Cognitive Behavior Therapy (CBT)

CBT is a type of therapy that targets “Thought Distortions”. (DBT, which I have written about before is a specialized form of CBT) I find CBT to be useful when I find myself sliding down into depression, or winding up into anxiety. (I’m not so self-aware regarding mania) By using CBT, I can change my thoughts and thus change my feelings. It works the other way too, feelings can control thought and behavior. That’s usually not good, as these thoughts/behavior are often thought distortions formed by the bad emotions.

I look at my thoughts, and say, “Is this a realistic thought?”, “What’s really the worst thing that can happen?”, “Is that thing all that bad?” If I don’t do that I can start believing that what my emotions tell me. Of course, there’s a lot more to CBT than that, I’ll list some common thought distortions below. These are some of my favorites, if you can search, you can find more that aren’t listed here.

  • Black and White (All or Nothing) Thinking
  • Blaming (Personalization)
  • Catastrophizing
  • Disqualifying the Positive (Filtering)
  • Emotional Reasoning
  • Fallacy of Fairness
  • Fortune Telling
  • Jumping to Conclusions
  • Labeling
  • Magnification and Minimization
  • Mind Reading
  • Overgeneralization
  • Should Statements

Whew, that’s quite a list. Below I’ll describe these in more detail.

Black and White (All or Nothing) Thinking

This is where you see everything as all good or all bad, nothing in between. No shades of gray. People are your best friends, or they are your enemies, no acquaintances. You think, “I didn’t do that assignment at work perfectly, I have failed.” Of course it wasn’t perfect, but it was probably done pretty well. But you can’t see that. You’ve failed.

Blaming (Personalization)

This distortion causes you to believe that you are responsible for everything. If something goes wrong in your life, you take the blame, whether it’s your fault or not. You are going out with your family. It’s chaos getting the kids ready, and some of them drag their feet. You’re late for the beginning of the movie. You take this situation all on yourself, you blame yourself for being late.

Catastrophizing

This is where you ruminate about all the worst things that can happen in a given situation. Of course it’s prudent to make plans for when something could go wrong, but this is different. It’s different because of the magnitude of the thoughts and the distress it causes. The distress can be painful and debilitating. This is a very common thought distortion and causes untold anxiety.

Disqualifying the Positive (Filtering)

This is also very common (well, really they all are). As you go through your day, many things happen. You get a promotion, you have a great lunch with a friend, you see a movie and eat out with your wife and kids. You get to watch a new episode of your favorite TV show. But you have flat tire on the way home from the office. You have AAA fix it and you’re on your way without too much delay (OK we’re imagining that you get fast service from the auto club). When you look back on your day, what do you see? The flat tire. The day was awful. None of the good things even register, you dwell on that flat tire, and how everything goes wrong and that your life is a series of disasters.

Emotional Reasoning

Your reasoning is based on your emotions rather than the realities of the situation. You have a big test tomorrow. You really don’t want to study for it. You keep putting it off all night because your emotions tell you that you don’t want to study. You hate it. You fail the test. It goes on. Since you failed the test, you feel like an idiot. So your believe that you’re an idiot. Not pleasant. You’re not thinking clearly. What would be more realistic is realizing that you failed the test because you didn’t study and resolving to study next time instead of stewing in self loathing.

Fallacy of Fairness

“Life isn’t always fair” We grow up hearing this, but when we expect that, despite this common aphorism, things should always be fair, this can be a problem. It can cause great distress, and it can come out as anger, as well as as depression and anxiety.

Fortune Telling

This is feeling that you know what others are thinking, and then assuming that this is true, and acting that way. Perhaps you want a girl/boyfriend. You assume (or fortune tell) that this will never happen, so when you get a chance to ask someone out, you don’t because you “know” that they don’t like you. Depression and anxiety follow.

Jumping to Conclusions

You’re sure that things will turn out badly even thought you have no evidence of this. You’re up for a promotion at work. But you assume that you’re not going to get it, so you are depressed and thinking negative thoughts, when for all you know, you might get it anyway.

