COGNITIVE THERAPY

Cognitive therapy is acknowledged as the most successful treatment for the psychological aspects of depression. The word cognitive means ‘thoughts’ so cognitive therapy basically means therapy of your thoughts, or more simply put, changing the way you think.

The therapy is based on the following premises:

• It’s not what happens to you that causes our negative emotions, but rather the personal meaning that we associate with the event.
• While ill with depression, thoughts are negative and out of touch with reality.

From this, it logically follows that therapy involves examining your thoughts and replacing them others that are based in reality. Remember, our thoughts determine how we feel. Change your thoughts and your mood changes. If you think of something pleasant, your mood is happy, if you think of something unpleasant your mood goes down. Your feelings follow on from your thoughts, which in turn affect how you behave.

 THE DIRECTION IS ONE-WAY ONLY!

THOUGHTS

Our thoughts are automatic, we don’t choose them. They just pop into your head. Have you ever said ‘where on earth did THAT thought come from?’

• Learning to Drive 

Work through this analogy with me. Learning to drive a car, you think carefully about every single little thing you do. Now after several years driving has become automatic. True? How often have you arrived at a destination and wondered how on earth you got there? I certainly have. It would be far too stressful if every time you drove you had to rethink all the steps. The learning goes into your ‘automatic thinking’ part of your brain. Now the same happens with much of the way we live our lives. Growing up we were taught how to deal with this world and all of that was put into the ‘automatic’ storage part of our brains. Our responses are effectively hard-wired into our brains, unless we choose to ‘rewire’ our response mechanism. Impossible you might cry out! But it’s true. We are quite adept at changing our minds. If you moved from a right-hand drive country to a left-hand drive, you’d quickly learn to change your mind, your driving habits unless you had a death wish!  When we’re not too sure what our thoughts are, it’s not as easy but that is what is involved in overcoming depression.

• Self-talk

Our minds are never silent. There’s a constant stream of images and thoughts running through our heads, even when we’re asleep. This is known as self-talk and directs how we respond to situations. Once again these thoughts come in automatically and for that reason alone we presume them to be the truth and act on them as if they represent the truth.

I always find examples helpful so let me give you a couple.

Suppose your child walks home from school and she is late. As time goes by you get more and more worried and you find yourself thinking thoughts along these lines. ‘Something terrible has happened. She’s been hurt. Or kidnapped.’ Panic and anxiety set in. After a while your child comes home and tells you she had sport that afternoon, a fact that you had forgotten. All the anxiety was for nothing, as your thoughts were not based in reality.

If you are prone to this sort of anxiety you might even be aware that your thoughts have no real basis but you tell yourself that you can’t help it, you’re just an anxious sort of person. It’s true, you cannot help the thoughts that come into your head, but you do have a choice of believing them or not, checking out whether they are based in reality.

Often we make ourselves miserable and keep ourselves miserable by listening to a non-stop stream of inner nonsense – even when we know very well that the nonsense is not the truth.

• Listening to our thoughts or self-talk

Thoughts are a bit like the white noise of a fan. The noise is always there but after a while you stop hearing it. I live on a busy road and I don’t hear the noise of passing cars, whereas an upcountry visitor would remark on the noise. Only then do I hear it because it has been brought to my awareness. Thoughts are much the same; we need to bring them to our awareness.

Everything we do is motivated by a thought or a belief. You’ve read this far on this site probably because your thoughts tell you that you could learn something from it. If you didn’t think this you probably would have exited a long time ago. When you sit on a chair, you have the unconscious thought that it will support you. You drive to work with the thought that your car will get you there safely. These thoughts are automatic and often out of our awareness. Imagine going to your car in the morning, looking at it and wondering if it is safe or not to drive! However if our thoughts are causing depression and anxiety we need to look under the surface and examine the validity of what we are thinking because it is our thoughts that cause our moods which in turn affect the way we behave.

Even a proverb in the Bible tells us to be careful what you think because your thoughts run your life (Proverbs 4:23 Phillips version).

Change your thoughts and your emotions and mood will change and this will ultimately affect your behavior. Learn to discard thoughts that handicap you.

EMOTIONS

Our emotions are the key to unlocking how long since hidden thoughts. Unfortunately this key is so often damaged.

