The truth of these quotes lies in the fact that hundreds of years later we still hold these views - in fact they form the basis of a popular psychotherapy known as Cognitive-Behavioural Therapy.
What is Cognitive-Behavioural Therapy?
Cognitive-Behavioural Therapy (CBT) is a form of psychotherapy, or talking treatment, that helps you manage your problems by changing the way you think and behave.
Essentially CBT holds the view that the way we think about situations affects the way we feel and behave. If you interpret a situation positively, for example, you might experience positive feelings as a result, and those positive feelings might cause you to behave in a particular way. Conversely, if you interpret the same situation negatively, you might experience negative emotions and so behave in a different way.
For example, if your marriage has ended in divorce, you might accept that it is sad that your marriage has ended, but it does not mean that you are not capable of having another meaningful relationship. This could lead you to pay attention to what you can learn from the divorce and to feel optimistic about the future. This optimism could result in you becoming more socially active and getting out and meeting people and making new friends. (A helpful reaction).
On the other hand, if your marriage has ended in divorce, you might think you have failed and that you are not capable of having meaningful relationships. This could lead to you feeling hopeless, lonely and depressed, so you stop going out and therefore stop meeting new people. This makes you feel more hopeless, lonely and depressed and so you become trapped in a negative cycle of thinking, feeling and behaving – sitting at home alone and feeling bad about yourself. (An unhelpful reaction).
These examples illustrate how certain thoughts, feelings, physical sensations and actions can trap you in a negative cycle and even create new situations that make you feel worse about yourself. The aim of CBT is to identify and challenge the negative thinking patterns and behaviour which may be causing you difficulties. In turn, this can change the way you feel about situations and enable you to change your behaviour in future.
There is no single definition of CBT. It is made up of a variety of individual theories which maintain a diversity of views about the role that cognition plays in behaviour change. These theories are, however, tied together by common assumptions, techniques and research strategies. Common to all cognitive-behavioural interventions are:
- A direct style
- Focus on dealing with current problems rather than focusing on issues from the past
- Focus on problem-solving ability
- Structured, goal directed (undertaken for specific problems) and time limited (requiring between 10 and 20 sessions) treatment
- Action-oriented (use of homework assignments and skill practice).
History of Cognitive-Behavioural Therapy
The overlap among cognitive, behavioural and cognitive-behavioural theorists makes it difficult to classify what approaches and techniques are principally in one category or another. Some cognitive-behavioural interventions originate from behaviourally-based theories, whereas others come from cognitively-based theories. A case can be made for including dozens of interventions under the cognitive-behavioural banner.
Originators of CBT include:
- Albert Ellis - who formulated his Rational Emotive Behaviour Therapy (REBT) in the late 1950s and ‘60s. He focussed on the irrational beliefs that he thought were at the root of maladaptive feeling and behaviour and formulated his A-B-C Theory of personality.
- Eric Berne - who formulated his theory ofTransactional Analysis in the early 1960s.
- Aaron Beck - who formulated his Cognitive Therapy at about the same time as Ellis was doing his work. He developed methods for dealing with faulty attributions and attitudes associated with learned helplessness and depression.
All three are today considered to be examples of the cognitive-behavioural approach.
How Does Cognitive-Behavioural Therapy Work?
As mentioned above CBT is based on the idea that there are both helpful and unhelpful ways of reacting to a situation. The aim of CBT is to help you stop the unhelpful reactions which trap you in a vicious cycle of negative thoughts, feelings and behaviour.
CBT does this by breaking down the things that make you feel bad, anxious or scared into smaller parts. By making your problems more manageable, CBT can help you change your negative thought patterns and improve the way you feel. CBT helps you get to a point where you can achieve this on your own and tackle problems without the help of a therapist.
