Cognitive Behaviour Therapy. Joseph Avy

Scientific theories are designed in a way so they can be tested. CBT has been evaluated rigorously using evidence rather than just clinical anecdote. This is important for a couple of reasons:

      • The treatment can be founded on sound and well-established theories.

      • Ethically, CBT therapists can have confidence in the therapy they are advocating.

      Exercise

      List five things that people manage to change about themselves despite doing it badly at first (for example, learning to drive).

      1.

      2.

      3.

      4.

      5.

      List five positive things that you have learned in your life despite experiencing difficulties (for example, moving on from a failed relationship).

      1.

      2.

      3.

      4.

      5.

      Think of an inspirational person who has overcome enormous obstacles by having a powerful and constructive attitude and positive behaviour.

       Truth

      In CBT we examine our thoughts and behaviours to check if they are realistic. This means we judge and evaluate an event based on facts rather than perception, which can be flawed. Why do you think that, when an accident occurs, the police take statements from a number of people instead of asking just one person what happened?

      Truth is about being consistent with reality whilst striving for the goals that are important to you. It's about acknowledging and accepting the existence of the possibilities you dislike while persisting in your efforts to reach your goals.

      Exercise

      How many ‘F's can you count in the following statement?

      FINISHED FILES ARE THE RESULTS OF YEARS OF SCIENTIFIC STUDY COMBINED WITH THE EXPERIENCE OF MANY YEARS.

      Did you see 2 or 3 ‘F's?

      There are 6.

      I will leave you to find the rest but simply draw your attention to the word ‘of.’

      The above is a popular example used to highlight the fact that we don't necessarily see the whole truth. We interpret what we see and experience. What you have learnt from this simple but effective exercise is that your version of the truth can be faulty. It is important to question the truth that you hold about yourself and your ability just in case you are seeing only a few of the good things and missing many others. Sometimes we only see a few ‘F's, when in reality there are more. If the ‘F's represent your positive abilities and qualities, how many of the good qualities are you seeing?

      This is just one of the reasons why in CBT we question the validity or reality of our thoughts.

       Common sense

      In CBT we suggest taking a logical and common-sense approach to thinking.

      This does not mean that you become totally unfeeling and emotionless.

      Logic or common sense is about the purity of our reasoning skills, whether a conclusion correctly follows a premise or assumption.

      For example, which one of these two statements makes sense?

      A. Some men shave their heads … therefore anyone with a shaved head is a man.

      B. Some men shave their heads … but it doesn't mean everyone with a shaved head is a man.

      Clearly statement B makes sense. In statement A, the fact that some men shave their heads does not connect logically to the assumption that anyone with a shaved head is a man. Some women, children and teenagers also have shaved heads.

      Logical thinking is useful because we all have the ability to think and use common sense. In CBT, using your common sense well can lead you to form better conclusions about yourself.

      Some people think like this about certain goals:

      Others think like this:

      Which of the above two statements makes sense?

       Helpfulness

      Finally, in CBT we look at how helpful your thoughts are to you and in the pursuit of your goals. Your thoughts are responsible for how you feel about yourself and your abilities, so it is more helpful for you to have constructive and goal-oriented thoughts than not.

      Exercise

      Reflect on some thoughts you often have about yourself and your abilities. See if they are helpful to you. For example, you might think ‘I'm not very good at talking in front of people.’

      How can you make your thoughts more realistic, logical and helpful? For example, ‘I could improve by facing my fears slowly and gradually.’

Types of Thoughts

      In CBT we draw a distinction between different types of thoughts. Not all of our thoughts are involved with our feelings and behaviours. The thoughts that are involved in our feelings tend to have some sort of an assumption or judgement about ourselves, others or the world.

      There are two particular types of thought that are involved in our emotions or feelings.

       1. Inferences

      Inferences are assumptions you make about the things that matter to you, which can be about yourself, others or about the world. For example, if your boss contradicted you during a meeting that was important to you, you might think, ‘he is undermining me’. Then you would be making an inference. This means that in that moment you have gone beyond the facts and made an assumption about what happened because it was significant to you. In this example you would have an emotional response: you might feel annoyed, concerned, anxious, angry or some other negative emotion.

      The issue is whether your boss was undermining you or simply expressing a different opinion. In order to find out you would need to gather more information and evidence. Some of our inferences are accurate and some are not. In this ex- ample your inference has not been tested in reality.

      If you had thought ‘he has a different opinion, he is not undermining me’ then your emotional response would be different.

      Which of the following thoughts will lead to an emotion?

      1. I saw a woman getting on a bus.

      2. My workmates are ignoring me.

      3. I'm a failure.

      Thoughts 2 and 3 will lead to an emotional reaction. The second thought is an inference. It may or may not be true. Your colleagues have been ignoring you – they may just have been very busy with work. You need more information to assess the accuracy of conclusion. But if you conclude that you were being ignored then you would have an emotional reaction.

      The third thought also leads to an emotional response but it is more profound in its conclusion. ‘I'm a failure’ is an evaluative thought.

       2. Evaluations or beliefs

      Inferences influence our emotions but do not fully provoke them. Evaluations, on the other hand, are thoughts that are fully involved in provoking emotions and feelings. When you have an evaluative thought you are making a judgement about yourself, about others, or about the world. For simplicity let's call evaluative thoughts ‘beliefs’. These are fundamental in provoking either constructive feelings and helpful behaviours or destructive feelings and sabotaging behaviours.

      If you judge yourself as ‘useless’ when you are thinking about applying for a job, this may trigger additional thoughts such as ‘I won't get the job’. When you hold such a belief, you will probably feel anxious when you go for the interview. In a state of anxiety, you will probably not perform as well as you are capable of doing and