Cognitive Behavioural Therapy (Brilliant Business) 1st Ed.

4. Grappling with negative thinking

So you have grasped the basic principle of CBT. You know your NATs from your core beliefs and are getting better at spotting both. You can even recognise common thinking errors and traps. By this stage you will be all too aware of the power of your thoughts to twist reality into forms that can upset, frighten or depress you. You recognise that although it may well be appropriate to experience such feelings from time to time, if you are experiencing such emotions on a regular basis then the chances are your habitual ways of thinking are probably at fault.

Fortunately, because these ways of thinking offer an unrealistic or warped perception of the world they are also vulnerable to reason. Your powers of rationality are one of the main weapons you have at your disposal when countering negative thinking, but like all weapons, you need to learn how to wield them effectively. This chapter will show you how to get started.

You may be thinking to yourself that ‘rationality’ and ‘reason’ aren’t necessarily your strong point? Perhaps you see yourself as more of a ‘gut feeling’, intuitive type? Don’t be put off. In this case brilliance is not mandatory. To use these techniques requires neither the incisive logic of Spock or the analytical prowess of a chess grandmaster. A willingness to think things through and a good dose of common sense should see you right. Remember, deep down even the most flighty of us like things to make sense, and it is this drive that CBT harnesses in countering dysfunctional thinking. So how on earth do we go about reprogramming our thinking?

Look for exceptions to the rule

Strictly speaking, if something is true then it must be compat-ible with all the available evidence. Consequently, one of the basic cognitive procedures in taking a negative thought to task is to trawl for any information or experiences that might contradict your unhelpful belief.

You are at a social event feeling tongue-tied and awkward. Negative thinking may be telling you ‘I never have anything interesting to say’, but hold on a minute: what about that dinner party when you kept everyone enthralled for the best part of half an hour with your amusing anecdotes about your time in Nepal? And what about the friends who seek out your company on a regular basis? If you really had nothing to say would they keep coming back for more? And didn’t Jane comment that you had been missed at the recent book club meeting because of your original views?

Now of course your negative mind will swiftly cut in and try to disqualify these apparent anomalies. This is because if there is any substance to any of your examples then the claim ‘I never have anything interesting to say’ starts to look a bit shaky. The more contradictory examples you can pull up, the weaker the NAT becomes. What your counter-evidence suggests is that you have fallen prey to the thinking errors of filtering and generalisation. Once you realise this you can start to negotiate a more reasonable alternative position: ‘I have lots to say but it takes me a while to feel confident when meeting new people’. This feels a lot less damning and is actually more accurate.

tip

Keep it real

Remember: Your alternative thoughts must always be believable. There is no point just trying to deny your NATs by defiantly asserting that the opposite is true. You need to find a balanced position that feels realistic. There is no point replacing one distortion with another: ‘I am the best at everything I do’ is not an appropriate counter to the core belief ‘I am hopeless at everything I do’ because it is unlikely to convince you or anyone else. An alternative position such as ‘no one is good at everything but there are many things I do well’ is a much more potent response - especially if it is based on a conscientious and level-headed review of examples of your various skills and talents.

The most powerful challenges to our negative beliefs are usually those drawn from our own experience, which is why behavioural experiments play such a key role in CBT – but more of that in the next chapter. However, information from trusted sources can also provide us with useful ammunition at times. For example, for some people who are phobic about flying it does make a difference to learn that the accident statistics confirm that there really is more chance of dying crossing the road than in an aircraft crash.

If your response to this is something along the lines of ‘That’s all very well but I feel I have more control when I cross the road…’, then you may just have tapped into an underlying dysfunctional assumption (‘I must feel in control in every situation…’) that may be making flying – and a bunch of other experiences – difficult for you.

Give your ‘but’ a workout

In sessions when you present someone with a piece of evidence that doesn’t fit with their negative thoughts there is one small word you will hear with great frequency: ‘but’.

Therapist

Inga, you tell me that you are not academic but what about this ‘A’ that you got on your latest assignment? That doesn’t sound like the grade of someone who is, I quote, ‘rubbish at studying’?

