Cognitive therapy: mind conquers mood

“The greatest discovery of all time is that a person can change his future by merely changing his attitude.” — Oprah Winfrey

Cognitive therapy (CT) is a powerful technique therapists use to help their clients deal with life’s tougher moments.  It’s used worldwide to help individuals overcome psychiatric problems like phobias, depression, anxiety, personality disorders, bulimia nervosa, and addiction. This intervention is also beneficial for people without mental illness who are dealing with life transitions, divorce, insomnia, chronic pain, or back-breaking stress.  While CT is usually done with a therapist, there are many self-help workbooks that can help you learn the technique if you prefer to do so on your own.

But what is CT, and what’s the hype about?

CT is based on the assumption that emotions are affected by many things, including the environment, genetics, diet, physical health, thoughts, and behaviors.  You can improve your mood by working on any one of these issues.

Psychiatrist Aaron Beck honed in specifically on the power of thought and behaviors as a means for changing mood – and cognitive behavioral therapy was born (CBT).  (For purposes of this article, we’re focusing on the cognitive side of CBT.)  CT asserts that our thinking affects our emotions. Here’s an example.

Imagine you’re hanging out at your local supermarket glossing over your favorite cereal when a man steps up next to you. If your first thought is, “This guy has an 18 inch blade in his hand and wants to stab me to death,” you’re going to feel scared.  If you believe the thought, you’d likely be in a panic. On the other hand, thinking “This fellow probably wants to reach his favorite cereal, and I’m blocking the way” brings on a very different emotional reaction.  You’d probably just step out of the way and go on with your shopping.  Your thoughts affect your mood.

CT uses this connection between thought and emotion to fix problems.  It proposes that we can change how we feel by changing how we think.  The trick is to identify distorted thoughts that bring us pain and replace them with healthier, more reality-based thinking patterns.  This strategy helps us view challenging situations with better clarity and respond to them in a more effective manner.

For example, in the supermarket scenario, the one with the blade-guy, imagine you’re stuck with the “he’s going to stab me to death” thought process. This leaves you feeling pained and panicky.  But you have your CT tool in your pocket, which helps you examine the thought and rewrite it in a healthier, more reality-based way: “This fellow reminds me of my frigging dad, but it isn’t my dad and there’s no danger here.  The man just wants to get to his favorite cereal, and I’m in the way.”  As you realize the new statement is true, the emotion backs off 80% and the panic dissolves into nothing.  Likely you’ll still be wary of his presence, but you’ll feel a lot better.

Isn’t CT just “positive thinking?”

Positive thinking is a beautiful concept, but sometimes it isn’t reality-based.  Positivity is about rewriting negative thoughts with optimism and idealism, “everything is going to turrn out okay,” regardless of the actual facts.  On the other hand, CT focuses on reality.  It’s based on the facts.  Sure, there’s a positive message here, that painful thoughts aren’t the whole picture, but CT looks for realistic alternatives to painful thoughts, not just positive ones.

How does CT work?

Many of us aren’t 100% in tune with what we’re thinking and feeling, so typically the first step is to identify emotions and thoughts, especially problem thoughts.

Problem thoughts are called “negative automatic thoughts,” which are distorted cognitions that bring about painful emotion.  Negative automatic thoughts jump up spontaneously and are usually accepted as true without being tested, and they leave us miserable.

Once you’re an expert at recognizing problem thoughts, the next step is to re-sculpt them into healthier, more realistic and helpful ways of seeing things.  In simple terms, there’s a Before and After.

How do I learn CT without seeing a therapist?

Self-help CT is catching on in the community. If you don’t want to pay to see a counselor, consider buying a workbook that teaches the technique.  Just type “cognitive behavioral therapy workbook’ into Amazon or your favorite search engine, and you’ll come up with a dozen options.  Below you’ll find a quick run-down of the method, but this review just touches the surface.

(1) Find those feelings and thoughts.

As described above, the first step is to recognize that your thoughts affect your mood: if you think negative thoughts, you’ll probably feel bad.

Keep a mood and thought record for a week.  Each time you feel a rush of negative emotion shift into the picture, pause and ask yourself, “Whoa, where did that come from?”  Sometimes it’s a situation.  Sometimes it’s a behavior.  One way or another, there’s always a thought attached to it, and that thought isn’t usually a kind one.  Ask yourself: “What was I thinking when the emotion started?”

