Monday, September 26, 2011

Don't Believe Everything You Think!

Whatever their theoretical orientation, most clinicians have learned at least a little about Cognitive Behavioral Therapy (CBT). After all, CBT is hallmark "evidence-based treatment," and favorite of insurance companies.

Perhaps the most widely known element of CBT is the process of identifying and replacing cognitive distortions. Often occurring underneath the surface of our awareness, as "automatic thoughts," distortions are irrational thoughts that tend to be negative, and negatively impact our mood and ability to cope. We all have them. By learning to become more aware of our thoughts, and to recognize and dispute irrational thoughts, we gradually find ourselves feeling better and responding to the world more adaptively.

Sounds pretty straight forward, right? Well, if you've been on either side of this process, you probably know that it's much harder to achieve than it sounds. A difficulty arises when the client firmly believes that a "distorted" thought is "true."

Now, I could discuss postmodernism and the social construction of truth, but I think it's more helpful to go further into CBT - because congitive distortions are only the most surface level of a more complex therapeutic approach. According to the cognitive model, automatic thoughts arise out of deep and fundamental core beliefs (assumptions about self, others and the world that are formed in childhood and regarded as absolute truths), and the attitudes, rules and assumptions (intermediate beliefs) they engender.

However, these core and intermediate beliefs are harder to access, so automatic thoughts offer a starting point through which to begin conceptualizing and ultimately changing dysfunctional beliefs. Modifying automatic thoughts often results in symptom relief, but to prevent the reemergence of symptoms in the future, it's important to also work on the underlying beliefs.

Problematic core beliefs often fall into two categories: 1) I am helpless (inadequate, a failure, defective, trapped, needy, weak, etc.), and 2) I am unlovable (unworthy, different, rejected, alone, bad, unwanted, undesirable, etc.).

CBT's approach to changing such core beliefs is a topic for another day. I'll just leave you today with the invitation to wonder, when you or your client seem to be holding tight to a cognitive distortion, what core beliefs are at work.

(For more, see Cognitive Behavior Therapy, Second Edition: Basics and Beyond)

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