Inga:

But you see, it’s only because I was able to borrow my friend’s lecture notes – he’s just got a really clear way of presenting stuff because he understands it – unlike me.

Our instinctive and irrational drive to defend our negative thoughts means that we all too swiftly find reasons and excuses to dismiss the information that doesn’t fit, but this is actually a tactic that can be used against your NATs and dysfunctional assumptions.

Collect the evidence that supports your negative thought and then systematically work through it, using the word ‘but’ as your cue to find loopholes and exemption clauses that might discredit the evidence.

example

Negative thought: ‘I am going to make a complete idiot of myself when I get onstage tonight.’

Evidence supporting the negative thought

 

Qualifier/excuse

Time when I couldn’t read out loud in class because I felt like I couldn’t breathe. Everyone laughed.

BUT…

I did have undiagnosed asthma and I’ve got an inhaler now.

I’m not confident in front of groups…

BUT…

I can be quite outspoken and assertive when I really believe in something.

I’ll probably forget my lines at some point.

BUT…

Sally is there to act as prompt and it’s a pantomime. I can always ad lib a bit.

Remember, as any defence lawyer knows, if you can undermine the foundations of a witness’s testimony then you can do serious damage to their plausibility. Taking apart the evidence for your automatic thoughts or even core assumptions piece by piece can sometimes be enough to bring the whole edifice tumbling down.

Aim at the right target

Sometimes people fail to make much impact on their problems because they attempt to do battle with the surface thoughts rather than the more damaging assumptions and implications behind them. This is a bit like trying to control a cholera epidemic without paying attention to the cracked sewerage system and polluted water supply.

example

Dinah is preparing a birthday party for her son Luke. She takes the cake out of the oven to find that it has risen unevenly and feels a wave of panic sweep over her while the negative thought plays through her mind: ‘Oh my god! Now everything’s ruined!’ She could, of course, use the techniques we have been discussing to dispute this thought:

·        Many things in her life and even her son’s party will remain completely unchanged by this so-called culinary ‘disaster’.

·        Judging from previous experience the children will probably not even notice if the cake is uneven.

·        Even the cake is not technically ‘ruined’ because she knows full well she can disguise the sunken section with extra butter cream.

However, even though she is applying appropriate counters Dinah finds that these alternative thoughts make little impression on her low mood. The reason for this is that she has not delved sufficiently deeply into the assumptions underlying her mood shift. Had she pushed herself a little further she would swiftly have uncovered the immediate source of her anxiety, namely the belief that ‘everything I do has to be perfect’.

Dinah could have unearthed this dysfunctional assumption by using a technique known in CBT as the downward arrow. Put simply this means that when you hit a negative thought you ask yourself ‘What does this mean about me or the world?’ or ‘What is the worst implication of this?’ and you repeat the pro-cess until you hit the appropriate ‘hot’ thought. If Dinah had used the downward arrow technique the results would have looked something like this:

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The thought that actually provoked Dinah’s anxiety was the dysfunctional assumption ‘I must ensure everything I do is perfect… or I won’t be loved’. This was the thought that she needed to be challenging, so in her case the following counters would probably have proved more effective:

·        I have made mistakes in the past such as when I reversed the car into that bollard. My husband was just relieved that I was okay. My foul-up didn’t seem to make any difference to how he felt about me. Luke probably won’t love me any the less if the cake is a bit lopsided for once.

·        Other people make mistakes and are still lovable. Uncle Henry did terrible things and everyone still adored him so maybe my assumption isn’t always true.

·        There is a respected school of thought that people should be loved for who they are, not what they do.

tip

The jury is out!

Some people get despondent because they cannot ever imagine themselves not believing their negative thought. One strategy that can help is to cast yourself into the role of a lawyer. Solicitors and barristers don’t take on their cases on the basis of whether they believe their client to be guilty or innocent. Their job is to represent one side of the argument to the best of their ability. The weighing of the relative merits of the arguments comes later down the line when the jury considers its verdict. At this stage you do not have to convince yourself of anything - merely commit yourself to examining the available evidence in an unbiased way and make the best case you can for revising your current belief.