You might find it difficult to identify your thinking patterns.  That’s normal.  Cognitions can be fleeting or ill-formed.  If that’s the case, sit down and consider the following questions.

• What triggered the sudden mood?
• What was the situation?
• What were you doing when it started?
• What did this all make you think about at first?
• What did you think next?

Jot down any thoughts that come to mind, then circle those that are most connected to the emotion.

For example, you’re still at the supermarket, this time perusing the yogurt section, looking for your favorite yogurt, when you suddenly have the urge to leave the store.  With the urge comes a rising sense of doom.  You can’t breathe.  Your heart is racing.  “Okay,” you ask yourself, “where did that come from?” 

You look around.  A woman just walked by, a child at her hand, and the child is watching you with a goofy smile on its face.  Fifteen feet away there’s a bright-colored old lady studying the cream cheese section.  There’s no danger here, but the emotion is over-powering. 

Of course you pull out your handy notebook and start writing.  In time you realize it’s the music over the loud-speaker that’s set you off!  The song is lively, yes, but it brings back a horrible memory.  Your reaction to the music is deep angst, plus a speedy heart-rate and shortness of breath, which unconsciously leaves you catastrophic: “The past is happening all over again” or “I’m having a heart attack, I’m going to die.”  These thoughts loop around and make the physical symptoms worse, which exacerbate your thinking and mood, pushing you into a panic attack. 

(2) Rewrite the problem thought.

So you’ve caught yourself a negative automatic thought. It’s a nasty thing, burns to the touch, and leaves you feeling miserable.  These distorted cognitions can be very convincing.  They bury you under the rubble if you don’t stop to examine and reshape them, and they take work to rewrite.  Problem is there’s usually so much going on and such intense emotion that you don’t know where to start.  No worries. We’ll talk you through it.  Look at the thought and ask yourself the following questions:

• What evidence do you have to support the thought?
• What evidence do you have to the contrary?

Now restructure the thought using the answers to both questions.  Write an alternative perspective.  Consider the following outline: “The problem thought might seem true, but [my new perspective] is more likely the case because…”

For the supermarket example above, the restructured thought might be, “The song reminds me of bad times, but there’s no danger here.  I’m in the present, I’m in the now, I’m in a safe place.”

How are you doing with that problem thought?  Still not finding an alternative perspective?  If so, consider the following questions to help flesh out the issue:

• Are there other ways to approach things, different viewpoints that are missing here?
• Are you assuming this perspective is the only one possible?
• Are you only paying attention to the negative side of things?
• What’s the worst thing that could happen? Would you live through it?  What’s the best thing that could happen?  Now, what’s the most realistic outcome?  (The latter is usually somewhere between the worse and best case scenario.)
• What would you tell a friend who was in the same situation?
• If you’re having problems coming up with a different perspective, consider asking a close friend: is there an alternative way to see the situation?

Answer the questions above, then reshape the thought according to what you find.  Again, try that same formula: “The problem thought might seem true, but [my new perspective] is more likely the case because…”

The new point of view should be convincing to both your heart and mind.  If you don’t find it uplifting or don’t believe what you’ve written, keep working at it until the rewrite is both helpful and believable.

Here are more examples of problem thoughts and their healthier alternatives.

(3) Take on the next problem thought.

Repeat the process each time you feel a negative perspective take over.  Over time you’ll come across a complicated framework of beliefs and cognitions that need to be rewritten.  We’re complex creatures, with complex belief systems, and sometimes we base our lives on some false or dysfunctional premises.  The trick is to focus on one problem thought at a time.  The deeper stuff rewrites itself as you take on the superficial stuff.

That’s CT in a nutshell.

If you find that your thoughts are such a jumble that they’re difficult to decipher, or so intense they bring up intolerable pain each time you get too close, think about touching bases with a psychotherapist.  Look online for “cognitive therapists” (psychologists, social workers, and licensed clinical professionals) or contact your family doctor or insurance company for a referral.

If you’ve found this post helpful, then please keep going with the bad-thought busting!  Thanks for reading, and I wish you peace and joy.