About Cognitive Behavior Therapy
Cognitive Behavior Therapy (CBT) is designed to help individuals look at distortions in their thinking (cognitions), which causes them to feel badly, which in turn affects their behavior. The therapy aspect encourages individuals to begin looking for the evidence that supports their negative distortions. Take the following example. If a client says in session, “I have nothing to live for,” this is an example of “all or none” thinking. It is probable that a CBT therapist working with this individual might help them to find at least one reason to live for. This might include their spouse, children, pet, job, etc. This would immediately disprove the statement made, confirming the thought as a negative distortion, and then help them to build upon the areas in their life that are worth living for.
It is important to remember that everyone has distortions in their thinking. However, frequently when someone is depressed, they can’t see these thoughts as distortions and tend to respond to them as if they are real. Those who are not depressed might be able to see the negative thoughts for what they are and not respond to them.
It is important to remember that feelings don’t always represent reality. Imagine the times when you “felt” someone was angry with you, only to come to find out that they weren’t. Or, imagine the time when you “felt” you failed an interview, and got the job. Most of us can find many examples in our lives of how this concept has proven to be true. So, by identifying our thoughts when they are negative as “distortions,” and disproving them by looking at the evidence that does not support them, individuals can slowly begin to feel better.
Here is a list of some of the common cognitive distortions:
1. All or None Thinking: You see things in black and white categories. If your performance falls short of perfect, you see yourself as a total failure.
2. Overgeneralization: You see a single negative event as a never-ending patter of defeat.
3. Mental Filter: You pick out a single negative detail and dwell on it exclusively so that your vision of all reality becomes darkened, like the drop of ink that discolors the entire beaker of water.
4. Disqualifying the Positive: You reject positive experiences by insisting that they “don’t count” for some reason or other. In this way, you can maintain a negative belief that is contradicted by your everyday conclusion.
5. Jumping to Conclusions: You make a negative interpretation even though there are no definite facts that convincingly support your conclusion.
- Mind Reading: You arbitrarily conclude that someone is reacting negatively to you, and you don’t bother to check this out.
- The Fortune-Telling Error: You anticipate that things will turn out badly and you feel convince that your prediction is an already-established fact.
6. Magnification (Catastrophizing or Minimization): You exaggerate the importance of things (such as your goof-ups or someone else’s achievements), or you inappropriately shrink things until they appear tiny. This is also called the binocular trick.
7. Emotional Reasoning: You assume that your negative emotions necessarily reflect the way things really are: “I feel, therefore it must be true.”
8. Should Statements: You try to motivate yourself with should’s and shouldn’ts as if you had to be whipped and punished before you could be expected to do anything. “Musts” and “oughts” are also offenders. The emotional consequence is guilt. When you direct should statements toward others, you feel anger, frustration, and resentment.
9. Labeling and Mislabeling: This is an extreme form of overgeneralization. Instead of describing your error, you attach a negative label to yourself. “I’m a loser.” When someone else’s behavior rubs you the wrong way, you attach a negative label to him: “He’s a louse.” Mislabeling involves describing an event with language that is highly colored and emotionally loaded.
10. Personalization: You see yourself as the cause of some negative external event which in fact you were not primarily responsible for.
Let’s go through another example. If an individual has the thought, “I’m going to be depressed forever,” before you read on, go up to the list of cognitive distortions and see if you can identify which form of distortion this is. If you came up with “catastrophizing,” you are correct. Now, some of you may have said, “fortune telling.” This too is correct. Many of the terms for the cognitive distortions can overlap. The key then is to find the evidence against your identified distortion.
The Role of Medication
Medication has shown to be effective in the treatment of depression as well. Many studies support that medication in combination of Cognitive Behavior Therapy tends to yield the highest overall positive treatment outcome. That being said, there are many different medications and one should consult a psychiatrist to find the one that is best for them. For more information on how to find a psychiatrist, please go to www.AnxietyTreatmentExperts.com and go to the “How to find a psychiatrist” page located within the website. It provides detailed information on questions to ask and what to expect during your evaluation. But, remember! Although medication is designed to help reduce your symptoms of depression, it does not teach an individual the tools to prevent or decrease future episodes.
A key aspect in treatment is to remember that an individual may continue to experience negative thoughts throughout their lives. We can’t stop those thoughts. However, through Cognitive Behavior Therapy an individual learns that they have tools to manage them and not to feel so helpless in the face of these thoughts. The skills that are learned can be used the rest of one’s life. A sense of empowerment and confidence ensues as they feel more equipped. Additionally, many individuals who are taught these skills and actively use them find that the negative thoughts and distortions decrease over time. This contributes to increased enjoyment and pleasure in their daily lives.
Barriers to Getting Proper Treatment
We also use Exposure and Response Prevention (ERP) techniques, which are based in Cognitive Behavioral Therapy (CBT). While this outcome can be enhanced with the implementation of medications, we have found that many people benefit from therapy alone. As discussed earlier, Cognitive Behavioral Therapy (CBT) has two components. First, it helps to change thinking patterns (cognitions) that have prevented individuals from overcoming their negative thoughts (distortions). And second, the behavioral component helps individuals to slowly change their thoughts, helping to influence their behavior.
If we take these same principles, with regard to anxiety, helping individuals understand how thinking patterns have resulted in fear and often times avoidance, by challenging and facing these fears, individuals learn to no longer be afraid. This is done through Exposure and Response Prevention Therapy (ERP) and is designed to systematically desensitize one to their fears. This treatment is exceptionally effective and produces remarkable results, allowing individuals to learn that they can successfully face their fears. Repeatedly facing one’s fears and learning to manage the uncomfortable feelings and thoughts associated with these fears allows the anxiety to gradually fade away. Situations in which the fears may have caused anxiety that was paralyzing can become manageable. The person learns he can choose to “flee” or “fight”, and what was once a “flight” response may become nothing more than an acknowledgement of the fear.
Here's how it works. The first step is to make a list of triggers. This may include objects, people, situations, words, images, and thoughts. For some, these lists will be quite long and extensive. Next, we explore the list of triggers and look to find those that produce the least amount of anxiety, which will be our starting point. We rate the triggers on a scale of 1 to 10. A "10" would be at the top and potentially create panic if exposed to it too soon; a "1" would be in the range of manageable. Once the first exposure is determined, the approach to the exposure is discussed. If it involves an object, the individual may not be ready to touch it, and may simply need to spend some time looking at it. The next step is to move the object closer until the individual is ready to come in contact with it (exposure). Then, the key will be to make sure there will be no compulsions, either during or after the exposure (response prevention). This process is then continued up the hierarchy until all feared objects, thoughts, or impulses are addressed.
