Helping to Understand Cognitive Therapy

There are numerous strategies, procedures and techniques employed in cognitive therapy, but all fall within the context of the Cognitive Model. David Clark, a world leader in the treatment of anxiety has said: ‘never give up on the model’.

The Cognitive Model is based on an understanding of the way the mind functions. The brain interprets incoming information about the world before an emotional or behavioral response occurs. Emotional responses are based on interpretations of events, not as reflex reactions to events. Emotions (such as anxiety, depression and anger) powerfully interact with our behavior and create many of the physical sensations we experience under stress. However, what we pay attention to, how we interpret, and what conclusions we draw in response to life events – our cognitions – are the critical processes that create these intense emotional
experiences. Epictetus wrote that “men are disturbed not by things, but by the views that they take of them”. That human emotions are based on ideas can be traced to eastern philosophies like Taoism and Buddhism as well as Stoicism. The founders of modern Cognitive Therapy (CT) are considered to be Albert Ellis and Aaron Beck. Since the late 1970’s research has confirmed the clinical effectiveness of CT.

APPLYING THE MODEL

A person with a phobia such as fear of heights experiences intense anxiety in high places. Heart rate increases, blood pressure rises, and muscles tense. They are compelled to escape. What is the critical difference between the person with this emotional response and one who simply enjoys the view from the high place? The critical difference is that the person who is calm, believes they are safe. Anxiety is based on the belief that there is danger (e.g. ‘I will fall’). CT helps to identify and change irrational, distorted and stress inducing beliefs.

GETTING THE MOST FROM OUR RESEARCH ANALYSIS

Research has identified the primary irrational beliefs and distortions in our thinking that lead to stress, anxiety, depression and anger.

All approaches to CT recognize that ‘should’ statements are dysfunctional. Albert Ellis has correctly recognized that ‘shoulds’ are at the root of almost all human emotional disturbance. He has identified the major ‘should’ statements as demands for perfection in the areas of self, relationships, others and life. These are manifest as the irrational beliefs that: 1) I should be perfect; 2) I should always be loved and approved; 3) Others should be perfect; 4) Life should be perfect. When these demands are not met, we create dysfunctional thought processes. For example, low self esteem is rooted in the irrational belief that ‘I should be perfect’, and the corollary that ‘if not, I am worthless’ which is a black and white distortion. The cognitive distortions identified by Aaron Beck, include black and white thinking, catastrophic thinking, personalizing, overgeneralizing, minimizing positives and maximizing negatives, mind reading, emotional reasoning, jumping to conclusions and predicting the future. Distortions are almost always the result of the irrational demands made in ‘should’ statements. The most elegant cognitive solutions involve challenging and reframing these ‘shoulds’.

Identify ‘should’ statements (include synonyms like ‘must, need, have to’…etc). Change these to ‘want’ or preference statements. This will help reduce stress.

SMARTER THERAPY: Break Down Your Shoulds

1. I should be perfect. ‘if not I am no good’ – Low self esteem anxiety & depression.
2. I should be approved of by everyone. Social anxiety, depression and relationship demands.
3. Others should be perfect. At the root of most anger.
4. Life should be perfect: or ‘it should be easy; I can’t stand it!’ – Frustration & impulse related behaviors.

A Publication of the Centre for Cognitive Therapy. Written by Dr. Arthur Blouin.