• Damaged Emotions

Does this sort of comment sound familiar? ‘I know I shouldn’t feel this way, but …’ Many people criticize their emotions and I think this is a carry over from parents criticizing their children’s emotions with comments like ‘you’re oversensitive, nice children don’t get angry etc etc etc’ These then become beliefs on how to deal with life. I remember a man telling me that even at the age of 80 he still battled to speak out in front of people. Fortunately for him he could trace this back to his mother telling him that ‘children are to be seen and not heard’. This had a life-long effect and changed into a a belief that he didn’t have anything worthwhile to say, so he better keep quiet. I do hope you can think of comments like this that could have damaged your emotions. Because then you can ask yourself whether they are true or not, and worth holding onto.

• Emotions are neither good nor bad

We all have emotions but often we criticize them unfairly. We need to learn to recognize our emotions and name them (sad, angry, upset, etc.) Sometimes people think it’s wrong to feel anger. What is the truth about anger? It’s actually a God-given emotion and serves a purpose. Our emotions allow us to check on a moment-to-moment basis whether our belief systems and thoughts represent the truth.  We are then responsible for what we do with our anger. An answer like ‘that’s just the way I am’, just doesn’t cut it. No matter what our emotion we are responsible for the behavior that follows on.

• Starting to feel again!

Many people say they only really started to feel their emotions again while overcoming depression. They were also quite surprised at the intensity of these emotions. If this applies to you that’s good. You’re healing as you get in touch with emotions long since denied or buried.

Emotions serve a purpose and it is better to feel than not to feel. If you placed your hand on a hot stove and had no feelings you would get burnt. Be thankful for your feelings, your emotions. Maybe they’re like friends you’re now getting acquainted with. As an aside, don’t criticize your children’s or your spouse’s emotions either, you’re damaging a God-given warning system!

Another point worth remembering is that the greater the emotion the greater the meaning to you of what has happened.

FAULTY THINKING PATTERNS

Look out for your emotions that feel like a thump in the chest or a punch in the stomach. Don’t let these emotions go unexamined. Ask yourself ‘ what am I thinking?’ ‘what does the situation mean to me that gives me such a bad reaction?’ Do some detective work! The following are the types of thinking that are common to depression and anxiety. Actually most non-depressed people can also recognize themselves in the list. You’re definitely not alone! I’ve included lots of examples.

1. SHOULD STATEMENTS: You try to motivate yourself with `shoulds and shouldn’ts’, as if you had to be whipped and punished before you could be expected to do anything. ‘Musts’ and ‘oughts’ are also offenders. The emotional consequence is guilt. When you direct `should’ statements toward others, you feel anger, frustration and resentment. This type of thinking is common among perfectionists.

It is amazing that a word like `should’ can affect how we feel, can affect our mood. I think that this word causes more problems in relationships than any other.

When other people tell you what you should or shouldn’t do, the consequence is anger and resentment. Others have the same feeling if you tell them what they should or shouldn’t do. It comes across as controlling and unaccepting. What you are really saying is that if you do what I tell you your life will be much better. This is quite arrogant, as we cannot possibly know what is better for another person. Don’t presume that what is right for you is right for the other person.

You’re out shopping and get irritated. ‘That salesclerk should treat me with respect’ you say, ‘after all I am the customer’. You could also change your response to something like this: ‘The salesclerk could treat me with respect, but then again, it looks like she’s having a really rotten day and I get crabby too, when thing go like that’. Try and not to always reflect situations negatively onto yourself. Try to see what could be happening with the other person.

People who are task oriented are more inclined to want to fix up peoples problems, which involves a lot of ‘should’’ statements. Rather try to just listen to how the person is feeling, believing that they have it within themselves to solve their problem and maybe just need a listening, uncritical ear. Once we feel that we have been heard we often are able to move on and sort out our problems. Often being given advice and being told what we should or shouldn’t do actually makes it worse.

2. ALL-OR-NOTHING THINKING: You see things in black and white categories. If your performance falls short of perfect, you see yourself as a total failure. Also common to perfectionists.