Stand it on its head

Sometimes the best way to expose the weakness of a negative thought is not to contradict it directly but to examine the opposite of the thought. This can be an especially productive strategy to adopt with dysfunctional assumptions.

example

Peter has OCD and a host of anxious thoughts about cleanliness and infection. He is standing at the kitchen sink having just washed up a chopping board when it occurs to him that it may not be entirely clean. He washes it again. And again. And again. Each time he does so his negative thoughts become stronger and his anxiety levels escalate. The thought that keeps playing through his head is this one:

Peter’s NAT:

‘If I don’t wash this one more time I cannot be sure all the germs are gone.’

Using this technique Peter inverts his original thought:

Peter’s inverted assumption:

‘If I do wash this one more time I can be sure that all the germs have gone.’

As soon as he put it to himself in these terms Peter realises this is nonsense. His new thought – although simply an inversion of his original one – no longer felt convincing. He was then able to dispute the new thought using the following counters:

·        Even if I wash this board a thousand times I will never know for sure that all the germs have been removed.

·        New germs may be falling on the board all the time – and there is nothing I can do about that because I can’t keep washing it for ever.

Once the whole enterprise had convincingly been exposed as pointless, Peter was finally able to abandon his obsessive cleansing ritual for the time being. It didn’t deliver him from his anxiety because he was not quite ready to challenge his entrenched beliefs that things needed to be sterile if he and other people were to avoid contamination. However, the futility of his actions did put a break on a behaviour that was inevitably reinforcing his problems.

Inverting your NATs and seeing whether the opposite holds true can be a helpful starting point. The transformed NAT may feel outlandish, but the mirror image won’t carry the negative emotional charge of the original. This means you may find yourself able to examine it more objectively.

If I am telling myself that ‘nobody loves me…’ I may find it hard to appraise such a thought rationally. The inverted form – ‘everybody loves me’ – is, of course, also grossly inaccurate, but considering the arguments ‘for’ and ‘against’ may allow me to recall one or two people who do care about me. Neither of the polarised extremes are correct, but while the first may be paralysing, its mirror image may be more open to objective evaluation. Evidence from that process can then be carried over to dispute the original NAT:

New counter:

‘I feel unloved at the moment but there is good evidence that some people in the world have cared about me and absolutely no reason to believe that they do not continue to do so.’

See the situation through fresh eyes

A great many of the beliefs that seem self-evident to us are not so obvious to other people. One simple but surprisingly effective technique you can employ to counter your negative beliefs is to ask yourself how the situation would appear to someone else and check whether they would agree with your conclusions.

Fred can’t get to sleep. Yesterday he forgot to ring his mate Steve on his birthday and he is rapidly convincing himself that he has jeopardised the friendship. However, by putting himself into the shoes of Chris, a mutual and more laid-back friend, he is able to use Chris’s perspective to answer some of his own NATs.

Fred’s negative thoughts

The ‘Chris’ take on the situation

What I’ve done is unforgivable…

That’s a bit strong. It’s an easy mistake to make – and Steve is a really understanding guy. That’s partly why we both like him. I forget stuff all the time. What are you getting so worked up about?

He won’t ever want to see or speak to me again.

You’re his best friend – wouldn’t that be cutting off his nose to spite his face?

How could I be so stupid?

Don’t give yourself such a hard time. You’ve had so much on your plate this week what with your dad’s operation and your brother’s arrest. Steve knows that.

I don’t deserve to have a good friend like Steve.

Isn’t it up to Steve to decide who he wants to be mates with? Anyway you’ve been a good friend to him: it was you that got him through the whole ugly divorce with Angie.

Since many of our negative thoughts involve our critical self-perceptions it can be particularly useful to choose as your alternative viewpoint someone who you know cares about you and is sympathetic towards you. What this technique encourages you to do is de-centre or step outside your own restricted perceptions by accessing parts of your mind not necessarily held hostage to your negative assumptions. If you are finding this approach a struggle why not actually ask a friend or loved one for real? It can be an eye-opener.

