CCognitive behavioral therapy or CBT is a combination of behavioral therapy (behavior modification) and cognitive therapy. The most basic idea of the cognitive part of Cognitive Behavioral Therapy says that thoughts influence how we feel, and how we behave. CBT also says thoughts cause distress when they are distorted, which can be treated by you and a therapist. A distorted thought is one that does not reflect reality. Cognitive behavioral therapy further says that it is not a situation in and of itself that causes us to feel and act but instead it is the meaning that we attribute to the situation.
Situation: “My friend walked right past me on the street without even saying hello.”
Thoughts: “Did I do something wrong?” “I can’t imagine why he didn’t notice me.”
Feelings, emotion: Sad, hurt and confused.
Behavior: Stood there on the sidewalk for a few seconds and finally finished my chores and went home to call him and see what was up.
The Call: My friend told me that at that time he had just heard that his mother had been in a car accident and was in the hospital. He said he was a nervous wreck and almost completely preoccupied until he found out that she was alright. She had just sustained cuts and bruises.
It is not unusual for us to feel hurt if a friend does not acknowledge us. But if it is a consistent pattern of distorted thinking that affects the quality of our life it can be a problem. As you can see his assumption was wrong. Read through the list of distortions below to get a clearer understanding of distorted thinking. Cognitive behavioral therapy in Philadelphia, the Main Line, and Montgomery County also teaches you skills to look at beliefs about the world yourself and how you fit as well as provides a means to improve your life by learning to correct these distortions.
By JOHN M. GROHOL, PSY.D.
Aaron Beck first proposed the theory behind cognitive distortions and David Burns was responsible for popularizing it with common names and examples for the distortions.
1. Filtering or Selective Abstraction. We take the negative details and magnify them while filtering out all positive aspects of a situation. For instance, a person may pick out a single, unpleasant detail and dwell on it exclusively so that their vision of reality becomes darkened or distorted.
2. Polarized Thinking (or “Black and White” or ”All or Nothing” Thinking”). In polarized thinking, things are either “black-or-white.” We have to be perfect or we’re a failure — there is no middle ground. You place people or situations in “either/or” categories, with no shades of gray or allowing for the complexity of most people and situations. If your performance falls short of perfect, you see yourself as a total failure.
3. Overgeneralization. In this cognitive distortion, we come to a general conclusion based on a single incident or a single piece of evidence. If something bad happens only once, we expect it to happen over and over again. A person may see a single, unpleasant event as part of a never-ending pattern of defeat.
4. Jumping to Conclusions. Without individuals saying so, we know what they are feeling and why they act the way they do. In particular, we are able to determine how people are feeling toward us. For example, a person may conclude that someone is reacting negatively toward them but doesn’t actually bother to find out if they are correct. Another example is a person may anticipate that things will turn out badly, and will feel convinced that their prediction is already an established fact.
5. Catastrophizing. We expect disaster to strike, no matter what. This is also referred to as “magnifying or minimizing.” We hear about a problem and use what if questions (e.g., “What if tragedy strikes?” “What if it happens to me?”). For example, a person might exaggerate the importance of insignificant events (such as their mistake, or someone else’s achievement). Or they may inappropriately shrink the magnitude of significant events until they appear tiny (for example, a person’s own desirable qualities or someone else’s imperfections).
6. Personalization. Personalization is a distortion where a person believes that everything others do or say is some kind of direct, personal reaction to the person. We also compare ourselves to others trying to determine who is smarter, better looking, etc. A person engaging in personalization may also see themselves as the cause of some unhealthy external event that they were not responsible for. For example, “We were late to the dinner party and caused the hostess to overcook the meal. If I had only pushed my husband to leave on time, this wouldn’t have happened.”
7. Control Fallacies. If we feel externally controlled, we see ourselves as helpless a victim of fate. For example, “I can’t help it if the quality of the work is poor, my boss demanded I work overtime on it.” The fallacy of internal control has us assuming responsibility for the pain and happiness of everyone around us. For example, “Why aren’t you happy? Is it because of something I did?”
8. Fallacy of Fairness. We feel resentful because we think we know what is fair, but other people won’t agree with us. As our parents tell us when we’re growing up and something doesn’t go our way, “Life isn’t always fair.” People who go through life applying a measuring ruler against every situation judging its “fairness” will often feel badly and negative because of it. Because life isn’t “fair” — things will not always work out in your favor, even when you think they should.
