Cognitive Behavioral Therapy (CBT) is one of the most popular forms of therapy used in the Western world. The premise behind CBT is that stressful states such as depression, anxiety and anger are often maintain or exacerbated by exaggerated or biased ways of thinking. The role of the therapist is to help the patient recognize his or her idiosyncratic style of thinking and modify it through the application of evidence and logic.
One of the key components of CBT is getting the person to start recognizing their automatic thoughts which usually serve to maintain their undesired state.
Automatic thoughts come spontaneously, so much so that we often give no thought to them, and they appear to be true even when distorted, which often lead to problematic behaviors and disturbing emotions.
Some forms of automatic thoughts include fortune telling, dichotomous (all or nothing thinking), catastrophizing, personalizing, mind-reading and labeling.
Automatic thoughts could be true or false. For example, someone may have the mind-reading thought that “My boss doesn’t like me” and that could be true. However, the problem is that without sufficient evidence, we usually believe our automatic thoughts to be totally accurate, even when they aren’t. Combine this with the other underlying assumptions and rules that we all have, which tend to be rigid, over-inclusive, almost impossible to attain and ascribe vulnerability into the future, and we have a recipe for repeated disappointment, anger, depression, anxiety and a host of other unhealthy feelings and thoughts (Leah, 2003).
For example, if the person who has the automatic thought “My boss doesn’t like me”, also has the underlying rule that “Everyone must like me or I am a bad person”, will be deeply upset over the thought that his/her boss doesn’t like them. The same is true with rejection which partially explains why some people do not take rejection as well as others. One person can ask someone out on a date and if that person politely says “no”, that person goes on with their day, giving little thought to the rejection. But if another person has the rule and automatic thought “If she rejects me, that means I am undesirable to all women and will spend the rest of my life alone”, they will handle the rejection totally differently.
Underlying assumptions are deeply linked to personal schemas. Personal schemas are basically the core beliefs of what we belief about ourselves. We all have personal schemas, some positive and some negative, which influence the way we interpret information filtered through our automatic thoughts.
Back to our example. If someone has the personal schemas, “I am undesirable”, “I am worthless”, “I am unattractive”, they will have selective attention and memory as they look to validate their core beliefs about themselves and thus their automatic thoughts will also work to validate their core beliefs. So if the person already has the personal schema “I am undesirable”, and the automatic thought “this person will probably reject me” (mind reading), if they get rejected it will validate their personal schema and thus send them into a tail spin of self-pity, depression and anxiety, building on the strength of their erroneous thinking, assumptions, and schema.
(The ego always wants to be in balance with you and wants to make you happy. “The ego’s mission is to take the beliefs of the self and turn them into the experiences of the self.” – Falco, 2010)
This person, like many people with depression or anxiety, will filter out any information that contradicts their negative personal schemas and assumptions. For example, they may not notice the cute guy that flirts with them, but will fall to pieces at the person who makes a disapproving comment about her hair or her dress.
The goal of a CBT therapist would be to get the person to start recognizing all of these erroneous patterns of thinking, unravel them and replace them with more accurate forms of thinking.
We will discuss in a later post how thoughts create feelings.