Ask yourself: ‘How did I come to believe this in the first place?’

When in the grip of a negative thought process our instinctive response to this question might be, ‘Because it’s true, of course!’: but the origins of our beliefs are usually based in specific experiences that have taught us to think in certain ways.

When addressing a negative thought, can you identify any critical incidents or experiences responsible for the current levels of your conviction regarding your belief? If you had not been through that experience would that have changed the way you see things?

Maybe your belief is a piece of received wisdom, a piece of programming handed down from someone close to you. When you think about your belief can you picture anyone else who shares it? Is this something you can remember someone else saying to you? Was it an explicit or implicit message repeated in your childhood? This of course does not necessarily mean that the belief is invalid but you might want to scrutinise it carefully to see whether it holds true. Critical experiences and repeated childhood patterns can mould our core beliefs about ourselves in various ways. We will return to the topic of core beliefs and how you tackle them later in this chapter.

For now, be reassured that the very process of thinking about your thinking – called metacognition by the psychologists – is valuable, because in order to do so you have to take a step back. Sometimes this is all that is needed to bring about a perceptual shift and make our negative thoughts seem less compelling.

How helpful is this belief?

CBT is a pragmatic business. Its focus is results – results measured against the targets that you have set for yourself. When we think of problems it is usual to think of them as something we want to resolve or move away from, but CBT encourages you to think more positively than this. It would ask you to reflect upon the state that you wish to move towards. This may seem like a subtle distinction but it is an important one. In CBT you don’t only evaluate your negative thoughts on the basis of how true they are: you will also be considering how useful they are in terms of achieving your goals.

Say, for example, that my problem is that I am agoraphobic – in other words I have found myself feeling increasingly unsafe in crowded places. I have set myself the following goal:

Goal:

To be able to get out and about without feeling afraid so I can live a full and active social life again.

I go to the cupboard to get some bread to make toast for breakfast but find that I have used the last of the loaf. I briefly consider nipping to the local bakery which is a five-minute walk from the house, but as I do so a terrible sense of foreboding starts to gnaw away in the pit of my stomach. I start shaking and feeling unsteady. Because I have dutifully worked my way through the preceding chapters of this book I begin to become conscious of a stream of negative thinking. In particular I picture myself panicking in the bakers and drawing attention to myself by acting in an eccentric, ‘crazy’ fashion. I think to myself:

Question: If I am to become someone who can get out and about without feeling afraid is this image helpful to me?

Answer: Absolutely not. All it does is make me more afraid. It is completely incompatible with my goal so I need to either get rid of it or modify it.

Question: When I have achieved my goal of conquering my agoraphobia then what image will I have in my head in these circumstances?

Answer: I probably wouldn’t dwell on it and just grab my keys and go. But if I did stop to anticipate it I would picture myself walking cheerfully into the bakers, possibly meeting someone I know, calmly buying my bread and walking home again.

While mentally rehearsing this alternative vision of the trip I notice that my hands have stopped shaking so much. Although my anxiety has certainly not gone away, it would appear that this new vision of myself buying bread has the potential to move things in the desired direction. One image intensifies and consolidates my symptoms, the alternative brings me a little more into alignment with my goal. There is little question as to which I should consciously embrace if I want to progress towards an anxiety-free future.

Asking yourself how you will think about things once the problem has gone and trying it on for size is another way of opening up alternative perspectives that can loosen the hold of even the pernicious NAT.

Say it is so… What can you do about it?

One of the chief difficulties with negative thoughts of all kinds is their capacity to paralyse us and leave us feeling helpless. They usually come with an unspoken implication which reads, in effect, ‘…and there is nothing you can do about it!’

·        I am such a jealous person… [and you’re stuck like that].

·        I just don’t have the energy to get my act together… [so there’s no point trying really].

·        I never have been popular [and never will…].

