISBN 064636622X [3]

·               McCullough Jr., James P. Treatment for Chronic Depression: Cognitive Behavioral Analysis System of Psychotherapy (CBASP). Guilford Press, 2003. ISBN 1-57-230965-2

·               Wikepedia, Beck, Aaron T. http://en.wikipedia.org/wiki/Aaron_T._Beck

·               Royal College of Psychiatrists Publication on CBT found at http://www.rcpsych.ac.uk/info/factsheets/pfaccog.asp

Graham Brown

21 March 2006


 

[1] Wikepedia, Beck, Aaron T. http://en.wikipedia.org/wiki/Aaron_T._Beck

[2] Table adapted from Royal College of Psychiatrists Publication on CBT found at http://www.rcpsych.ac.uk/info/factsheets/pfaccog.asp

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