Cognitive Behavioural Therapy (Brilliant Business) 1st Ed.

2. First principles

In this chapter you will be given an overview of the CBT model of the mind and introduced to the five key principles upon which it depends. To any reader eager to get stuck in, please don’t be tempted to rush through the next few pages. Unless you grasp the underlying principles, and have confidence in them, it will be hard to apply them effectively to your own situation.

Principle 1: There is always another point of view

Our minds are capable of organising the same input in very different ways. To illustrate this principle have a look at the famous optical illusion below. What do you see?

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Some of you will see an old lady with a beaked nose and a downcast gaze. Others will instantly recognise the illustration as that of a young woman with her head turned away from the viewer.

Keep looking and you will be able to make the image morph from one to the other, although it is not possible to ‘see’ both versions simultaneously. In selecting one interpretation our mind excludes the other.

So what has changed? Certainly not the illustration itself – the lines are fixed. It is our brain that organises the sensory information in different ways, yielding different interpretations of the picture that evoke very different responses in the observer.

CBT claims that a similar process takes place in the way we experience many aspects of our daily lives. There are engrained habits in our thinking style that predispose us towards ‘seeing’ the world in particular ways, and that encourage us to favour certain interpretations of events over others.

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Anyone who doubts how differently the same events can affect people has only to look at footage of Barack Obama’s election victory in November 2008. None celebrated harder than those who perceived the election of America’s first black president as a landmark for civil rights. As a jubilant Oprah Winfrey announced to the world’s media, ‘It feels like hope won.’

However, this reaction could not have contrasted more strongly with that of the Republican supporters who had gathered at the Arizona Biltmore in time to hear John McCain concede defeat. The angry booing at the mention of Obama’s name and the many disappointed, tearful faces bore witness to a very different perception of the night’s results. As the Greek philosopher Epictetus remarked: ‘Men are disturbed not by things, but by the view they take of them.’

Principle 2: Events don’t cause our feelings

You have had the day from hell. You lost your car keys. Your boss shouted at you about filing that report late even though it wasn’t your fault. Everyone went to the pub at lunchtime and for some reason you weren’t invited. You return home to find the children are playing up and your wife in tears because the central heating has broken down. Is it any wonder you feel depressed, demoralised and overwhelmed? It’s not difficult to see what made you feel that way.

But hold on. If the things that happen to us are responsible for our feelings how do we explain the fact that individuals react so differently to similar events? Why for one person does losing their car keys feel like a disaster, while for another the event is a minor inconvenience that is swiftly forgotten?

According to Beck, despite what we may assume, in themselves such events are not responsible for what we feel: rather it is our interpretation of events and the way we react to them that ultimately determines their impact upon our mood. This is a fundamental tenet of the cognitive behavioural approach.

Common sense may tell us that event A produces consequence B:

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However, CBT proposes there is always a crucial intermediate stage:

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Once we start recognising the importance of the meanings we assign we can quickly grasp how different readings of events carry such different emotional consequences.

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A man arranges to meet someone on a date. It is 10 minutes after the time agreed and his date still hasn’t shown up. Look at the examples below and try to identify the emotional responses on the right that are most likely to accompany three contrasting interpretations of the same event.

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These contrasting thoughts all carry a very different emotional tone. The first way of thinking is likely to leave the thinker feeling sad and forlorn and is typical of the thinking of a depressed person; while the second train of thought is more agitated, generating feelings of hostility and anxiety. It is pretty obvious that the third point of view is likely to generate less distress than either of the alternatives.

Principle 3: We all evolve characteristic ways of seeing the world

Although some ways of looking at events may leave us feeling better than others, surely people don’t exercise much choice about the way they view situations or how they react emotionally? Many upsetting thoughts simply seem to pop into our heads unbidden – don’t they? Aren’t most of our responses just instinctive?

A cognitive behavioural therapist would completely agree with you. In fact Beck coined the term Negative Automatic Thoughts (NATs for short) to emphasise that much of the thinking responsible for our unwanted emotions is involuntary.

However this does not mean that it is not therefore possible to retrain the way we think. Indeed CBT aims to do just this, helping us ‘change our minds’ by unlearning unhelpful habits of thinking that can leave us at the mercy of unwanted emotions.

So how do these styles of thinking develop and become so entrenched? CBT points to two basic shaping processes – one that works from the outside in and a complementary process that works from the inside out.

How experience shapes our beliefs from the outside in

Events shape us. Indeed the behavioural element in CBT acknowledges its debt to a school of psychology – Behaviourism – that emphasised the way the brain forms associations in response to environmental input. What the early Behaviourists soon discovered, however, was that much more was going on than the blind pairing of stimulus and response: the rats in their mazes were actively learning. The results of some experiments simply didn’t make sense unless the rats were creating internal maps of their world and automatically modifying them in response to new experiences.

