"Our thinking is very changeable. If you
changing your thinking everyday by reading,
the audio exercises, and completing a cognitive
you will find your thinking changing even within
As you may realize as you read the articles on this
site, the underlying core issue for many problems
resides with irrational thinking styles. That, of
course, is the basic premise of cognitive-behavioral
therapy (CBT). We develop styles of thinking based
upon our learning experiences, our parents'
thinking, and societal/community beliefs and
. When we are
growing up, we have many experiences and the outcome
of these experiences contribute to beliefs or ways
of thinking that we develop. For instance, as a
child I was very shy and fearful of speaking in
public due to fear of making a mistake and being
ridiculed. In the 7th grade I had a teacher who
encouraged me to attend speech competitions. I was
so excited that she thought I could be good at this
that I was willing to face my fear and engage in
speech competitions which I continued even
throughout high school. As a result, I developed the
belief "Even though talking in front of people
causes anxiety I am capable of doing it." Now, if I
had not had that experience and my main experience
was being embarrassed in front of my class because I
couldn't say the word "peculiar" when I was reading
out loud (it sounds different than it looks and I
couldn't get my brain to switch from the visual to
the auditory because I was so anxious), I may have
developed the belief "Talking in front of people
leads to embarrassment which I must avoid." The
problem that causes this belief to be irrational is
that it is black and white--it leaves no room for
alternatives. I would be assuming that talking in
front of people always leads to embarrassment.
Instead, by doing speech competitions I learned that
talking in front of people could be enjoyable and
could lead to awards.
Trauma is an important subset of learning
experiences that severely affects an individual's
belief system. For example, an individual who
survived a fire has a fear of low probability
catastrophes. Due to the fact that a low probability
catastrophe occurred to him or her, it is more
difficult to challenge the thinking with a statement
such as "It is unlikely to occur." Or a person who
was raped and then told it was her fault because she
left her door unlocked may tend to unreasonably
blame herself for things that happen.
In the course of my twenty-five years of clinical practice, I have found a number of common errors that can prevent cognitive-behavioral therapy (CBT) from being as effective as it could be. The following describes these errors and how to correct them.
ERROR 1: Not Understanding the Necessity of Repetition for Change
A few years back when I was lecturing a group of psychiatric residents (future psychiatrists) about using CBT with sexually traumatized clients, one of the doctors stated “I tried that cognitive therapy with my patients and it doesn't work at all!” As I explored with her the specifics of what she had tried with her patients, I ascertained that, basically, she had told them how they should think and then expected them to change their thinking.
When I asked her what method she used to help them practice and repeat the new ways of thinking in daily life, she was speechless. I then explained that the key to successful cognitive therapy was repetition of the statements that challenge the irrational thinking and that the therapist must use a method to help clients do that.
People don't change their thinking just because they are told to think differently. If that was the case, most people wouldn't need CBT because someone else has probably already told them how they should think. The difference with CBT is that a variety of methods have been developed to provide the steps to change thinking.
The importance of repetition as a key component of CBT can't be emphasized enough. This is true of any new skill. When I was training for my black belt in Kenpo karate my instructor told me “When you have done this self-defense move 6,000 times, it will be automatic.” And he was right! At first, I was awkward and slow in executing the movements. I had to think about every aspect of each move. I thought initially that it would never be automatic. However, I continued to practice. One day (after years of training) when I was teaching one of the brown belts, I realized that I was able to automatically respond to a wrist grab and put him on the ground without even thinking about it.
Changing your thinking is learning a new skill in the same way you learn a physical skill.
Often, when I suggest to my clients to use the
to help change irrational thinking styles, they protest "But I know my
thinking is wrong and how I should think. That doesn't make a difference. How will writing it down help?" Many people, even
medical professionals, believe that cognitive therapy is about telling someone to think accurately. If that were the case, then we
should all be thinking rationally because people are always telling one another how they should think.
However, several aspects of using the Cognitive Diary help people to actually learn
how to change their thinking. The first is
developing a rationale that you can believe more than the irrational thinking. The second is repeatedly using this rationale until
it becomes automatic thinking. And the third is using different sensory modalities to help reinforce the thinking.
"...'I wouldn't have it any other way.' In other words, why
dwell on what you can't have? Focus on what you do have."
Many times when I first meet clients some comment, “I've tried that positive thinking and it doesn't work.”
What they don't expect is that I tell them I am fully in agreement with them that positive thinking doesn't
work. However, negative thinking doesn't work either. We need to develop realistic, believable thinking.