In CBT, problems are broken down into four main areas:
- Situations (events, circumstances)
- Thoughts (beliefs, attitudes, views, opinions) and images
- Feelings (both emotions and physical sensations in your body e.g. butterflies in your tummy)
- Actions (behaviour, performances)
These four areas are interconnected and affect one another. For example, your thoughts about a certain situation can often affect how you feel both physically and emotionally and your thoughts, together with your feelings, can affect how you act in response. It can be illustrated like this:
Source: Claire Newton
Head is what we think. People’s beliefs, views and opinions about an event or situation.
Heart is how we feel. People’s emotions and the physical sensations in their bodies.
Hands is what we do. People’s behaviour and performance.
In other words…
- What you think
- Affects how you feel, which
- Influences your behaviour.
So if we want to change people’s behaviour, we need to change people’s thinking and feelings.
To do this, CBT combines cognitive therapy (examining the things you think) and behaviour therapy (examining the things you do) and typically involves:
- Helping you recognise how your thoughts, attitudes, beliefs and assumptions affect the way you feel
- Teaching you to question whether your automatic negative thoughts really reflect the truth
- Teaching you to replace your automatic negative thoughts with more realistic thoughts
- Helping you to change your behaviour.
With CBT, your therapist will focus on what is going on in your life right now, but you might also consider your past (without going into great depth) and think about how your past experiences have an impact on the way you see the world in the present.
CBT typically follows a 4-step process.
- Identify troubling situations or conditions in your life.
These may include such issues as a medical condition, divorce, grief, unemployment, anger or symptoms of a mental illness, such as depression and anxiety. You and your therapist may spend some time deciding what problems and goals you want to focus on.
- Become aware of your thoughts, emotions and beliefs about these problems.
Once you've identified the problems to work on, your therapist will encourage you to share your thoughts about them. This may include observing what you tell yourself about an experience (self-talk or what I call ‘head talk’), your interpretation of the meaning of a situation, and your beliefs about yourself, other people and events. Your therapist may suggest that you keep a diary or journal of your thoughts.
- Identify negative or inaccurate thinking.
To help you recognize patterns of thinking and behaviour that may be contributing to your problem, your therapist may ask you to pay attention to your physical, emotional and behavioural responses in different situations. Your therapist will likely encourage you to ask yourself whether your view of a situation is based on fact or on an inaccurate perception of what's going on.
- Reshape negative or inaccurate thinking.
This step can be difficult. You may have long-standing ways of thinking about your life and yourself. With practice, helpful thinking and behaviour patterns will become a habit (in the same way that unhelpful thinking and behaviour had become a habit) and won't take as much effort.
Understanding Negative Thinking
How Does Negative Thinking Start?
Negative thinking patterns can start when we are very young children. For example, if you didn't receive much attention or praise from your parents or teachers at school, you might've thought "I'm useless”; “I'm not good enough"; “I am unlovable”. Over time you might come to believe these assumptions, until these negative thoughts become automatic. This way of thinking might then affect how you feel at work, university or in your general life going forward into adulthood.
Transactional Analysis refers to these automatic thoughts as our Life Script.
Please read my article ‘Transactional Analysis: The Games we Play’ for more information.
Why Does Negative Thinking Continue?
If your negative interpretation of situations goes unchallenged, these patterns in your thoughts, feelings and behaviour can become part of a continuous cycle. This can be illustrated as follows:
Source: Claire Newton
Source: Claire Newton
Cognitive distortions reinforce negative thinking or emotions. Cognitive distortions are ways we tell ourselves things that sound rational and accurate, but really only serve to keep us feeling bad about ourselves. For example, a person might tell themselves, “I failed when I tried to do something new; I will therefore fail at everything I try.” This is an example of ‘black or white’ (or polarized) thinking. The person is only seeing things in absolutes — that if they fail at one thing, they must fail at all things. If they added, “I am a total loser!” that would be an example of over-generalization — taking a failure at one specific task and generalizing it to refer to their very self and identity.
