After being absent from this site for about a year I wondered what a nice resource would be to share with you. From personal experience I can say that Cognitive behavioural therapy (CBT) is a very good treatment for mood disorders (as well as some others).
Cognitive behavioural therapy was founded by Aaron Beck whilst working at the university of Pennsylvania in the 1960s. This approach is applicable to people from all walks of life, and can be used effectively to treat depression, generalized anxiety disorder, panic disorder, social phobia, substance abuse, eating disorders and couple problems.
All of us form our views of ourselves and the world as we grow up, and the views and beliefs we form at a young age is our core beliefs. They are the beliefs that are the most fundamental to who we are and how we view others and the world around us. Our intermediate beliefs are shaped from our core beliefs and are the ways in which we deal with our core beliefs. Finally, we come to the automatic thoughts – these pop into our heads as soon as things happen to us, and we have very little control over them.
Let’s look at this example:
Carla has the core belief that she is inadequate, her way of coping with or making up for her inadequacy is that “if my apartment is not spotless, I am a failure”thus she believes her apartment should stay immaculate. Now one day the following situation occurs: She sees crumbs on the floor, her immediate thought is “I will never be able to keep my apartment clean”, and she has the following reactions: Emotionally she feels sadness, behaviourally she avoids looking at the crumbs on the floor and curls up in front of the TV, and physiologically she feels a heaviness in her abdomen.
Now you are probably wondering how CBT can help Carla, well the therapist will firstly carefully listen to Carla with empathy and without judging her and give Carla some information on what CBT is and how dysfunctional thoughts can ruin her day. There are certain errors in thinking that all of us have at some point, one example of this is the one Carla made – Catastrophising. It is when you assume that the worst possible outcome will happen, and it leads to hopelessness. Other examples are disqualifying the positive– Here you will unreasonably tell yourself that positive events or actions don’t count. For example, “I did well on my exam, but it doesn’t mean that I am competent, it was an easy exam”. Overgeneralization– you make a sweeping negative conclusion that goes far beyond the current situation. For example, “(Because I felt uncomfortable at the class discussion) I don’t have what it takes to make friends”. Personalization– when you believe that others are behaving negatively because of you, without consideration of more plausible explanations. For example, “They didn’t invite me to the party because I did something wrong”. Below are some of the unhelpful thinking patterns I have discussed and more.
How can CBT help Carla? Well there is a tool that she can use, which is called a Dysfunctional thought record, which looks like this:
By completing the page together with her therapist, Carla will be able to look at what thoughts she is having, and what the roots for those thoughts are, she will then be able to write a more adaptive response in the place of the negative one. There are many more techniques that can be used to work on negative automatic thoughts, for example downward arrow technique and socratic questioning.
Downward arrow technique:
Therapist: Carla, you indicated that you want to discuss your day at work. Tell me more about it, what happened?
Carla: I had a stack of work in front of me and I just knew I won’t be able to finish it.
T: What were you feeling at that moment?
C: Very anxious.
T: And what thoughts went through your mind?
C: That I will never get it done, it’s hopeless.
T: What would be the worst thing about not being able to finish?
C: That I will need to stay at the office while everyone leaves.
T: What will that say about you?
C: That I’m a loser.
T: What will that mean for you?
C: That I am helpless.
Carla: My boss hates me.
Therapist: Carla, what is the evidence that your boss hates you?
C: Well, she always talks loudly to me.
T: Could there be an alternative explanation for why she talks loudly to you?
C: The construction outside gets really loud sometimes, so it could be that she is trying to just come across clear above the noise.
T: Is there any other evidence that your boss hates you?
C: I guess not.
T: How does you thinking of an alternative explanation help alter what you thought?
C: I never thought of it that way. I feel so much better now.
These exercises are usually helpful because they help you see what automatic thought got in your way, and then create a new one that will help you move on to a better day. It will give you insight into yourself and a better understanding of who you are, and how you can help yourself by working on your thoughts.
I hope this post helped explain what cognitive behavioural therapy is and equipped you with some tools to use.
For a blank dysfunctional thought record, click here.
Feel free to leave any questions or comments in the section below, and I will get back to you.
Beck, A. T., Rush, J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of Depression. New York, N.Y.: The Guilford Press.
Beck, J. S. (1995). Cognitive Therapy: Basics and beyond (1st ed., pp. 1–352). New York. NY.: The Guilford Press.