Positive thinking is believing “Everything will be all right” whereas realistic thinking is “I might encounter
some obstacles but I can figure it out.” As you can see, realistic thinking is more believable than positive
thinking and that is what makes it effective.
However, all too often, people believe that their negative thinking is realistic. Therefore, they need to
be able to evaluate it and determine how to look at the problem more realistically. The two main problematic
areas of negative thinking are negative evaluation whether of yourself, others, or the situation and negative
labeling of yourself or others. Let's examine each of these types of thinking.
"When you are in a state of mindfulness
you are actually more aware
and able to engage in
I ask clients what they do for daily relaxation I
usually get responses such as:
"I relax by watching TV every night."
"I have a glass of wine."
"I read a book."
"I go out with friends."
"I go to the gym and work out."
"I find gardening relaxing."
"I like to fish."
Although each of these activities may be perceived
as relaxing and may even have an element of
mindfulness, they don't provide the brain and body
with the deep meditative relaxation we require. In
fact, most of these activities are stimulating to
the brain or the body rather than quieting.
After experiencing severe heart
palpitations and shortness of
breath while driving, Diane
rushed to the emergency room of
the nearest hospital. Extensive
tests showed no physical
abnormalities or problems. She
was told she had a panic attack
and was given an anti-anxiety
medication. As a result of the
panic attack, she quit driving
by herself because she became
fearful of having another panic
attack and losing control while
driving. Whenever she would
attempt to drive by herself, she
would have a panic attack. Her
family physician explained to
her that Panic Disorder was a
chemical imbalance and that
medication helps to regulate the
chemicals in the brain. An
anti-depressant was prescribed
in addition to the anti-anxiety
medication. Diane found that she
began to feel less anxious with
the medications, but that she
was still avoiding the driving
due to her fear of having a
panic attack. Additionally, she
became concerned about needing
to be on the medication for a
long time and wondered if any
other treatment could help.
A serious problem exists with
the public's understanding of
depression. The problem occurs
because of the clinical term
"Major Depression" and the
general use of the word
"depression." One of the
definitions in the
indicates that depression is "a
state of feeling sad."
Therefore, the general public
typically defines "depression"
interchangeably with "sadness"
as in "I'm so depressed today."
The tendency, then, is to assume
that clinical depression is just
extreme sadness or the inability
to handle normal stress and
sadness of life.
This assumption is not only
wrong but it is a disservice to
all individuals who experience
one of the clinical forms of
depression: Major Depressive
Disorder, Dysthymic Disorder,
Depression NOS (Not Otherwise
Specified), or Adjustment
Disorder with Depression.
to the weather forecast one
frigid day, I realized how much
we are influenced by the
catastrophic thinking of the
media. The weatherman reported,
"The weather has brought more
to the St. Louis
area." Certainly, the weather
was causing problems that day.
An ice storm caused car doors
and locks to be frozen so that
people had a great deal of
trouble getting into their
cars. However, I thought,
unless someone was in the middle
of nowhere with no cell phone
and they were unable to open
their car door because of the
ice, this was not "misery."
Instead, I would call it an
"inconvenience." Most of us
walked out to our cars to find
that we couldn't open the door,
went back inside a warm house or
office, and found some solution
to our problem.
Most of the time parents and
spouses of individuals with
depressive or anxiety disorders
truly want to assist in the
treatment. However, sometimes
their efforts may interfere due
to lack of understanding or due
to fears and their own internal
pressure to make the situation
better. So often family members
may have their own irrational
thinking that might influence
the person with the disorder.
Therefore, if you have a loved
one with anxiety or depression,
you may need to examine your
behavior to prevent interference
with their improvement. The
following is a list of ways that
family members interfere with
treatment and some ways to
change these behaviors.
is a 38-year-old married woman
with two young children. She
obsesses continuously about
whether her house is neat and
clean enough. She frequently
stays up until three in the
morning scrubbing and
straightening. In addition,
Janine is painfully shy and has
few friends. She worries about
what other people think of her
and is terribly afraid of
rejection. Some of her neighbors
get together with their children
to play in a nearby park or each
other’s homes, but Janine never
You may easily recognize that
Janine has obsessive-compulsive
disorder (OCD). What you may not
recognize is that she has an
additional anxiety disorder
called social phobia. Janine is
not alone; recent research (1)
estimates that 24% of
individuals diagnosed with OCD
receive an additional diagnosis
of social phobia. In fact, this
study found that social phobia
is the most common additional
anxiety disorder diagnosis made
for those individuals with OCD.