Cognitive distortions are at the core of what Cognitive Behavioural Therapists try to help a person change. By learning to correctly identify distorted thinking, a person can then refute it. By refuting the inaccurate thinking over and over again, and replacing it with more accurate thinking, it will slowly diminish over time and be automatically replaced by more rational, balanced thinking.
American psychiatrist, Aaron Beck, propounded that a therapist should be attuned to six cognitive distortions:
Drawing conclusions about oneself or the world without sufficient and relevant information.
For example, a man not hired after a job interview believes he will never find employment of any sort.
Magnification and Exaggeration
The process of overestimating the significance of negative events. I.e. blowing your own mistakes and flaws out of proportion and perceiving them as more significant than they are. This type of thinking is so common in everyday situations that we have popularized the idiom, "to make a mountain out of a molehill".
Note: In most cases the positive characteristics of other people are exaggerated and negative characteristics are understated, but depressed clients magnify their negative characteristics and understate their positive ones, while the positive characteristics of other people are exaggerated and the negative ones understated or ignored.
There is one subtype of magnification:
Catastrophizing – Giving greater weight to the worst possible outcome, however unlikely, or experiencing a situation as unbearable or impossible when it is just uncomfortable.
Example: A runner experiences shortness of breath and interprets it as a major health problem, possibly even an indication of imminent death.
Note: Minimisation is the opposite of magnification – underestimating the significance of negative events. E.g. when someone dismisses a mistake they have made as far less significant than it actually is.
Making a very broad conclusion based on a single incident or a single piece of evidence. If something bad happens once, it is expected to happen over and over again.
For example, a depressed woman who has relationship difficulties with her boss may believe she is a failure in all other types of relationships.
Taking something personally that may not be personal. I.e. seeing events as consequences of your own actions when no objective basis for such a connection is apparent.
For example, believing someone’s brusque tone must be because they’re irritated with you.
Another example would be a mother whose child is struggling in school, and who blames herself entirely because she believes that she is a bad mother. In fact, the real cause may be something else entirely.
Note: Blaming is the opposite of personalization; holding other people responsible for the harm they cause, and especially for their intentional or negligent infliction of emotional distress on us.
For example, when someone blames their spouse entirely for marital problems, instead of looking at his/her own part in the problems.
Polarised Thinking (Also known as splitting or dichotomous reasoning)
Seeing things in black or white as opposed to shades of grey. It is an ‘all-or-nothing’, ‘good or bad’, ‘either-or’ approach to viewing the world. Polarised thinking involves using terms like "always", "every" or "never" when this is neither true, nor equivalent to the truth.
Example: When an admired person makes a minor mistake, the admiration is turned into contempt or when someone says, "If I don’t always get A’s, I’m a complete failure."
Selective Abstraction (Also known as filtering)
Drawing conclusions from very isolated details and events without taking into account the larger context or picture.
For example, a student who receives a ‘C’ on an exam becomes depressed and stops attending classes, even though he has As and Bs in his other classes. The student measures his worth by failures, errors and weaknesses, rather than by successes and strengths.
Another example is when after receiving comments about a work presentation, a person focuses on the single critical comment and ignores what went well.
Other Forms of ‘Automatic Thinking’ Include:
Always Being Right
This cognitive distortion is characterized by actively trying to prove one's actions or thoughts to be correct, while sometimes prioritizing self-interest over the feelings of another person (an “as long as I am right, I don’t care how you feel” attitude). Being wrong is unthinkable.
Disqualifying the Positive
Discounting positive events.
For example, when a person receives a congratulation and dismisses it out-of-hand, believing it to be undeserved, and automatically interpreting the compliment (at least inwardly) as an attempt at flattery or perhaps as arising out of naïveté.
Thinking something is true, solely based on a feeling. I.e. presuming that negative feelings expose the true nature of things, and experiencing reality as a reflection of emotionally linked thoughts.
For example, when someone says, "I feel (i.e. think that I am) stupid or boring, therefore I must be."
Or, feeling that fear of flying in planes means planes are a very dangerous way to travel.
