In this short blog I’m going to take you through the basics of CBT. Though it can be quite complex, in the Stress & Anxiety Companion app, we have attempted to reduce CBT into a user friendly model. If you are seeing a therapist, the app isn’t intended to take the place of your work with a therapist but it can be used as a very helpful adjunct to therapy.
Remember, the ancient Greek philosopher Epictetus (d. 135 AD) reminds us that it’s not what happens (either experienced or projected) that necessarily makes us feel the way we do, it’s what we think about the situation or event, or what we ‘make it mean’ that causes us to feel the way we do.
"OH NO, I'M LATE!"
As an example, I could be late for a meeting. Whilst this may be very unfortunate, if I tell myself that I absolutely shouldn’t be late for the meeting , that I’m completely hopeless for being late, not only is it unrealistic (as I am already late for the meeting), but also thinking this way is likely to make me feel anxious, guilty, angry, ashamed or embarrassed.
This in turn will probably encourage me to want to avoid dealing with the situation constructively. I may well want to escape. I may even be aggressive because I know I’m in the wrong and feel bad about it. This is hardly a compassionate, constructive way to have to cope with being late.
THE COGNITIVE LOOP
The Cognitive Loop diagram shows the main points that we focus on in CBT.
We start with the trigger (1) – triggers can be an external trigger (an event, a situation, a series of circumstances) or an internal trigger (a feeling, a physical sensation, anticipatory thoughts about a projected situation etc).
In response to this trigger, we have a series of thoughts or graphic responses, what we call a ‘cognitive response’ (2).
Our cognitive response to the trigger can be very quick. This fast or habitual thinking is often referred to as ‘automatic thinking’. It can be both ‘in awareness’ – in that we are consciously aware in the moment of what we are thinking, or just below the level of awareness, so that we’re not conscious of our automatic thought, we just begin to feel an emotion (3).
It’s too easy to think that the trigger ‘causes’ the emotion. Whilst we may not feel the emotion without having experienced the trigger, the trigger doesn’t actually cause the emotion. It’s the way we evaluate the situation or event that determines how we feel.
In other words, it’s what we think about the trigger or ‘what we make it mean’ in the thought bubble (2) that causes the level and quality of our emotion (3).
There are many ways of thinking negatively, as most of us know only too well, including over inflating negative situations, negatively biased thinking that focuses on the negative rather than the neutral or positive. In general though negative thoughts fall into four main categories:
Black and white thinking
Characterised by absolute thinking, words like 'should', 'have to', 'must', 'mustn’t' and 'can’t'.
Catastrophising or negative predicition
Characterised by overly negative thinking such as when we tell ourselves that something terrible is going to happen or when we automatically predict a very negative or catastrophic outcome.
Low frustration tolerance
Characterised by thoughts like 'I can’t bear this' or 'it’s too difficult'.
Condemnation of oneself and/or someone else
Characterised by thoughts like 'I’m useless', 'I’m hopeless', 'I’ll always be like this' and 'I’m a failure'.
Self and other condemnation often coincides with global thinking and negative magnification e.g. 'because I couldn’t do XYZ, that means I’m a complete failure as a human being!'
So, if you’re feeling a negative emotion, it’s important to try and take a moment to ask yourself if you can identify the trigger (step a), and then ask yourself 'what am I telling myself about this?' or 'what am I making this mean?' (step b).
This short process will help you identify your negative thinking.
Next, you need to challenge the thought and identify a realistic, compassionate and constructive alternative. I look at this in the fourth part of my guide to all things CBT.