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Cognitive Behaviour Therapy Practical Approach

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“My wife left me because I wasn’t good enough for her. I will never be able to get along without her.”

“My hair is thinning. I am losing my looks. No one will care about me anymore.”

“I am such a lousy secretary. My boss just keeps me because he feels sorry for me. Nothing I do ever turns-out right.”

“I just can’t get myself to do any work around the house. My marriage is falling apart.”

 

These are typical thoughts of people who are depressed. While these notions seem correct to them on the surface, they actually show a change in the way people have come to think about themselves.

Depressed people make such mistakes over and over. In fact, they may misinterpret friendly overtures as rejections. They tend to see the negative rather than the positive side of things. And they do not check to determine whether they may have made a mistake in interpreting events.

If you are depressed, many of your bad feelings are based on mistakes in thinking. These mistakes relate to the way you think about yourself and to the way you judge things that happen to you.

Still, you have many skills and you may be good at solving problems in other areas. In fact you have solved problems all your life.

 

You can help yourself by:

(1) Recognising your negative thoughts.

(2) Correcting them and substituting more realistic thoughts.

 

CHECKLIST OF NEGATIVE THOUGHTS

 

Whenever you notice that you are feeling somewhat sadder,

Think back and try to recall what thought either triggered or increased your feeling of sadness.

This thought may be a reaction to something that happened quiet recently, perhaps within the last hour or the last few minutes, or it may be a recollection of a past event.

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The thought may contain one or more of the following themes.

1. Negative opinion of yourself. This notion is often brought about by comparing yourself with other people who seem to be more attractive or more successful or more capable or intelligent: "I am a much worse student than Mike," "I have failed as a parent," "I am totally lacking in judgment or wit."                                                             You may find that you have become preoccupied with these ideas about yourself, or dwell on incidents in the past when people seemed to dislike or despise you. You may consider yourself worthless and burdensome and assume that friends and relatives would be happy to be rid of you.

2. Self- Critics : and Self-Blame. The depressed person feels sad because he focuses his attention on his presumed shortcomings. He blames himself for not doing a job as well as he thinks he should, for saying the wrong thing or causing misfortune to others. When things go badly, the depressed person is likely to decide that it is his own fault. Even happy events may make you feel worse if you think, "I don't deserve this, I am unworthy". Because your opinion of yourself is so low, you may make excessive demands on yourself. You may require yourself to be a perfect housekeeper or an unfailingly devoted friend or a physician of unerring clinical judgment. You may run yourself down by thinking "I should have done a better job". Negative interpretation of events. Over, and over, you may find yourself responding in negative ways to situations that don't bother you when you're not depressed. If you have trouble finding a pencil, you may think "Every thing is difficult for me". When you spend a little money you may feel blue, as if you had lost a large sum. You may read disapproval into comments other people make, or decide that they secretly dislike you – although they may act just as friendly as ever 

3. Negative expectation of the future. You may have fallen into the habit of thinking that you will never get over your feeling of distress or your problems and believe they will last forever.

Or you may have negative expectations whenever you try to do a specific job: "I am sure to fail at this."

A depressed woman would have a visual image of herself running dinner whenever she cooked for guests. A man with a family to support pictured himself being fired by his employer for some mistake. The depressed person tends to accept future failure and unhappiness as inevitable and may tell himself it is futile to try to make his life go well.

"My responsibilities are overwhelming." You have the same kind of jobs to do at home or at work that you have done many times before, but you now believe you are completely unable to do them or that it will take weeks or months before they are completed. Or you tell yourself that you have so many things to do that there is no way of organising the work.

Some depressed persons deny themselves rest or time to devote to personal interests because of what they see as pressing obligations coming at them from all sides. They may even experience physical feelings that can accompany such thoughts – sensations of breathlessness, nausea, or headaches.

 

What you would better know about negative thoughts?

 

A non depressed person might occasionally have such thoughts but he generally dismisses them from his mind. But the depressed person has them all the time – whenever he thinks about his own value or ability or what is likely to get out of life.

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 These are some of the ways you can recognise depressed thinking:

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1. Negative thoughts tend to be automatic. They are not actually arrived at on the basis of reason and logic – they just seem to happen. These thoughts are based on the low opinion depressed people have to themselves, rather than on reality.

2. The thoughts are unreasonable  and serve no useful purpose. They make you feel worse and they get in the way of attaining what you really want out of life. If you consider them carefully, you will probably find that you have jumped to a conclusion that is really not accurate. Your Psychotherapist will be able to show you how unreasonable your negative thoughts are.

3. Even though these thoughts are unreasonable, they probably seem perfectly plausible at the time you have them. They are usually accepted as reasonable and correct, just like a realistic thought such as "The telephone is ringing – I should answer it".

4. The more the person believes these negative thoughts (that is, the more uncritically he accepts them), the worse he feels.

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If you allow yourself to sink into the grip of these thoughts, you will find that you are interpreting everything in a negative way. You will tend more and more to give up since everything seems hopeless. But giving up is harmful – because depressed people often interpret the fact that they have given up as yet another sign of inferiority and failure.

You can help yourself by learning to recognise your negative thoughts and understanding why they are incorrect and illogical. Check the characteristics listed above and see how well they fit your negative thoughts. 

