Cognitive Behavior Therapy
There is nothing good or bad, but thinking makes it so.
- William Shakespeare
Few of us have been taught how to think, and we tend to follow the thinking patterns that emerged when we were children. Alas, some of these primitive thinking patterns lead us to believe things that are not only untrue, but evoke self-sabotaging emotional states, including depression and anxiety. [Click here to see a list of some popular Thinking Errors]
Our judgments — particularly of ourselves — change according to the situation. Consider your appraisals for the benefits of a first lapse before and after it happens, or your views of yourself and your future at these moments.. Moreover, whatever the distortions are, you will be blind to them when they occur [see The Soul Illusion].
Even though you understand that your perceptions and beliefs and not the same as objective truth, at the critical moments of crisis you are likely to be taken in by the illusion.that you are perceiving things as they really are. Needless to say, there is often little relationship between our degree of certainty about a belief and its veracity. A by-product of Meta-Cognitive Awareness is the understanding is that all my beliefs, even those of which I am certain, are the conclusions of an easily fooled bio-psycho-social creature and may not be true at all.
Fortunately, beliefs are easy to change. In fact, education is the process of discarding more primitive beliefs on the basis of additional information. Cognitive Behavior Therapy — applying the principles of inductive and deductive reasoning to our beliefs about ourselves — has proven to be the most effective form of psychotherapy for Mood Disorders. For all but the most severe cases of Mood Disorder, Cognitive Behavior Therapy [CBT] produces better long-term outcome than strategies based on medication alone.
The CBT approach to resolving a Mood Disorder involves active collaboration between therapist and client. In contrast the Medical Model involves a doctor providing treatment to a passive patient. When the improvements result of an external source of control, they tend to disappear when the external source of control dissipates. For example, the effects of medication last as long as the person takes the medication. If the medication loses its effectiveness or is discontinued, patients are no better off than they were before. On the other hand, the skills learned during a course of CBT are irreversible.
The Core Beliefs of Cognitive Behavior Therapists
Our first task as a cognitive therapy collaborators is to look at your thoughts and beliefs from the perspective of a kindly, rational observer, so you can identify the irrational thoughts and beliefs that elicit negative emotional states and the state-dependent distortions that result from the unintentional trance formations, Identifying the pathogenic cognitive events is the key to escaping the recurrent self-defeating pattern of a Mood Disorder. CBT does not seek to make you happy or feel safe when you are not; it seeks to free you from the thinking errors that are so costly to you and to those around you.
You are not bound by objective reality to react to the events that happen in ways that are counter to your interests. The emotional reactions that promote self-sabotage result from what we believe these events mean about ourselves, other people, our future, etc. The telephone rings in the middle of the night, but there is no one on the line. Bernie reacts to this event with anger, but Barry reacts to the same event with fear. Note that the same Antecedent event produced a different Consequent emotion in these two individuals. The different Consequent emotions to the same Antecedent event demonstrates the ABCs of CBT: The Antecedent event was filtered through a different Belief system and thereby resulted in a different Emotional Consequence
Certain beliefs are special: They not only have the power to transform a neutral event into powerful emotional reactions, but once elicited, these emotional reactions distort state-dependent phenomena in ways that produce outcomes that confirm the original belief. Once established a Self-Confirmatory Belief can last a lifetime. Mood Disorders that result from these beliefs are hard to change, because they are continually validated by real world events. For example, consider the effect of Barry's belief that he is socially awkward:
Barry's Self-Confirmatory BeliefsBarry, a clever but socially anxious engineer, can be very funny but is inarticulate in social settings in which he feels like a loser. The appraisals: “I’m a loser,” or “I am a witty guy” exist only in Barry’s mind and not in the objective world. Nevertheless, his subjective reality influences how he behaves in the objective world. Whether he reacts to the snide insult at the office party with a witty come back or with a humiliating silence depends to a large extent on his subjective reality at the time. His retort is more likely to be clever if he is in a confident trance than if he is in his “loser” trance. He wants to bring on the clever version of himself and enjoy a social victory for a change, but he expects to be intimidated as usual. Observers who know Barry have their predictions, but these are just the creative fictions of their minds. Only the actions Barry performs become part of objective reality; the other expectations and possibilities will fade into oblivion.