•  Sue thought she had done pretty well on her history test. She thought she might get an A or a B. Instead, she got a D. As she looked at the paper, she thought, ‘I’m a total failure. I’m so stupid. I never do anything right! I work so hard in school and still nothing seems to work out right for me.’ There are quite a few distortions in this thinking including all-or-nothing thinking, overgeneralization, as well as blowing things out of all proportion (magnification).
•  What about the common statement, ‘if you can’t do things perfectly don’t do it at all’. This is also a case of all or nothing thinking. This kind of thinking robs one of learning from the mistakes we all make and which teach us lessons.
• Your house has the normal everyday clutter and you label yourself as a failure as a housekeeper because your house isn’t perfectly tidy. A normal house is somewhere in between. If you label yourself as a failure if your housekeeping is not perfect you’ll also be quite a pain to live with, always nagging your spouse to put things away. If your spouse is not tidy agree to have some area for them to have their mess. Tidiness doesn’t have to be all-or-nothing.
• What about the thought ‘if you can’t say anything intelligent don’t say anything at all.’ Better keep quiet, in case you say something ‘stupid’! This thought is also ridiculous as much conversation is just ordinary chatter make connections with people. Relax a bit. You can remain a silent captive or change your belief and practice becoming more spontaneous which will probably open up the possibility of more friendships and give you more joy.

3. OVERGENERALIZATION: You see a single negative event as a never-ending pattern of defeat. The key words here are ‘always, never, nobody, everybody, totally, completely, forever, every time’. When you overgeneralize you see a single negative event as a never-ending pattern of defeat.

•  If you are arguing with your spouse it doesn’t help to say you never listen to me, or you always come home late. Because you will start arguing about whether it is actually always or never. The important issue is actually how it makes you feel. So a statement like I feel unloved when you come home late so often, or when you don’t phone and tell me, is much better and based in reality. You can state how you feel as this does not come across as an accusation.
•  Your spouse criticizes or starts arguing with you. You get an emotional reaction inside but you keep smiling and try to keep the peace at all costs because you have a false belief that happy couples never disagree. You have to behave in a way to keep the peace so that you keep your basic belief intact. This is so unrealistic as no two people can always agree. To keep this belief intact any dissatisfaction or hurt has to be suppressed. Eventually the pressure cooker will burst and the result can be very hurtful and messy. The truth is that we all have different opinions and it’s okay. It’s only an opinion, not a reflection on us. If your spouse doesn’t agree with you it doesn’t mean that he is right and that you are wrong. It means that you have different opinions and you are entitled to your own opinions. When you get that negative thump on your chest and you say, ‘I always say the wrong thing’, change your self-talk to `it is only his or her opinion, it doesn’t mean that I am wrong’ I know that this advice has helped many people that I have counselled, because this is the truth.
•  If someone disappoints you do you write them off 100% declaring that you will never trust them again. Or if someone of the opposite sex hurts you might even overgeneralize even more to never trusting anyone of that sex again. Isn’t it true that we all disappoint people at times? We’d like to be forgiven so maybe we also need to be more forgiving.
• Some other common statements are overgeneralizations include: Things will never get better, I’ll never amount to anything.

These kind of statements lead to a feeling of hopelessness and therefore ultimately depression.

4. MENTAL FILTER: You pick out a single negative detail and dwell on it exclusively so that your vision of all reality becomes darkened, like the drop of ink that discolours the entire beaker of water.

•  You have a pleasant family outing but the children fight on the way home. You tell them they’ve spoilt the entire day. It’s just not true. The children were noisy in the car going home which was understandable as they were tired. It did not spoil the entire day but you block out the many pleasant moments of the day by this thinking. In fact we can’t really expect children to behave like angels all the time – that’s unrealistic.
• You go out for dinner and the service takes a bit long. You have two choices, either let this spoil your whole evening or you can acknowledge it as an inconvenience, accept that the waiter is probably not intentionally out to spoil your entire evening. Rather choose to enjoy your time together. You can choose what you think.

5. DISQUALIFYING THE POSITIVE: You reject positive experiences by insisting they `don’t count” for some reason or another. In this way you can maintain a negative belief that is contradicted by your everyday experiences.

• You did well in an assignment. ‘Oh it was just luck, or the lecturer was in a good mood when he marked it, or the sun was shining or whatever.’ Your positive input, the time you spent studying is just negated, you’ve disqualified the positive experience, the reward for your hard work.
• You get a promotion at work and conclude that it’s only because you’ve been working there for 10 years so they had no choice.