Now depending on whose company you keep, you would probably agree that the average human being is more sophisticated than a rat. Our brains are remarkably good at searching for patterns. Human beings instinctively draw conclusions from their experiences all the time. If a child burns his hand on a stove he is unlikely to touch it again: he knows it is hot. However, not only is he unlikely to touch that particular stove, he will also approach any stove-like object he encounters in future with caution. His internal model of the world has been updated. We all generalise from our experience in ways that helpfully allow us to predict what might be coming up next.

Emotional learning is no different. A child who is neglected or abused may instinctively generate theories or even reach hard and fast conclusions about herself and the world around her: ‘If I am being treated like this it must be because I am bad’ or ‘This person has hurt me… Other people will hurt me too’.

The layers of our belief system

We have already introduced NATs, the negative thoughts that spring unbidden into our minds and influence our emotional responses to things. However, our NATs are often closely linked to enduring assumptions we hold about ourselves and the world. These assumptions begin to form in childhood as we start to try to make sense of our experience. They make up a personal set of working theories about reality but they are not usually ‘set in stone’. This is just as well because, as children, we often form our assumptions on the basis of limited life experience and inadequate evidence.

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The formative years

Our internal models are very susceptible to input from other people, especially our parents. If you have been told throughout childhood that you are a capable, lovable individual you are likely to grow up seeing yourself that way. If you have been told you are ‘an idiot’ who will never amount to anything, these kinds of remarks will colour your assumptions about yourself and predispose you towards negative patterns of thought and feeling.

In CBT assumptions that are rigid, oppressive or narrow-minded, and that consequently end up making us unhappy, are usually referred to as dysfunctional assumptions. These often take the form of conditional statements (e.g. ‘If I do everything perfectly then I will be loved’) or moral imperatives (e.g. ‘I must never express my anger…’, ‘I should always put others before myself’).

Dysfunctional assumptions represent the next layer down from NATs and tackling them in therapy can make a person much less vulnerable to a host of NATs that flow so readily from them.

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Over time our experiences and assumptions gradually harden into our core beliefs – a set of fundamental position statements that we have intuitively distilled from our accumulated learning. Core beliefs can be much harder to pin down than NATs because they often take the form of implicit knowledge, only revealing themselves in our most generalised assumptions about ourselves, other people and the world around us.

Examples of destructive core beliefs

·        ‘I am a bad person.’

·        ‘Everyone is out for themselves.’

·        ‘I am not allowed to have anything good in my life.’

·        ‘The world is a dangerous place.’

They are the bedrock of our internal working model of the world and are usually strongly resistant (but not impossible) to change.

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Sometimes once is enough!

If you want to teach a dog to come when you blow a whistle you will probably have to pair the whistle with a suitable reward many times. Classical conditioning theory states that the more often an outcome (the dog treat) is paired with a particular contingency (in this case coming at the whistle) the stronger that association will become. This is why childhood, with its strong repertoire of repeating patterns, is such a fertile breeding ground for our core assumptions.

However, after a single bad dose of food poisoning from a fish dish, psychologist John Seligman found that he couldn’t stomach fish for a long time afterwards. Seligman realised that in some cases we only need to have one truly bad experience to alter our model of the world fundamentally.

It can be the same with events that unleash particularly powerful negative feelings – sometimes referred to by CBT therapists as critical incidents. Such events can make us jump to conclusions about ourselves and the world that can be hard to shake, even when unsupported by other evidence. Because they are associated with such threatening emotions we don’t normally revisit or examine such beliefs.

How beliefs shape our perceptions from the inside out

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We often filter out what doesn’t fit with out existing beliefs

So far we have considered the way experience can shape how we see the world, but in CBT even more weight is given to the way that, once formed, our beliefs and assumptions can end up dictating the nature of our experience.

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Imagine someone with strongly racist views reading a newspaper. On page 10 is an article reporting that the number of black youths arrested by the police in a particular district has doubled since last year. On page 13 is a story about an Asian man who ran into a burning building and rescued two children. Which of these two stories is likely to grab our racist reader’s attention? How is he likely to respond when he reads that arrest rates correspond to an innovative local initiative persuading members of the community to volunteer information about teenage gang members using knives and other weapons? How will he explain the Asian man’s motivation in rescuing the children? The reality is that our racist reader will probably enlist a combination of the sorts of strategies outlined below.

He will:

·        Discount or ignore information that does not fit with his preconceptions. He might not bother to read the article about the fire rescue at all or skim quickly through the encouraging response to the new neighbourhood initiative.