Often what you need to dispute is not the validity of the thought itself, but the truth of this invisible corollary – that you are completely helpless in the situation. In most cases there certainly is something you can do about the scenario painted by your negative mindset, often many things. One of the most effective ways to counter negative thinking is to approach your NATs as cues to start problem solving. Even if you currently find it impossible to accept that your distorted view of reality is right, there is nothing to prevent you from doing something about it.

Your negative thoughts tell you that you have no friends. So rather than colluding with this thought by getting really miserable and brooding on your isolation, you make a list of three things you could do to start changing that:

1.     Ring up the bloke who gave you his number after the match last Saturday and see whether he wants to go for that drink.

2.     Open up a Facebook account and find out what your old mates from school are up to.

3.     Go to that office party next week rather than sitting glumly at home as usual and make an effort to be a bit more sociable.

The joy of this approach is that before long you will probably have a number of new experiences that will arm you to dispute future negative thoughts in a similar vein.

Once more with feeling!

Sometimes people find that even once they have achieved a more balanced position and are no longer logically convinced of the truth of a negative thought it continues to exercise power over their mood. This is actually not surprising.

Firstly, while we do sometimes have flashes of insight and revelation that transform our worldview and lift the scales from our eyes, such incidents are the exception rather than the rule. It’s easy to see why.

For a start your negative beliefs have probably been rehearsed and reinforced over a very long period. At a physical level, the pathways in our brains get strengthened the more times we use them. In particular, thought processes relating to core beliefs will inevitably have been reinforced assiduously over many years. A new and consequently more fragile neural trace (your alternative thought) will need to be strengthened by constant repetition before it begins to take hold. In short, reprogramming your thinking involves running the new programme many times before it becomes spontaneous, natural and convincing. Be prepared to repeat the new thought to yourself again and again.

The other reason why alternative thoughts sometime fail to control our negativity is that we don’t mobilise them with sufficient oomph! Our NATs already come with a pre-set emotional charge. In fact it is their power to mobilise our emotions that partly defines them and gives them their hold over us. However, if we are to establish the supremacy of a new position then this needs to be applied with equal and opposite emotional force, even if it is the product of ‘cooler’ processes like logic and reason.

When you superimpose your new alternative belief over your old one be assertive! Imagine you are delivering it with the force of a knock-out blow. Mentally shout it out – if you are hesitant or tentative the underlying implication is that you don’t have much faith in your new perspective. Think it like you mean it. If you can bear it, it can really help to actually say it out loud with as much vocal conviction as you can muster. Sometimes I encourage clients to write their alternative thoughts on a piece of paper next to the bathroom mirror and repeat them every morning five times at the start of the day. You may feel self-conscious but it does help.

Working with thought records

If you are serious about tackling your issues, the mundane reality is that when you start countering your dysfunctional thought patterns you will be filling in a lot of thought records. This stage will not go on for ever, but really is worthwhile for a number of reasons:

·        Thought records teach you to dispute your NATs in a systematic and methodical fashion.

·        They will provide feedback in the form of mood ratings so you can see how you are doing.

·        They will help you work towards more balanced, realistic alternative thoughts by synthesising the evidence for and against your automatic thoughts.

·        The very act of writing your thoughts and feelings down will give you a more objective perspective on your thinking process.

·        With a permanent written record to consult you will start to become aware of repeating themes that may point you towards core beliefs that otherwise might elude you.

·        Practice makes perfect. The discipline of filling in the thought record forms is the best way to rehearse techniques that will eventually become second nature to you. At that point you can dispense with them!

So how do they work?

Most thought records consist of a blank sheet divided into multiple columns (see Appendix 2 for an example).

Column 1: the situation

This is where you record what was going on at the time when you felt distressed. It will allow you to pinpoint relevant triggers and help you understand the context of your negative thoughts. Take note of who you were with, what you were doing and any significant changes in your environment that might be important.

Column 2: your feelings

It will almost certainly be a change in your mood that will alert you to the fact that negative thoughts are around. Record each of the emotions that you experience as specifically as you can. Try to make distinctions between different shades of feeling and be precise. Writing down that you felt unappreciated, disappointed, lonely and glum is more useful than simply putting ‘felt bad’ because these more accurate labels may help you access the related NATs.

