Understanding Cognitive Behavioral Therapy – Part 1

Many people have the false impression that psychotherapy always involves years of tedious exploration of the subconscious mind in order to get to the root of whatever ails them. In the movie Pretty Woman, Richard Gere’s character somewhat jokingly alludes to this tedious process when he recalls how it took him 10 years of therapy to realize that he was angry at this mother. Although long-term, intensive therapy definitely has its place, not everyone can – nor wants to – invest the substantial time and money involved in such an approach. Fortunately, there are other types of therapy that are more practical, goal-oriented, and short term – and, many would argue – more effective. Cognitive Behavioral Therapy is one such approach to treating a vast array of common life problems and diagnosable mental health disorders.

Origin of Cognitive Behavioral Therapy

Back in the 1960’s, renowned psychiatrist Dr. Aaron Beck made some profound observations while working with his patients. He realized that they were engaging in self-talk – the internal dialogue we all have with ourselves as we evaluate and process what’s going on in any given moment, as well as when we contemplate upcoming situations. For example, the internal dialogue of a depressed therapy client might go something like this: “This whole therapy process is pointless; my life doesn’t work and it never will. No one can help me. I’d be better off dead.” As you can imagine, such bleak, hopeless thoughts would make anyone feel more depressed than ever. Beck also noted that his therapy clients held deeply ingrained (and distorted) beliefs – “core beliefs” – that played a major role in how they viewed themselves, other people, their experiences in life, and their future. Negative, distorted, or irrational core beliefs fueled their depression, anxiety, and other troubling emotions. For example, a fairly common core belief of individuals who struggle with depression is “I’m unlovable”. Those who battle anxiety often have the deeply ingrained core belief that “I can’t handle it” – with “it” referring to the various scary “what if’s” that constantly play out in their imagination. This powerful connection between people’s internal dialogue and their emotions is the cornerstone of Beck’s “Cognitive Therapy”. The “cognitive” aspect refers to the emphasis on the role of thoughts and beliefs. The “behavioral” aspect of “Cognitive Behavioral Therapy” (CBT for short) refers to the elements of behavioral therapy that are often used as part of the overall treatment approach.   CBT helps people identify and change their unhealthy thoughts, beliefs, and behaviors to ones that empower them while eliciting more positive, healthy emotions.

Automatic Thoughts and Thinking Errors

Beck coined the clinical term “automatic thoughts” to refer to the emotionally-laden, habitual thoughts of his patients. These thoughts, which tend to be absolute, unrealistic, and exaggerated, are often triggered by situations. In the earlier example of the depressed patient, “it’s pointless” (and similar statements, such as “why bother – nothing ever works”) is one of his automatic thoughts whenever he’s presented with an opportunity. On any given day, various statements of futility may pop into his mind at least a hundred times. As a result, he feels hopeless, unmotivated, and apathetic. He gives up before ever trying, which, of course, reinforces his sense of futility because nothing ever seems to change for the better. In CBT, one of the goals is to help individuals become aware of their automatic thoughts. They can then stop the thought in its tracks, refute it, and change the direction of their thinking to something more positive and empowering. For example, if one of your automatic thoughts is that you always fail no matter how hard you try, CBT can help you 1) identify the thought, 2) challenge it (e.g. by making a list of all your successes in life so you can refute the thought) and 3) change it to something more helpful and empowering (e.g. “I don’t always fail; I’ve had many successes in my life”, or “It’s okay if I fail; I’ll learn from it and do better next time”). Often, the automatic thoughts of individuals struggling with depression, anxiety, relationship problems, and other issues involve “thinking errors” or “cognitive distortions”. There are several different types of thinking errors. Some of the most common include: “Should” or “ought” statements – These refer to the inflexible rules and unrealistic expectations people have for themselves or others, such as “I should be able to…” or “They should always…” Should statements trigger feelings of regret, resentment, anger, or disappointment. CBT can help you recognize that you can’t control everything, and would be better served by thinking in terms of “I would like to be able to…” or “I am grateful when people…” Emotional reasoning – This refers to assuming that something is true or valid based on how you feel. For example, “I feel worthless, so I must be worthless”. Just because you feel worthless, doesn’t mean you are. A CBT therapist would All-or-Nothing / Black and White Thinking – This type of thinking error involves the use of absolutes and extremes, such as “always”, “everyone”, and “never”. There is no allowance for exceptions, a middle ground, or shades of gray. CBT helps you identify and challenge these extremes, and change them to more realistic statements.   For example, “Nothing ever works out” becomes “Sometimes (or often) things do work out”. Jumping to Conclusions – People prone to depression and anxiety are especially good at assuming the worst. And when they do, it quickly elicits all sorts of negative emotions. For example, if your date calls to cancel your plans due to an “emergency”, you assume that he or she is making an excuse and doesn’t really want to get together. CBT will help you learn to give others the benefit of the doubt and consider other possibilities when you don’t have all the facts. Disqualifying the Positive – This involves discounting, minimizing, or rejecting the validity of positive experiences (the classic, “Yes, but…” or “That doesn’t count…”) and focusing only on the negative ones. Other thinking errors include: Labeling / mislabeling – “I’m a failure” or “They’re all much smarter than me” Magnifying or minimizing – Blowing something out of proportion or downplaying something positive Blaming – Blaming others for your problems or negative feelings, or blaming yourself for most, if not everything, negative in your life Personalizing – Assuming someone’s hurtful words or actions are directed at you when they’re not, or taking personal blame for something bad that happens that had nothing to do with you Filtering – Focusing on anything negative in a situation, while ignoring or discounting all the positive aspects of it One of the great things about CBT is that once you learn how to identify and change negative thought patterns, thinking errors, and irrational core beliefs to ones that are more realistic, empowering, and rational, you’ve got an invaluable tool that you can use throughout your life. It can help you cope more effectively with negative emotions, stress, interpersonal conflicts, and other challenges that will inevitably come up from time to time. [To be continued in Part 2]

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