Ignoring the positive implies that we should only pay attention to problems, or areas that need improving. This robs us of joy, satisfaction and self-esteem. It gives us a dreary outlook on life and we can stay negative even when all sorts of positive things are happening around us.

5. JUMPING TO CONCLUSIONS: You make a negative interpretation of an event without any definite facts to support your conclusion. This type of thinking is typical of anxiety and whenever you jump to conclusions ask yourself what evidence you have.

• Mind Reading: You arbitrarily conclude that someone is reacting negatively to you, and you don’t bother to check this out. You assume you know what they are thinking. ‘She told me she had to visit her grandmother, but I know it was just an excuse not to visit me’. ‘Your friend tells you how nice you are looking but this has confirmed your belief that she normally thinks you look terrible. Afterall why else would she make the comment’. ‘Your son comes and starts a conversation. You half listen because you’re reading the paper and decide that he’s only talking to you because he wants something from you, it’s definitely either money or your car. You get impatient and say. Okay, what do you want?’  Maybe he doesn’t want something, maybe he just wants to talk.’ Often married couples expect their spouse to mind read their needs. Learn to verbalize your needs; it will make for a happier marriage.
• Nobody can mind-read so as soon as you start deciding what someone thinks you’ve got to consciously stop mid-track and ask yourself, ‘what did the person actually say’ rather than presuming that your mind-reading is reflecting the truth. Ask yourself what proof you that that your thought is true.

• Fortune Telling: This one is future related. you anticipate that things will turn out badly, and to go from bad to worse, you’ve convinced yourself that your predition is an established fact. ‘I won’t go to that party tomorrow. So and so is going to be there and I know it’s going to be so boring!’  When the boss doesn’t greet you in the morning you convince yourself that he’s going to fire you. Maybe you wait anxiously for the bad news or maybe you decide to get in first and save the embarrassment of being fired and hand in your notice by lunchtime! Your husband is late, dinner’s getting cold and you haven’t heard a word and he hasn’t got a cell phone. What thoughts rush into your mind – He’s having an affair, he’s at the pub, he’s been in an accident! The anxiety mounts! When he walks in you blast him before he has a chance to tell you the perfectly valid reason for being late. Acting on what you incorrectly believed to be the truth you have spoiled the mood for the evening.  How often do you hear people say `never mind – things will be better in the morning – you just need a good nights sleep’. How can they predict that things will be better in the morning?

If you obsess or have sleepless nights over some conversation, replaying it over and over again in your mind, you are probably magnifying the importance of what was said.
If you loose your temper over minor incidents you are probably magnifying the importance of what has happened. You are turning relatively unimportant things into a train smash.
Or maybe you minimise your good qualities. Someone tells you how nice your dress is and you reply ‘oh this old thing’. Basically you are rejecting their compliment and they will stop complimenting you. A compliment is a gift – say thank you!
Sometimes when a girl is dating a guy with a drinking problem, she minimizes the seriousness of the problem. She is not seeing the situation realistically because of her need to be in a relationship. A drinking problem is serious but she minimizes it because of her need.
How do you respond to your child’s report card? Do you say things like ‘you did well getting 5 A’s but the B was disappointing’. If you point out other peoples imperfections or weaknesses you are a minimizer. Sometimes parents think that criticism will motivate children to improve. It doesn’t, it minimizes them. If you use the word ‘but’ or ‘yes, but a lot, you are probably a minimizer because the word ‘but’ negates all that comes before it.

7. EMOTIONAL REASONING: You assume that your negative emotions necessarily reflect the way things really are: `I feel it, therefore it must be true’.

‘I don’t feel like getting up so it must be a bad idea, I’ll just stay in bed all day’. The truth is that getting up and doing something will help you. Check out your feelings, they can be distorted.
‘I feel like an idiot so I must be an idiot!’ Not true, your feelings don’t always reflect the truth.

9. LABELING AND MISLABELING: This is an extreme form of overgeneralization. Instead of describing your error, you attach a negative label to yourself: `I’m a loser’. When someone else’s behaviour rubs you the wrong way, you attach a negative label to him: `He’s a jerk’. Mislabelling involves describing an event with language that is highly coloured and emotionally loaded.

