The CBT Cheat Sheet

A guide to cognitive behavioral therapy

Lesson 1: The Power of Thoughts!

Oh Sh*t! You’ve Just Stepped Into the Cognitive Model!

Imagine for a moment you’re watching the season finale of Game of Thrones or the recent FIFA World Cup Final or even the premiere of Walt Disney and Marvel's Guardians of the Galaxy. Many people, while watching events like these, find their heart racing, palms of their hands getting sweaty, muscles tense, and stomach turning as if they’re right there in the middle of the action! Why does this happen? After all, we know going in that “it’s only a movie/television show” or “just a game” don’t we? And why is it that other people watching the exact same thing might feel bored? 

Perhaps a story (adapted from Stott, Mansell, Salkovskis, Lavender, & Cartwright-Hatton, 2010; Kendall, 2012) will help. Imagine it’s morning in a nice neighborhood, just like the one you live in. The good people in the neighborhood are getting ready to head out for work. Now, imagine that unfortunately, earlier that morning, a dog pooped right in the middle of the sidewalk and no one cleaned it up. As fate would have it, several of the people hurrying out to start their day fail to notice the dog poop and step right into it! 

It's not about the poop!
The first person that steps into the pile looks down at his shoes and thinks, “Well, that’s just my luck. This just typifies my life. I can’t seem to do anything right. There’s no use in even trying today. I am just going to go home and go back to bed.” How would you think he is feeling? If you guessed sad, depressed or something similar, you’d probably be right!

But now imagine a second person leaves for the day and steps right into the same pile of poop. Only this time, the person looks down at her shoes and thinks, “Oh no! I'm already running late! If I go home and change my shoes, l’ll be late for my meeting and my boss will think I am disorganized! But if I go to work with this poop still on my shoes, my boss will surely smell it and think I have a hygiene problem! I could get fired! What am I going to do?” How would you think she is feeling? If you guessed anxious, worried, or something along these lines, you’d also probably be right! 

Now, imagine yet a third person hurrying out steps into the same pile of poop! This time, however, the person looks down at his shoes and thinks, “What kind of world am I living in? This neighborhood is going downhill fast because people just don’t have the decency or consideration to care about cleaning up after themselves! I am certain that I know the S.O.B. whose dog made this mess! I am going to sit on my porch and wait for him to come by and then let him have it!” How would you think this person is feeling? If you guessed angry, mad or something similar, you’d probably be right again!

How is it that three different people, encountering the same situation (stepping in the poop), can have three very different emotional reactions to the situation? Is it really about the poop? Well, yes and no! Curious? Read on!

Many people who are new to cognitive behavioral therapy (CBT) are presented with stories and examples such as these by their therapist in order to illustrate two of the fundamental principles of the cognitive model: (1) it is not events in life that upset us, but rather our thoughts about these events, and (2) specific emotions are connected to specific thoughts.

This is why two people who find themselves in the exact same situation (e.g., watching an episode of The Walking Dead) may experience it emotionally in two very different ways (e.g., excitement for me; terror for my wife!). And this is why it really wasn’t about the poop in the story above – it was about each person’s thoughts about what it meant to have stepped in the poop! 

This idea is not a new one. The English playwright, poet and actor William Shakespeare alluded to a similar notion in Hamlet when he wrote (Act 2, Scene II): “There is nothing either good or bad, but thinking makes it so.” Before him, the Greek sage and Stoic philosopher Epictetus (c. 55 – c. 135 AD) noted that “People are not disturbed by things, but by the view they take of them.” And even before him, Lao-Tzu, a philosopher and poet of ancient China wrote, “If you correct your mind, the rest of your life will fall into place.”

Based on this notion (that thoughts influence feelings and vice-versa), the cognitive model proposes that if we can learn to be more aware of what we’re thinking in situations we find upsetting (e.g., “These zombies could attack me!”), then we can put ourselves in a position to change how we’re feeling in those situations (e.g., terrified). While various forms of CBT strive to accomplish this using different approaches and techniques, all of them serve the same general function: to help us develop a new relationship with our thoughts.

For example, one CBT approach might involve learning to catch, challenge, and change these automatic negative thoughts - such as by looking for distortions in the thoughts and/or for evidence supporting and refuting the thoughts. An alternative CBT approach, however, might involve learning to be mindful (i.e., the intentional, accepting and non-judgmental focus of one's attention on the thoughts occurring in the present moment) in order to mentally disentangle from the thoughts.

Regardless of the CBT approach used, the good news is that these types of skills are not just good for fending off thoughts of the zombie apocalypse! In fact, once you understand and accept this simple principle, you’ll see how you can apply it to all situations in life!

And yet, simple does not mean easy! For many of us, these thoughts are automatic – flying around in minds and influencing us without us even being so aware of them! This is not to say that they are “unconscious” (in the Freudian sense) as much as “non-conscious” in that they are brain processes that do not require our conscious processing (e.g., think about how while driving a car you can listen to music and talk to a passenger while staying straight in your lane - all at the same time!), yet are influenced by the context we find ourselves in, as well as our past experiences, pre-existing emotional state, values, and beliefs. 

This is also not to say that all situations in life are distorted! In fact, many situations are realistically scary, upsetting, anger-inducing, etc. Therefore, we are not always wrong in our reactions and the goal of CBT is not simply to think positive when the circumstances don’t call for it. Rather the goal of CBT is to be as objective and/or realistic as possible in interpreting the situation and then, if the situation turns out to be objectively and realistically unpleasant, the cognitive challenge becomes to accept the fact that some situations in life are in fact unpleasant and embrace the emotions that come with it. Alternatively, in some of these situations it might also be possible to take action in some way to improve things – but that’s a topic for a future blog!

For now, your mission, should you choose to accept it, is to become more aware of the power of your automatic negative thoughts. The easiest way to do this is to keep a log or journal and write out exactly what you’re thinking whenever you notice you’ve had a strong negative emotional reaction to something. Once you’ve got a few of these situations jotted down, I’ll be back to explain how you can start to develop a new relationship with your thoughts in these situations.

And in the meantime, the next time you're upset about something, you should remind yourself that it’s not really about the poop!

For more on what I’m up to, check out my website: www.simonrego.com 

 

References:

Kendall, P. C. (Ed.). (2012). Child and adolescent therapy: Cognitive-behavioral procedures (4th ed.). Guilford Press.

Stott, R., Mansell, W., Salkovskis, P., Lavender, A., & Cartwright-Hatton, S. (2010). Oxford guide to metaphors in CBT: Building cognitive bridges. Oxford University Press.

 

Copyright © 2014 by Dr. Simon A. Rego. All rights reserved. No part of this material may be reproduced without direct permission from the author.

Simon A. Rego, Psy.D., is an Associate Professor of Clinical Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine.

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