THINKING TO CHANGE TECHNIQUES TO CHALLENGE THINKING CFIRSTSTEPCOUNSELINGONLINE

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1 THINKING TO CHANGE TECHNIQUES TO CHALLENGE THINKING CFIRSTSTEPCOUNSELINGONLINE

2 Disclaimer Disclaimer: All content within this site is provided for general information only. It should not be treated as a substitute for the medical advice of your own doctor or health care professional. The owners of this site are not responsible or liable for any diagnosis made by a user based on the content of the evagregorycounselingonline website. The owner is not liable for the contents of any external internet sites listed, nor does it endorse any commercial product or service mentioned or advised on in this or any linked site. Always consult your own Doctor if you are concerned about your health or your child s health. C)FIRSTSTEPCOUNSELINGONLINE

3 TOPICS Negative Programming Self Deception ABC Model Cognitive Restructuring Cognitive Distortion Cognitive Behavior Therapy CFIRSTSTEPCOUNSELINGONLINE

4 AFTER COMPLETING CLASS, PARTICIPANTS WILL 1. RECOGNIZE NEGATIVE PROGRAMMING; 2. UNDERSTAND SELF DECEPTION; 3. KNOW THE DYNAMICS OF COGNITIVE RESTRUCTION; 4. RECOGNIZE ABC MODEL; 5. IDENIFY COGNITIVE DISTORTIONS; 6. EXPLAIN COGNITIVE BEHAVIOR THERAPY. CFIRSTSTEPCOUNSELINGONLINE

5 Each person has two minds; the conscious and the subconscious. The conscious mind belongs to you, but your subconscious belongs to your early environment and those who raised you. Much of who you are hasn't much to do with you. Negative programming is the major cause of low self respect, distorted thinking and self defeating thoughts and behaviors. The negative circumstances in your life are not all your fault. You are responsible for your actions, but others must take responsibility for some of your bad programming. You may not have control over your subconscious mind, but you do your conscious mind. Each accountable person knows right from wrong. Not everyone who comes from a dysfunctional home becomes a criminal. To become a criminal is a conscious choice. CFIRSTSTEPCOUNSELINGONLINE

6 Life isn't fair. You didn't get to choose your parents or early environment. You didn't have control over your beginnings, but you do have control over your endings. There is no wrong you can do that is worth the price you have to pay for it. If you keep on doing what you have been doing, you will keep on getting what you have been getting. If you want to stop what your are getting, you will have to stop what you are doing. If you don't stop what you are doing, life will get harder and harder. Much of life is based on perception or belief and not necessarily the truth. You are not your bad memories or what other people say you are. The truth is you are many times better than you think you are. The more you find the truth about yourself the happier you will be. CFIRSTSTEPCOUNSELINGONLINE

7 You can change who you are by changing what you are doing. You can change from doing wrong to right as soon as you want to. Excuses are only reasons why you don't want to change. You can change regardless of your circumstances. Life is what you make of it. If you are not successful and happy in this life, it is your fault. Self deception is a dysfunction of the mind that allows individuals to continuously act in a negative manner. Without intervention, the cycle of justification and deception gets worse. The result is resistant people stay in denial and blame others for their problems. Resistant people are self deceived; that is, they are in denial, always blaming others when they are the real problem. The problem with self deception is the person doesn't "think" he/she is the problem. They think everyone else must be wrong. They can't see that the biggest problem they have is themselves. CFIRSTSTEPCOUNSELINGONLINE

8 People who are self deceived instill in others the very behavior they dislike and then point to that behavior to justify their treatment of that person. Self deceived people are angry, contentious, demeaning, selfish, calculating, and arrogant. They objectify, control, marginalize, and physically and/or emotionally abuse others. Self deception can reach such a level in a person's life that they lose empathy and turn people into objects who can be abused without guilt or mercy. Thus, for example, men can beat their partners or molest children without remorse. CFIRSTSTEPCOUNSELINGONLINE

9 THE COGNITIVE (ABC) MODEL Albert Ellis, one of the pioneers of CBT, illustrated how our emotions and behaviors are often the result of what we think or believe with his ABC model. In the model, A stands for the event or situation that triggers a cognitive, emotional, and behavioral reaction. B stands for our underlying beliefs about ourselves, other people, and the world and the resulting interpretations and evaluations we make of the event or situation. C stands for the consequence of our interpretations and evaluations which can include both an emotional reaction and a behavioral response.. ACTIVATING BELIEFS CONSEQUENCES CFIRSTSTEPCOUNSELINGONLINE