 

Typical Thinking Errors

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Incorrect thinking leads to and aggravates depression. You probably make one or more of the following errors.

Read these and see which apply.

1. Exaggerating. You see certain events in an extreme way. For example, if you are having some everyday difficulty, you start to think that it will end up as a disaster – you exaggerate problems and the possible harm they could cause. At the same time, you underestimate your ability to deal with them. You jump to conclusions without any evidence and you believe your conclusion to be correct. A man who invested his savings in a new house suspected that the house might have termites. He immediately drew the conclusion that the house would fall apart and be worthless, his money squandered. He was convinced that nothing could be done to save the house.

2. Overgeneralising. You make a broad, general statement that emphasises the negative: "Nobody likes me" "I am a complete failure" "I can never get what I want out of life" If someone you know tells you off you think: "I am losing all my friends''.

3. Ignoring the positive. You are impressed by and remember only negative events.

   • When a depressed woman was advised to keep a diary, she realised that positive events happen often but that she had a tendency not to pay attention to them. Or she would tell herself that the good experiences were unimportant for one reason or another.

   • A man who for weeks had been too depressed even to dress himself spent eight hours painting a bedroom. When he finished he was disgusted with himself for not getting exactly the results he wanted, fortunately his wife was able to make him realise what remarkably fine work he had done.

   • On the other hand, you may tend to view some positive events as losses. For example, a depressed young woman received a letter from her boyfriend, which she decided was a letter of rejection. She broke off with him with great sadness. Some time later, when she was no longer depressed, she read the letter again and realised no rejection was intended. What she had received was not a rejection, but a love letter.

 

What To Do?

(1) The daily schedule. Try to schedule activities to fill up every hour during the day. (See special form for the weekly activity schedule.)

Make a list of items you plan to attend to each day. Start off with the easiest activity then progress to the more difficult. Check off each activity as you complete it. This schedule can also serve as a running record of your experiences of mastery and satisfaction.

(2) Mastery and pleasure methods. You have more things "going for you" than you are usually aware of. Write down all of the events of the day and then label those that involve some mastery of the situation with the letter "M" and those that bring you some pleasure with the letter "P".

(3) The A B C of changing feelings. Most depressed people believe that their life situation is so bad that it is natural for them to feel sad. Actually, your feelings are derived from what you think about and how you interpret what has happened to you.

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If you think carefully about a recent event that has upset and depressed you, you should be able to sort out THREE parts of the problem.

A. The event

B. Your thoughts

C. Your feelings

 

Most people are normally aware only of points A and C.

A. Suppose, for example, your wife forgets your birthday.

B. You feel hurt and disappointed and sad.

C. What is really making you unhappy is the meaning you attach to the events.

 

You think "my wife's forgetfulness means she doesn't love me any more." I have lost my appeal to her and to others." You may then think that without her approval and admiration you can never be happy or satisfied. Yet, it is quite possible that your wife was just busy or doesn't share your enthusiasm for birthdays. You have been suffering because of your unwarranted conclusion – not because of the event itself.

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(4) If you happen to get a sad feeling, review your thoughts. Try to remember what has been "passing through your mind." These thoughts may have been your "automatic" reaction to something that just happened – the chance comment of a friend, receiving a bill in the mail, the onset of a stomach ache, a daydream. You will probably find that these thoughts were very negative and that you believe them.

(5) Try to correct your thoughts by "answering" each of the negative statements you made to yourself with a more positive, balanced statement. You will find that not only are you regarding life more realistically but that you will feel better.

A house wife was feeling gloomy and neglected because none of her friends had telephoned for a few days. When she thought about it, she realised that Mary was in the hospital and Jane out of town and Helen really had called. She substituted this alternative explanation for the negative thought: "I am neglected," and began to feel better.

(6) The double column technique. Write down your unreasonable automatic thoughts in one Column and your answers to the automatic thoughts opposite these. (Example: John has not called. He doesn't love me. Answer: he is very busy and thinks I am doing better than last week – so he doesn't need to worry about me)

(7) Solving difficult problems. If a particular job you have to do seems to be very complex and burdensome, try writing down each of the steps that you have to take in order to accomplish the job and then do just one step at a time. Problems that seem unsolvable can be mastered by breaking them up into smaller manageable units.

 

If you feel frozen into only one approach to a problem and are not making any progress, try to write down different, alternative ways of tackling the problem. Ask other people how they might handle such a difficulty. We have labeled alternative ways of looking at and solving problems – "Alternative therapy".

Dr. Akeel. A.Abdul Wahab

Fellow & Member of The Royal College of Psychiatrists (UK)

FRCPsych. (UK), MRCPsych. (UK), Board NeuroPsych. (London University ,UK), Dip.Psych. (London University, UK), MB.ChB.(Basra University , Iraq )

Formerly Senior Consultant Psychiatrist  & Clinical professor

References:

Cognitive behaviour therapy for psychiatric problems: A practical guide.KE Hawton.PM Salkovskis.JE Kirk,DM Clark -1989- Cognitive therapy for suicidality: An integrative, comprehensive, and practical approach to conceptualization, MD Rudd-Journal of contemporary psychotherapy, 204-spriger

Book-An introduction to cognitive behaviour therapy: skills and applications D Westbrook, H Jennerley, J Kirk-2011

 Metal Health Public awareness/cognitive therapy   /AAW/2021