9. Blaming. We hold other people responsible for our pain, or take the other track and blame ourselves for every problem. For example, “Stop making me feel bad about myself!” Nobody can “make” us feel any particular way — only we have control over our own emotions and emotional reactions.
10. Shoulds. We have a list of ironclad rules about how others and we should behave. People who break the rules make us angry, and we feel guilty when we violate these rules. A person may often believe they are trying to motivate themselves with shoulds and shouldn’ts, as if they have to be punished before they can do anything. For example, “I really should exercise. I shouldn’t be so lazy.” Musts and oughts are also offenders. The emotional consequence is guilt. When a person directs should statements toward others, they often feel anger, frustration and resentment.
11. Emotional Reasoning. We believe that what we feel must be true automatically. If we feel stupid and boring, then we must be stupid and boring. You assume that your unhealthy emotions reflect the way things really are — “I feel it, therefore it must be true.”
12. Fallacy of Change. We expect that other people will change to suit us if we just pressure or cajole them enough. We need to change people because our hopes for happiness seem to depend entirely on them.
13. Global Labeling. We generalize one or two qualities into a negative global judgment. These are extreme forms of generalizing, and are also referred to as “labeling” and “mislabeling.” Instead of describing an error in context of a specific situation, a person will attach an unhealthy label to themselves. For example, they may say, “I’m a loser” in a situation where they failed at a specific task. When someone else’s behavior rubs a person the wrong way, they may attach an unhealthy label to him, such as “He’s a real jerk.” Mislabeling involves describing an event with language that is highly colored and emotionally loaded. For example, instead of saying someone drops her children off at daycare every day, a person who is mislabeling might say that “she abandons her children to strangers.”
14. Always Being Right. We are continually on trial to prove that our opinions and actions are correct. Being wrong is unthinkable and we will go to any length to demonstrate our rightness. For example, “I don’t care how badly arguing with me makes you feel, I’m going to win this argument no matter what because I’m right.” Being right often is more important than the feelings of others around a person who engages in this cognitive distortion, even loved ones.
15. Heaven’s Reward Fallacy. We expect our sacrifice and self-denial to pay off, as if someone is keeping score. We feel bitter when the reward doesn’t come.
References: Beck, A. T. (1976). Cognitive therapies and emotional disorders. New York: New American Library.Burns, D. D. (1980). Feeling good: The new mood therapy. New York: New American Library.
The behavioral part of CBT would point out that we are also trained (conditioned) to react. Therefore, behavioral change influences symptoms without a primary focus on thought. See below. There are two major types of conditioning:
1. Classical conditioning is a technique used in behavioral training in which a naturally occurring stimulus is paired with a response. Next, a previously neutral stimulus is paired with the naturally occurring stimulus. Eventually, the previously neutral stimulus comes to evoke the response without the presence of the natural.
To better understand the basic concepts of classical conditioning, let us look at the observations studied by Pavlov on his dog, as illustrated in the image below:
As Pavlov observed his dog he found out that there should be a stimulus present which can automatically trigger a reflexive response (US > UR). Since no learning is involved in the relationship between that stimulus and the corresponding response, both the stimulus and response are considered unconditioned. In the experiment, US is the food, which reflexively triggers UR, salivation. In addition, before conditioning occurs NS must also be presented to the organism. In the picture, when the tuning fork (NS) is rung, no salivation occurs.
When conditioning is initiated, the neutral stimulus will be presented together with the unconditioned stimulus. As shown in the image, the tuning fork (NS) is presented with the food (US), causing salivation (UR). With the repeated presentation of this pairing, the organism will learn to create a connection between NS and US.
After conditioning, US becomes CS and UR become CR, as they are both products of the process of conditioning. Just ringing the tuning fork, without even encountering the food, the dog salivates. Although conditioning is a type of learning, it is said that there are no new behaviors learned. What is learned is the connection between the two stimuli.
2. Operant conditioning: Operant conditioning (sometimes referred to as instrumental conditioning) is a method of learning that occurs through rewards and punishments for behavior. Through operant conditioning, an association is made between a behavior and a consequence for that behavior.
The two work well together because they are both rooted in scientific method that supports experimental research to test hypotheses. Both focus on here and now observation. CBT is empirically supported for the treatment of the full range of anxiety disorders, depressive disorders, personality disorders, substance abuse and tic disorders. Both the client and the therapist work collaboratively to address presenting problems. CBT is designed to be a time limited outcome focused treatment.