·        Exaggerate elements from the reports that fit with his current views. ‘Unbelievable: now they’ve all got knives. No wonder crime rates in those black ghettos are soaring out of control…’

·        Explain away elements that don’t fit with his beliefs as ‘exceptions to the rule’. ‘You can bet your life most of those Pakis would just have let those poor kids burn…’

·        Attribute motivations that fit with current beliefs. ‘He probably only did it because he thought there might be a reward…’

Racial prejudice is an extreme case, but most of us resort to similar tactics in protecting our internal models of the world. Our assumptions and core beliefs often act as filters that block out anything that does not fit with our preconceptions. In Victor Hugo’s famous novel Les Misérables the police inspector Javert eventually kills himself because of the unbearable conflict created in him by the altruistic and noble behaviour displayed by a man branded in his own mind as a criminal.

We may even find ourselves unconsciously seeking out experiences designed to reinforce our existing beliefs. This sort of mechanism operates when people go from one abusive relationship to the next. Sustained bad treatment at the hands of someone else is a surefire way to affirm hidden beliefs such as ‘I am worthless’, whereas allowing oneself to be loved properly within a healthy relationship might put real pressure on such a negative view.

Sadly we often cling to our belief system even if those beliefs make us miserable. Perhaps this is because ‘knowing where we stand’ – even if we convince ourselves that reality is very bleak – protects us against feeling lost and out of control. We are all creatures of habit. However, the techniques of CBT can help you prise open your grip on your assumptions and help you to challenge your own dysfunctional beliefs.

Principle 4: It’s a two-way street

We have seen previously how certain thoughts appear to be capable of creating certain emotions: for example, if I think to myself ‘I am ugly’ then there is a good chance that such a thought might trigger feelings of shame, disgust or sadness. However CBT points out that the effect works both ways: in other words, if I am already feeling sad or depressed I am also much more likely to entertain thoughts associated with those emotions, in this case my ‘ugly’ thoughts.

This does not just apply to thoughts and feelings. The way we act can also predispose us to experience certain emotions or strengthen certain ways of thinking while particular moods or states of mind can encourage us to behave in a particular manner. For example, every time I avoid walking home a certain way because I know that a mugging took place there I reinforce my belief that the street is particularly dangerous and (because I don’t go there anymore) I never have an experience that might alter that belief.

Our physiological reactions, which also count as ‘behaviour’ in CBT, can also cue powerful emotions and thoughts, but conversely emotions and thoughts can also directly affect our bodies.

My racing heartbeat and sweaty palms might provide all the evidence I need that ‘something is seriously wrong with me’ or ‘I am having a heart attack’. These particular beliefs will inevitably also create a strong emotional reaction that may include feelings of fear and panic. The body’s response to these emotions is to produce more adrenaline that, in turn, keeps the heart rate up, thereby ‘proving’ to the panicking person that something really is wrong. A feedback loop is established that just makes things worse.

This idea of mutual influence is really important because understanding these two-way, cause-and-effect relationships between symptoms can help us understand not only how problems become established, but also what keeps them going. CBT proposes that because our thoughts, feelings and behaviour are interconnected, changes in one area of the system will inevitably produce changes elsewhere.

Principle 5: We are all scientists at heart

You may not feel this one applies to you but, as we have seen, we are all theory-building creatures. We can’t help ourselves. We are constantly generating hypotheses about ourselves and the world, often even without being aware that we are doing so.

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Einstein and you… more in common than you might think?

Science is not all Higgs Bosons and Bunsen burners; more fundamentally it is a way of knowing things. Furthermore it is a way of knowing that has built-in quality assurance standards. In science a good theory or hypothesis has to meet at least two criteria:

1.     it has to be consistent with all the available data, and

2.     it can also be tested so we can find out whether it is trustworthy.

Even though we become very attached to our pet beliefs and may even distort our way of looking at things in order to defend them, ultimately CBT relies on the fact that we are not unreasonable: we need theories that fit with what we know of the world and that are able to make convincing sense of our lives. Cognitive behavioural therapy exploits this desire by encouraging us:

·        to look at the way we may be distorting things to uphold our existing beliefs

·        to become conscious of the underlying assumptions that steer our thoughts and reactions and treat them as provisional theories (hypotheses) rather than facts

·        to test out the truth of our beliefs and assumptions against hard evidence from purpose-built behavioural experiments

·        to conduct an objective review of all the relevant information available to see whether this data fits with our existing beliefs or whether those beliefs need to be changed.

In other words, CBT exploits the fact that, when it comes down to it, there are few of us who are not open to persuasion by a reasonable argument and the evidence of our own senses.

So now you know…

There you have it. You are now up to speed with the five fundamental principles upon which CBT rests. They may look simple but, when applied in the right way, these ideas can provide a remarkably powerful set of insights. In the following chapter we will begin to explore how they can be mobilised to challenge some of the more common, negative thinking patterns.



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