10. PERSONALIZATION AND BLAME: You blame yourself for something that you really were not responsible for. ‘If I were a better mother, my child would have done better at school’. This is really not logical as the bad marks probably had more to do with the child not doing enough studying.

On the other hand if your language is full of ’if only’ statements you are probably prone to blaming outside events for your situation. If only I hadn’t come from a dysfunctional family.  If only my husband was nicer to me, then I’d be happy.

If you blame others or circumstances, you are playing a victim role and will always be at the mercy of how you perceive others to treat you. Remember it’s not the event that causes your mood, but rather how you interpret the event. When you stand before God one day, you cannot say that you didn’t do much with your life because He put you into a dysfunctional family.

11. LABELLING Something goes wrong and you attach a negative label to yourself or someone else: ‘I’m stupid or a loser’ or ‘he’s an idiot’ or something worse. This type of language is emotionally loaded and not really true. Look up the dictionary and see whether the meaning is really the truth or not! When you label yourself as an idiot, according to the dictionary, you are saying that you are a person so deficient in mind as to be permanently incapable of rational conduct. I’m sure this doesn’t apply, not to most of us at any rate!

Don’t label your children either with labels like, that’s the naughty one, that one’s a handful. Labels can stick. When you label your children, they believe you are speaking the truth as parents to children are kind of ‘god-like’. The label can become a self-fulfilling prophecy because, don’t forget that our behavior matches what we believe about ourselves. Quite scary, I think.

LEARNING TO CHANGE YOUR THOUGHTS – A step by step guide.

Before you start you will need some ‘tools. You will need a notebook, a pen and a copy of the list called Faulty Thinking Patterns (see sidebar). Are you ready? Writing things down, really does help.

1. Listen to your emotions

When someone says something that leaves me feeling depressed or angry, I usually feel as if someone has just thumped me on the chest. Maybe you feel the same way. Some people react as if someone has punched them in the stomach. What physical reaction do you have when you are upset? This negative reaction is telling you that it is time to examine your thoughts.

2. Keep a notebook and write down THE EVENT that caused the negative event.

You might be tempted to skip this and try and do it in your head. Please don’t, writing it down is a very important step. It also helps to stops your thoughts from getting out of control like a runaway train.

3. Write down your automatic thought.

People get thoughts and feelings muddled. If in doubt, thoughts can always be preceded by the words ‘I think that …’

• Find the Faulty Thinking Pattern. Use your list of Faulty Thinking Patterns and see where your thinking could be wrong. You will need to become very familiar with this list so that with practice you can immediately identify where your thinking is going wrong.
• Replace your automatic thought with a more realistic thought.

With practice you will become quicker at replacing the thought before it takes you on a downward spiral. Maybe an event comes to mind now that gave you a negative reaction. Try now to work out what was going on. Most of us seem to have our ‘favorite’ faulty thinking pattern and possibly even as you read the list a few jumped out at you.

FEELING CONFUSED? At this point you might need a word of encouragement! Does it sound like too much hard work? It is hard work but I promise you that it’s worth the effort for overcoming depression and living a life free of depression, anxiety and emotional turmoil. Hang in there! Take one step at a time!

Let’s go through a few examples as this may help in understanding the process.

EXAMPLE 1.

Event Your friend has a problem and you automatically try to fix her up, give her advice She doesn’t listen to you.

Emotion You’re irritated, frustrated, maybe even angry. After all, you’re only trying to help her but she just doesn’t seem to want to listen to you. Your feeling frustrated is the negative emotion that indicates that you need to examine your thoughts.

Automatic thought  Maybe it could be ‘I’m responsible for making everyone happy. Negative emotions are unacceptable. Must sort the person out’.

Is this thought based in the truth? Are you really responsible for making everyone happy? This is a very common belief but it is not based in the truth, as we are each responsible for our own happiness. Remember that it is our own thoughts that determine our mood. If you believe that you are responsible for making everyone happy you will probably experience endless frustration, as we cannot change people. Our task is to love our friend and walk alongside her. Most people resist being told what to do and it makes them want to do the exact opposite. Try telling a child not to touch something in a shop and when your back is turned they will do what you told them not to do!