Or, concluding that it's hopeless to clean one's house due to being overwhelmed by the prospect of cleaning.
Doing, or expecting others to do, what they morally ‘should’ or ‘ought’ to do irrespective of the particular case the person is faced with. This involves conforming strenuously to ethical categorical imperatives which, by definition, "always apply," or to hypothetical imperatives which apply in that general type of case. Albert Ellis termed this "musturbation". Psychotherapist Michael C. Graham describes this as "expecting the world to be different than it is".
For example, while waiting for an appointment, thinking that the service provider should be on time, and feeling bitter and resentful as a result.
Another example is when someone says, "I should always give 100%", when the truth is that sometimes there is no important benefit of doing a task beyond a basic acceptable level.
How do we Identify and Stop Negative Thinking?
Most of the time we do not even notice our negative thoughts because they flash quickly through our mind, seem believable and become a habit, which makes them familiar and comfortable. All habits become automatic; we do them without even noticing that we are doing them. It is the same with negative thinking, so if we want to stop negative thinking, we have to first notice it by monitoring our thoughts. Once we have become aware of them, we can then challenge them.
Monitoring Negative Thoughts
The best way to monitor your thoughts is to keep a form of ‘diary’ in which you record what you are doing, what your thoughts are and how you are feeling.
These thoughts and feelings must be recorded as soon as possible after the ‘activating event’ because the longer you wait the harder it will be to accurately remember your thoughts and feelings.
|Activating Event||Thoughts and Images||Feelings||Behaviour|
|(What is happening)||(What I am thinking)||(What I am feeling – emotions and physical sensations)||(What I am doing)|
|My friend hasn’t invited me to the party, even though she said she would||She doesn’t want to be seen with me||
Hurt and angry
|Withdraw and never contact her again|
Completing the worksheet will allow you to see the effect of negative thinking. Remember, negative thoughts won’t help you solve problems or sort things out, they only make you feel bad.
Warning: While it is helpful to see the effects of negative thinking, don’t punish yourself for thinking this way. Punishing yourself merely creates another cycle of negative thinking!
You can find a full copy of this worksheet on my website.
This may not be as easy as it appears. Remember that your thoughts are automatic and so it is often quite difficult to even ‘hear’ them. Feelings are also not easy to identify. The more blocked you are from deep, underlying feelings, the harder it will be to identify them accurately. Working with a therapist will make the process easier for you in the beginning, until with practice you can do it accurately on your own.
You can find a list of feeling/emotion words on my website to help you identify your feelings more accurately and precisely.
Challenging Negative Thoughts
Once you are aware of your thoughts and feelings and the negative effect they are having on you, you can start to change them. This process of change begins with challenging your thoughts. In other words, assessing how accurate they are.
CBT encourages clients to act like scientists towards their thoughts. That is, to not take their thoughts for granted but rather to analyse them and assess the evidence for and against them.
The process of challenging or testing negative thoughts is a crucial part of CBT. Don’t expect to succeed at once; challenging thoughts is a skill that must be learned. You will most likely have to test the truth of your negative thoughts with real-life experiments. For example, if your friend did not call you and you are upset because you think she does not like you, your therapist might suggest that you call her and enquire why she did not call to find out the actual reason.
Challenging your negative thoughts requires you to answer many questions. The more you answer, the more you can ‘test’ your thinking. A list of useful questions to challenge or ‘test’ your negative thinking are below.
Questions to Challenge Thinking
- What evidence do I have for this thought? / Is my thinking based on obvious fact?
Weigh the facts that support the thought and the facts that contradict it. This task may be difficult because the more negative you are, the harder it will be to find the positive side. The more you try the easier this task will become.
- Are there alternative ways of looking at the situation?
There is usually more than one way to look at a situation. Try to think of a number of alternative explanations. It is useful to consider how other people would react. Ask yourself: How would someone else think about the situation? Even try actually asking other people how they would feel in the same situation.
- Is my thinking distorted? Which cognitive distortions (see above) am I applying to this situation?
