May 23, 2011

Ask Yourself This

Whenever I reread the list of cognitive distortions, I re-notice how they pepper my everyday thoughts. If you've started noticing your own distorted automatic thoughts, you may be wondering what you're supposed to do once you've identified them.

Here are three questions that will help you evaluate and alter your thoughts. NB: the point isn't to change our thoughts to think positively; rather, the point is to think realistically because realistic thoughts create helpful emotions and promote behaviour change.

1) What is the evidence for and against this thought? This exercise requires you to play devil's advocate with yourself, using objective facts. Say you're overtired and you lose your temper and yell at your daughter for knocking over her cup of milk. Your automatic thought might be "I'm a bad parent." Your supporting evidence might include things like you were so tired that you didn't read to her before bed even once this week, and you didn't put any vegetables in her lunch today. But if you look for evidence that contradicts your thought, you'll remember things like that you stood in line for two hours last weekend to register her in a good summer camp, and that your daughter's teacher recently told you that she seems overall happy and well adjusted. Considering the evidence will allow you to adjust your thought from "I'm a bad parent" to "I'm short-tempered when I'm tired but I'm a good parent in general."

Another example: You're having lunch alone at a cafe, feeling lonely. Looking out the window, everyone who walks by seems to be with family or friends and you automatically think "I'm the only person who's alone." That all the passersby are in groups supports your thought, but if you look for evidence against the thought, you might notice that there are four other people in the cafe who are reading or working alone. This direct and concrete contradictory evidence will help you adjust your thought from "I'm the only person who's alone" to "I'd rather be with a friend or partner right now, but I'm not the only one who's alone."

2) Is there an alternative explanation? This one is especially good for automatic thoughts about others' behaviour. If you're talking to someone you just met at a social event and he keeps looking away during the conversation, your automatic thought might be "I'm boring and socially awkward." But if you try to generate alternative explanations for his behaviour, you might come up with "He's keeping an eye out for a friend who hasn't arrived yet" or "He's shy and socially awkward." Second example: You don't get the grant you applied for and you automatically think "My application sucked." Generating alternative explanations, you'll come up with possibilities like "There were more applicants than usual this year" and "The funding body had a smaller budget his year." 

Final example: After your interview on Monday, your potential employer says she'll call by Thursday at the latest. By Thursday she hasn't called and you automatically think, "I didn't get the job." Alternative explanations for her behaviour include "She hasn't decided yet" and "Something  came up and she didn't have a chance to call." It doesn't mean you did get the job, but it allows you to change your thought from "I didn't get the job" to the more realistic "I don't know yet if I got the job."

3) And if it were true--is it that bad? If all the evidence supports your negative thought and you can't find alternative explanations, maybe it's true. If so, ask yourself: Is it that bad? The answer to this question works in two ways. First, it can help you realize that even if your automatic thought reflects reality, it's not the end of the world. For me, it's been the most useful for the thought that someone is upset with me. I'm prone to friendship paranoia (my own coined term, not a DSM diagnosis!) and have been known to interpret the slightest lack of warmth as a sign that my friendship is at risk. Recently, though, I've learned to consider that even if a friend is irritated or angry with me, it's not the end of the world. It's uncomfortable, but it's also normal, and most relationships can withstand a bit of conflict. Realizing this helps me calm down enough to apologize if necessary and otherwise, to let it go.

The second way that "and if it were true--is it that bad?" works is that when the answer is yes, it is that bad, it can motivate you to change. If all evidence indicates that your grant application did suck, you are the only person who is alone, or that you are socially boring or awkward--and these things bother you--maybe you'll get someone to edit your next grant application, try speed dating, or work on your social skills. This is the behavioural part of cognitive-behavioural therapy, where you actually change the way you behave (in turn changing your thoughts and emotions).

Up next: shorter blog posts.

May 16, 2011

Don't Believe Everything You Think

News Flash: Just because you think something doesn't mean it's true.

A lot of our thoughts are distorted or irrational and directly promote depression, anxiety, and anger, among other mental health scourges. Cognitive-behavioural therapists use the non-exhaustive list below to point out the things and ways we think that are unrealistic, distorted, and just plain false.

1) All-or-nothing thinking: You see things in black and white, as all good or all bad. You say things like "Everything sucks," and "That was a complete waste of time." The hallmarks of all-or-nothing thinking are words like complete, total, everything, and everyone.

2) Overgeneralization: You see a single negative event as part of a never-ending pattern of defeat. If you don't get a call back after your job interview, you think "I always screw up." If you plan a barbeque and it rains, you think "Nothing ever works out for me." Words like always and never figure prominently.