Faulty Thinking Pattern Offender number 1 – Should statements. You’re telling your friend what to do and you’re getting cross because she’s not listening. Should statements are usually associated with anger. You’re actually being controlling. Maybe some All-or-Nothing thinking as well as there is a belief that negative emotions are unacceptable and must be sorted out. This is known as emotional perfectionism.

Replacement thought Correct your thinking with something like this – ‘it is not my responsibility to fix up my friend but it is my responsibility to love her, accept her as she is and just listen to her. It’s okay for her to show negative emotion. We all have negative as well as positive emotions at different times’. This will probably immediately change how you feel, your mood, as a burden is lifted because this new thought is based in reality.

Now that you’re aware of this faulty thinking pattern, the next time you want to step in and ‘fix up’ your friend stop yourself and empathise and love her instead. If you have a tendency to say, I’m only trying to help, it probably indicates a tendency towards wanting to control others, to fix people up.

EXAMPLE 2

Event Jane sent her brother to the shops. On the way a drunken motorist killed him. Jane feels responsible for his death, as he wouldn’t have died if she hadn’t asked him to go to the shops. Now she won’t drive, remains housebound and fearful of going out.

Emotion. She suffers from depression and anxiety. These negative emotions indicate that  her underlying thoughts need to be examined.

Automatic thought – ‘I am responsible for my brother’s death. If I hadn’t sent him to the shops he would still be alive.’

Is this thought based in the truth? Is she responsible for his death? No, it was the drunken motorist who killed him. It is true that he might still be alive if she hadn’t sent him to the shops but she was not the one who killed him. She wouldn’t have sent him to the shops if she could have foreseen what was to happen.

Faulty thinking pattern She is taking inappropriate personal responsibility, known as Personalization – no. 10 on the list of faulty thinking patterns. Also a bit of Fortune Telling, criticizing herself for not having known the future.

Replacement thought – ‘The drunken motorist is responsible for my brother’s death. I feel terribly sad that I asked him to go to the shops but there was no way that I could have known what would happen. I am not responsible for his death, my brother would not hold me responsible and would rather I got on with living life to the full’.

EXAMPLE 3

Event John is retrenched from his job.

Emotion. He feels angry and despondent.

Automatic thought – ‘I’ll never get another job’. ‘They shouldn’t have retrenched me’.
Are these thoughts based in reality?  ’Never’ is a key word for Overgeneralization, no.2 on the list of Faulty Thinking Patterns, and should ring a bell. How can you possibly know that you will never get another job. Also some Fortune Telling. How can you see into the future and know you’ll never get another job. Also a Should Statement. If you convince yourself you’ll never get another job you’ll probably make this come true by the manner in which you present yourself at the interview. Remember, you always act out in a manner consistent with what you believe.

Replacement thought – ‘No reason why I won’t get another job. The company were downsizing and no longer needed my expertise. Even if I’m unsuccessful with 9 interviews it doesn’t mean I will never get a job. The 10th on could give me a lucky break!’ For a Should Statement replace the ‘should’ word with ‘it would have been nice if’.
Might sound corny but saying ‘It would have been nice if they hadn’t retrenched me but it is really a sign of the times with many companies downsizing. I can re-skill for other work.’ Feels better, doesn’t it?

BEHAVIOR

As your behavior is the final outcome of your THOUGHTS and EMOTIONS you can see that if you change the source ie. your thoughts, your behavior will also change as a result.

REALISTIC THINKING – NOT POSITIVE THINKING OR NEGATIVE THINKING

Maybe you can feel the changed emotions for yourself as you read the examples. It’s not a case of positive thinking but it is a case of lining up your thinking with reality. I cannot overemphasise the importance of this list in changing your thoughts. I know the list so well that as soon as someone uses the ‘ should’ word, I think no.1 ‘Should Statement‘, and immediately replace my angry or resentful thoughts associated with these statements’!

CLOSING COMMENTS

Overcoming depression is not easy, that much I do know, but I would really encourage you to persevere. Some people I know practiced the technique by looking at past situations that had hurt them to see how they could have thought differently. One friend went right back to childhood hurts and managed to get some degree of healing by using this technique. You’ve read this far in your search for overcoming depression, well done. You have my personal admiration!