In this column you also need to rate the intensity of your individual feelings, not least so that you have a baseline against which you can measure the helpfulness of your counters and alternative thoughts. You will be rerating your feelings at the end of the process. Most commonly people use percentages to do this, but you can use ratings from 1 to 10 if you prefer. There is, however, something to be said for a more differentiated scale because it allows you to track more subtle shifts. 100% would represent ‘the most intense this feeling has ever been or could possibly be’ whereas 0% indicates the feeling is no longer around at all.

Column 3: your automatic thoughts

This is where you write down the NATs that come into your head at the time of the downward turn in your mood. Initially write down as many as you can. Once you have collected them you can then sort through and identify your ‘hot’ thoughts, i.e. the ones that seem to be the most uncomfortable or upsetting. Remember also to use the downward arrow technique to mine the underlying meaning or implication that is really doing the damage.

Column 4: The case for your negative thought or belief

In this column list the reasons why your negative thought seems believable. Pay attention to experiences that have reinforced its credibility or any arguments that appear to support it. At this stage you must allow yourself to make as strong a case for the NAT as you can – otherwise when you attempt to counter it you may not be taking on the appropriate issues.

Column 5: evidence against your negative belief

This is where you get to work using what you have learned about spotting thinking errors and the techniques described in this chapter. You need to examine the evidence in column 4 and see whether you can find any flaws in it, or the assumptions behind it. You can also marshal any further evidence at your disposal that contradicts the negative belief, paying particular attention to any personal experiences that prove the NAT may be inaccurate or biased.

Column 6: the alternative, balanced thought

In this column you will need to combine the information and arguments from the preceding two columns and see whether you can arrive at a new position that authentically takes into account all the facts and represents an objective, reasonable take on the whole matter. As mentioned before, unless it is believable it won’t work, so take time to generate alternative thoughts that do justice to all the legitimate data but that are more closely aligned to your goals.

Column 7: rerate your moods

This is the moment of truth. Having worked through the pro-cess of disputing your negative thoughts and beliefs you now need to rerate the emotions you listed in column 2. Has your new, alternative thought had any impact on your mood? If the percentages have dropped – even by a little – you are on the right track. If not, you may need to re-examine the early stages of your thought record:

·        Did you identify the relevant ‘hot’ thoughts?

·        Have you been sufficiently thorough in working through the arguments ‘for’ and ‘against’?

·        Does your new, alternative thought really represent a balanced view of all the available evidence?

·        Have you been consistent in the way you have rated your feelings at the start and end of the process?

Remember: CBT is all about learning new skills. The thought record is just another tool to help you in the process. If you prefer (and own a smart phone), rather than use pen and paper records you can use one of the helpful apps now available like Thought Diary Pro, iCBT, eCBT, CBTReferee, MoodKit or Cognitive Diary CBT. Several of these programs will not only help you keep accurate records of your negative thoughts and how they affected you, but will even help you identify thinking errors and prompt you to challenge them. You can find details of these apps and where to obtain them in Appendix 1. However, in whatever format you choose to record your thoughts, be aware that all the techniques in this chapter will require a little application – and not just the kind you can download to your phone. These skills take time and effort to perfect, but do persist because ultimately you will see results.

Homework: making a start with thought records

Photocopy the thought record template in Appendix 3 or make your own equivalent. Over the next two weeks try to enter some examples in the first three columns – concentrating on recording your negative thoughts, the context, and getting used to rating your different emotional response to them. Try to record five or so examples each week.

For most people it is not practical to record their thoughts at the times they experience the negative shifts, but what you do need to do is pay attention to them and try to capture them in your memory so when you do have a chance to sit down and reflect, perhaps at the end of the day or whenever you have some regular quiet time to yourself, you can record the data accurately.

The next stage is to begin disputing your thoughts using the remaining columns and aiming to generate some balanced alternatives.

Most people find they need to employ thought records for at least a couple of months before the process of disputing them becomes second nature.



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