3) Labeling: This is an extreme form of overgeneralization. Instead of naming your own or someone else's specific behaviour, you attach a global negative label. Rather than say " I lost my temper and yelled at my son," you say "I'm a bad parent." Instead of saying, "My boss gave me an unfair evaluation, you say "My boss is an asshole."

4) Negative filter: You pick out negative details and dwell on them exclusively, not letting in any positive information. You focus on the one rainy day in the sunny week or the one snag in a project or relationship that is otherwise going quite well, darkening your overall perception until you see the whole world through a lens of negativity.

5) Disqualifying the positive: You reject positive experiences by insisting that they're trivial or somehow don't count, maintaining a negative perspective that's incongruent with reality. You say things like "I only got the job because no one else applied," and "Sure I finally completed my PhD--but most of my friends finished school a decade ago!"

6) Mind Reading: Without sufficient evidence, you arbitrarily conclude that someone is reacting negatively to you. You think things like, "Now that she knows I'm single, she thinks I'm a loser, "and "He didn't come over and say hi right away; he's wishing he hadn't invited me."

7) Fortune Telling: You predict failure and negative outcomes. You anticipate that things will turn out badly and are convinced that your prediction is already an established fact. You think things like "There's no way I'll win that competition," and "I'll never meet someone I'll love as much as I loved my ex."

8) Catastrophizing: You believe that what happened or might happen will be so awful and unbearable that you won't be able to stand it. In this case, it's not that you misperceive what happened or might happen--it's that you exaggerate the consequences and minimize your ability to deal with it. You believe things like "If he broke up with me, I'd fall apart," and "There's no way I can handle moving again this year."

9) Emotional reasoning: This one is neatly captured by "I feel it, therefore it must be true." You assume that your negative emotions are a reflection of reality and think things like, "Because I feel intimidated by him, he must be smarter than me," and "Because I'm scared of flying, it must be dangerous."

10) Should statements: You have rigid standards or expectations and you use them to judge yourself, others, and the world. You think things like "It shouldn't be this hard for me to stick to my diet," "I should have been able to handle that on my own," and "These people should treat me with more respect."

11) Personalizing: You assume total responsibility for negative events and arbitrarily conclude that they are your fault or reflect your inadequacy. You think things like, "If I were a better therapist, my client would do her homework," and "If I were a better mother, my daughter would have more friends."

Cognitive-behavioural therapists love this list and use any excuse to whip it out. It's been given to me by countless professors, supervisors, and workshop leaders, and by more than one therapist. I've in turn given it to my own friends and clients.

Next up: what to do once you've identified your distortions.

May 09, 2011

What is CBT?

We often say things like "I don't know why I feel anxious," or "All of a sudden, I felt so mad... out of nowhere!" or "I don't know why I acted the way I did." Here's a question: what were you thinking at the time?

Cognitive-behavioural therapy (CBT) is a psychotherapy approach that emphasizes the role of automatic thoughts in feelings and behaviour, and suggests that our feelings and behaviour aren't caused by people, situations, and events, but are instead caused by our thoughts about people, situations, and events.

Example: say your parents call three different times in one evening. How do you feel? If you think, "They're always trying to run my life," you might feel irritated or indignant and avoid returning their calls; if you think, "They love me and are excited for my upcoming trip home," you might feel warm and fuzzy and call them back the next morning; if you think "They're trying to reach me because something bad happened," you might feel worried and call them back that night even if it's late.

Another example: your work colleague walks by in the hall and doesn't say hi. If you think, "He thinks he's awesome now that he got that promotion," you might feel insulted and gossip about it with your office mate; if you think, "He's probably distracted; I heard his daughter's sick," you might feel sympathetic and send a quick email to ask how he's doing; if you think, "He's still mad about that mistake I made last week," you might feel anxious and avoid running into him again. In each of these cases, your reaction isn't the direct consequence of the event, but is the consequence of your thoughts and your interpretation of the event.

CBT is based on three principles: thoughts affect behaviour; thoughts can be monitored and altered; and changing thoughts can change behaviour. Learning the CBT lesson that emotions and behaviour don't come out of nowhere can help people who experience a lot of upsetting emotions or who are unhappy with certain elements of their behaviour gain some control over their feelings and actions. Cognitive-behavioural therapists first teach clients that a lot of distress is created by distorted or unhelpful thoughts, and then help clients adjust their thinking by teaching them to evaluate the validity of their thoughts and generate possible alternative thoughts.

CBT has proven to be an effective treatment for a variety of anxiety, mood, sleep, personality, substance use, and eating disorders, as well as for problems like chronic pain, stress, anger, and relationship issues. As a CBT student, client, and therapist, I'm here to tell you that it works. I believe in it and I recommend it.

Up next: examples of specific CBT concepts and interventions.