There is a battle between the creative fictions that will determine Barry's trance at the critical moment. On one side is his intention to be the cool and clever Barry, on the other is his expectation that he will be tongue tied. The winner of the battle will determine which version of Barry gets to be part objective reality. The expectations have the advantage—both Barry and his audience believe them to be true. From our dispassionate perspective we can see they are both creative fictions, which are neither true nor false until Barry performs and actualizes one of them.
Barry’s story illustrates the cause-and-effect relationships that tend to evoke self-confirmatory bias. Barry’s belief that he is socially inept sabotages his social performance, which confirms his handicapping belief. His social life is continually influenced by his expectation of social failure. The objective evidence that Barry does, in fact, perform poorly in social situations continually validates this expectation. Because it has a recursive structure, it can persist indefinitely and continue to have a negative impact on Barry’s actions and how his life unfolds. [Fortunately for Barry, once he appreciated how his trap worked he develop a strategy to cope with it - see Emotion Focused Coping].
Barry’s limitation does not come from outside of him, nor is it due to a slow wit. He is handicapped by his own self-sabotaging suggestion. In contrast to injuries that tend to heal with time, the source of Barry’s misery is Barry and so the passage of time offers no respite. Barry’s acceptance of the premise that he is socially incompetent continually recreates the conditions that confirm his worst fears.
Another example of the power of a self-confirmatory bias on an individual's entire biography is the fact that Bernie, who believes that everyone is trying to screw him so he better screw them first, is surrounded by people who are, in fact, trying to screw him. If you knew Bernie, you'd be trying to screw him too.
Both Barry and Bernie have influenced their subjective and objective worlds unintentionally. In each case the self-fulfilling prophesy resulted from "acting as if" the pathogenic premise was true. The consequence of accepting the suggestion is that state-dependent phenomena such as perception, motivation, and response tendencies are biased in ways that bring about unwanted outcomes.
The Consequences of Bernie's Expectations
Bernie reported: “During a chaotic situation at an airport ticket counter someone kicked me in the back of the leg. When I turned around to confront the ass hole I saw a handicapped girl in a wheelchair, which had evidently rolled, out of control, down a ramp and into me. She was terrified by the rage on my face. I felt terrible.”
Bernie still cringes over this memory several years after the incident took place.
The facts that Barry often behaves incompetently is social situations, and that Bernie is continually surrounded by people who are trying to screw him confirms each of the pathogenic beliefs that cause them to act counter to their own interests.
Once you appreciate that your beliefs determine how you react to the things that happen, and that these beliefs may be completely nonsensical [see Cognitive Distortion Mechanisms], you can begin to move beyond the mentality of childhood. The Thought Record is a powerful Cognitive Behavior Therapy tool that will help you unravel the knots of your neurotic trap.
Other people's thinking errors are more obvious than our own. Like Barry's friends, I see him as a successful and clever guy. Barry experiences a different subjective reality. Sadly, as long as he buys into his pathogenic belief he will continue to view his social awkwardness as an indication of his intrinsic defect rather than as the self-sabotaging consequence of his own belief. Consequently, he will continue to behave as if he were defective. [For a discussion of Self-Sabotaging Traps please click here].
As dispassionate observers, we can see that it is not Barry that is defective, but his belief. If Barry really was intrinsically defective then there would be no hope for change and he would be wise to accept a lifetime of social incompetence. However, if the cause of the problem is a thinking error, we can fix that relatively easily. Changing your beliefs is much easier than changing your behavior or your emotional reactions to the things that happen.
Striking examples of thinking errors occur daily in my office when clients describe their past relapses through the "20-20 of hindsight." In the office they can easily spot, and even laugh at some of the cognitive errors that seemed so believable during the actual episode. Please click here for a list of Pathogenic Beliefs.
Cognitive Behavior Therapy [CBT] is a method of detecting and defrocking pathogenic beliefs. This approach has proven to be remarkably effective for a range of emotional and addictive problems — generally more effective than medication with individuals who have the cognitive ability to take advantage of its methods
We are all vulnerable to the Traps that result from thinking errors. So it is important to evaluate the veracity of beliefs that undermine your ability to perform well. You will likely discover that most, if not all, of them are conclusions based on sloppy thinking. The goal of CBT is not that you think highly of yourself, but rather to recognize when your perceptions and appraisals are distorted. If you get rid of the self-sabotaging influence of pathogenic beliefs, everything else becomes much easier. This passage begins with The Thought Record