Thinking errors help to keep a negative cycle going – they distort information so that it fits in with your negative view of the world. If you are applying a cognitive distortion, stop it!
- Am I forgetting relevant facts or over-focussing on irrelevant facts?
- Am I setting myself an unrealistic or unattainable standard?
- Am I overestimating how much control I have over how things work out?
The ancient Greek philosopher said: “Happiness and freedom begin with a clear understanding of one principle. Some things are within your control and some things are not.”
- Am I overestimating how responsible I am for the way things work out?
- Am I underestimating what I can do to deal with the situation-/-problem?
- Am I overestimating how likely the event is to happen?
- What if it does happen?
- What is so bad about that?
- How will this situation/problem be in months/years to come?
- Will this situation/problem matter in months/years to come?
- Will my thinking best help me protect my life and health?
- Will my thinking best help me achieve my short and long term goals?
- Will my thinking best help me to feel the emotions I want to feel?
You can find a poster of these questions on my website titled ‘Challenging Negative Thoughts’. Please use it to help you challenge your negative thinking.
Changing Negative Thoughts
Once you have started noticing your negative thoughts, monitored them to see how they affect your mood and challenged their accuracy, you can start to change the way you think on a daily basis.
The ‘Self-Monitoring Chart’ will help you to do this. Please download it from my website and complete it as follows:
- Fill in the chart with the activating event and your reactions (thoughts and feelings)
- Rate how strongly you believe your (dysfunctional) thoughts and feelings
- Write down the behaviour that results from your (dysfunctional) thoughts and feelings
- Challenge your (dysfunctional) thinking and look for cognitive distortions
- Fill in the evidence against your (dysfunctional) thinking
- Rate how you NOW believe the original negative thought to be using the 0-100 scale. (This will help you see how effectively you’re challenging your negative thoughts).
- Consider alternatives and fill in more functional ways of reacting
A word of caution:
Changing your thinking is not a solution for all cases of mental disorder. It only works in some cases – when the mental disorder is caused by faulty thinking. If the cause of the mental disorder is biological, then CBT is not going to help.
For example, if an individual’s depression is caused by a chemical imbalance (biological cause), then changing your thinking is not going to help. The person needs to address the chemical imbalance with medication, diet and exercise. For more information about the causes of mental disorders please read “Understanding Mental Disorders”. For more information about depression, its causes and treatment please read “Defeating Depression”
What Conditions is CBT Useful for Treating?
CBT can be a very helpful tool in treating mental health disorders, such as anxiety, depression, post-traumatic stress disorder (PTSD) and eating disorders, but you don’t have to have a mental health condition to benefit from CBT – it can be an effective tool to help anyone learn how to better manage stressful life situations such as a medical condition, loneliness, divorce, grief and anger.
As mentioned above, it is most important to bear in mind that changing your thinking is not a solution for all cases of mental disorder. If the cause of the mental disorder is biological (e.g. depression caused by a chemical imbalance), then CBT is not the approach to use on its own. Some form of biological intervention needs to occur simultaneously.
Who can use CBT?
CBT is successful with clients who have the following characteristics:
- Average to above average intelligence (CBT cannot be used with mentally retarded individuals)
- Moderate to high levels of functional distress (if distress levels are too low the individual does not have the motivation to change)
- Able to identify thoughts and feelings
- Not psychotic or disabled by present problems (CBT cannot be used with schizophrenia or severe thought disorders)
- Willing and able to complete systematic homework assignments
- Possess a repertoire of behavioural skills and responses (CBT cannot be used with autistic individuals)
- Can process information on a visual and auditory level.
What are the Limitations of CBT?
As with all forms of Psychotherapy, CBT has limitations:
The main criticism is that it doesn’t deal with the total person. It ignores
- past history
- the unconscious
- developmental stages
- biological factors
With an over-zealous practitioner it may also be applied mechanically – with a resulting lack of empathy for the client.