Labeling

This is when you apply labels to people, yourself or others, that are unfair and too broad. You lose at a game, then you label yourself a “loser”. It hurts you to think about yourself this way, and you get depressed. Depressed based on distorted thinking telling you that you are a loser. But you’re not.

Magnification and Minimization

Minimization is very similar to “Disqualifying the Positive.” Magnification is the opposite, this is commonly known as “Making a mountain out of a molehill.” You pay more attention to the bad things and let them tear you down, and less attention to the good things, not allowing them to make you feel better about yourself.

Mind Reading

This distortion involves assuming that someone is going to think or do the worst based on no real evidence. People are going to hate the job you do on a project at work, so you don’t really put any effort into it, you just wallow in anxiety and depression You sabotage the work and yourself. Then they do think the worst, you ensured that they would by assuming the worst would be what happened. Guess what? Depression and more negative thoughts.

Overgeneralization

Basing your thoughts on one bad event, assuming incorrectly that if something bad happened once, it is sure to happen again, even if the circumstances change. This then causes you to base your actions on bad data. Again, a self-fulfilling prophecy, anxiety and a bad mood.

Should Statements

“Shoulda, Coulda, Woulda” This one happens when you think that your or other people’s actions should conform to what you think is right and proper. The first causes self-recrimination that is normally not deserved, both set you up for disappointment. Unearned disappointment based on distorted thinking.

 

Automatic thoughts

Automatic thoughts are thoughts that just happen. Something triggers you, them bam! you have an automatic thought. Usually nothing good. A thought that leads to anxiety and depression. Morbid automatic thoughts can happen when something bad happens. The event happens, and triggers an automatic, “I wish I were dead.” Once an automatic thought becomes ingrained, it can be very difficult to stop thinking it when triggered.

 

These thought distortions can really hurt you. They are especially bad at driving depression and anxiety, as well as many other bad moods/behaviors. If you can recognize these thought distortions and automatic thoughts as they happen and adjust your thinking to something more realistic, you can stem the spiral into mental distress.

An example of what to do when your thoughts are in turmoil, you are anxious, worried, and getting depressed: A therapist once told me that when I was worried about a situation, or upset about something that had happened, I should imagine a scale from 0 to 100. On that scale, I should think of the worst possible thing that could happen, assign it to 100, then think about the best, the very best that could happen. Assign that 0. After doing this, I should examine my thoughts. Look at what is most likely to happen, considering possible thought distortions while doing so. Assign that outcome to a a realistic place on the scale based on what is most likely to happen. Almost always, if you are realistic and take the exercise seriously, you’ll see that what’s likely to happen is not so bad.

Of course, thoughts are messy. In any given situation, you might suffer from more than one thought distortion. This just makes the situation worse, and it makes it harder to untangle the thoughts and see what needs to be done to end the suffering. This takes practice. You can’t just read a list of cognitive distortions and then feel great in every situation. If only new skills were that easy to learn. It takes practice. But with practice CBT can seriously improve your mental health.

For more help in using CBT in everyday situations, you could take a CBT class if one is offered in your area. But what if none is? There are books that teach you how to use CBT. The granddaddy of all of them is “Feeling Good: The New Mood Therapy”, by David Burns. To quote the Amazon blurb:

The good news is that anxiety, guilt, pessimism, procrastination, low self-esteem, and other “black holes” of depression can be cured without drugs. In Feeling Good, eminent psychiatrist, David D. Burns, M.D., outlines the remarkable, scientifically proven techniques that will immediately lift your spirits and help you develop a positive outlook on life. Now, in this updated edition, Dr. Burns adds an All-New Consumer’s Guide To Anti-depressant Drugs as well as a new introduction to help answer your questions about the many options available for treating depression.

You can find more books on CBT on Amazon (or other book sellers sites).

To quote something we recite every week in my graduate DBT group, “You can’t change the direction of the wind, but you can adjust your sails.” I looked this up on Google and found it attributed to at least three people, so it’s hard to say who we’re quoting here. It does apply to CBT as well as DBT though, and I think of it often.

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