10 A B C OF BEHAVIOR The basic tenet of behavioral analysis is to view behaviors as a function of a person and their environment. That is, something happens to precede behavior (the antecedent) which in effect causes or influences the behavior, resulting in a consequence. We can t change a person, but we can influence the way they behave by shaping the environment they function within. CFIRSTSTEPCOUNSELINGONLINE

11 Cognitive Restructuring Techniques Cognitive restructuring is a set of techniques for becoming more aware of our thoughts and for modifying them when they are distorted or are not useful. This approach does not involve distorting reality in a positive direction or attempting to believe the unbelievable. Rather, it uses reason and evidence to replace distorted thought patterns with more accurate, believable, and functional ones. To illustrate the role of thoughts in influencing emotions and behavior, consider the following vignette1: Suppose you are at a party and have been introduced to Alex (you can imagine Alex as a male or as a female). As you talk, Alex never looks at you; in fact, throughout your brief conversation s/he looks over your shoulder across the room. What are you thinking and feeling, and how would you respond? CFIRSTSTEPCOUNSELINGONLINE

12 Person A & B This is deliberately an ambiguous situation that can be interpreted in many ways, because much of life is like this. We often have to make sense of what is happening to us based upon limited information. Let s consider how three different people interpreted and reacted to this scenario: Person A thought Alex is rude. S/he is insulting me by ignoring me. As a result, they felt annoyed and they terminated the conversation and avoided Alex at future parties. Person B thought Alex doesn t find me interesting. I bore everybody. As a result, they felt ashamed and depressed, and they left the party and became more likely to decline invitations to parties in the future. Person C thought Alex seems shy. S/he s probably to uncomfortable to look at me. As a result, they felt sympathetic and attempted to engage Alex in a conversation about how Alex knew the host of the party. CFIRSTSTEPCOUNSELINGONLINE

13 To show how the vignette works, I am using Person B. Activating Event Beliefs Conseqences (a) Emotions (b) Behaviors Alex not looking at me when I talk. Alex doesn t find me interesting. I bore everybody. Emotions: Ashamed, depressed. Behaviors: Left party, more likely to decline party invitations. CFIRSTSTEPCOUNSELINGONLINE

14 The term cognitive distortion refers to errors in thinking or patterns of thought that are biased in some way. They may include: (A) interpretations that are not very accurate and which selectively filter the available evidence, (B) evaluations that are harsh and unfair, and/or (C) expectations for oneself and for others that are rigid and unreasonable. The more a person s thinking is characterized by these distortions, the more they are likely to experience disturbing emotions and to engage in maladaptive behavior. A number of common patterns of cognitive distortions have been identified, including: 1. All-or-nothing thinking: Looking at things in absolute, black-and-white categories, instead of on a continuum. For example, if something is less than perfect, one sees it as a total failure. 2. Overgeneralization: Viewing a negative event as a part of a never-ending pattern of negativity while ignoring evidence to the contrary. You can often tell if you re overgeneralizing if you use words such as never, always, all, every, none, no one, nobody, or everyone. 3. Mental filter: Focusing on a single negative detail and dwelling it on it exclusively until one s vision of reality becomes darkened. CFIRSTSTEPCOUNSELINGONLINE

15 4. Magnification or minimization (e.g., magnifying the negative and minimizing the positive): Exaggerating the importance of one s problems and shortcomings. A form of this is called catastrophizing in which one tells oneself that an undesirable situation is unbearable, when it is really just uncomfortable or inconvenient. 5. Discounting the positive: Telling oneself that one s positive experiences, deeds, or personal qualities don t count in order to maintain a negative belief about oneself. Or doing this to someone else. 6. Mind reading: Concluding what someone is thinking without any evidence, not considering other possibilities, and making no effort to check it out. The term cognitive distortion refers to errors in thinking or patterns of thought that are biased in some way. They may include: (A) interpretations that are not very accurate and which selectively filter the available evidence, (B) evaluations that are harsh and unfair, and/or (C) expectations for oneself and for others that are rigid and unreasonable. The more a person s thinking is characterized by these distortions, the more they are likely to experience disturbing emotions and to engage in maladaptive behavior. A number of common patterns of cognitive distortions have been identified, including: CFIRSTSTEPCOUNSELINGONLINE

16 7. Fortune telling: Anticipating that things will turn out badly, and feeling convinced that the prediction is an already established fact. It often involves: (A) overestimating the probability of danger, (B) exaggerating the severity of the consequences should the feared event occur, and (C) underestimating one s ability to cope should the event occur. B and C are also examples of catastrophizing. 8. Emotional reasoning: Assuming that one s negative emotions necessarily reflect the way things really are (e.g., Because I feel it, it must be true. I feel stupid, therefore I am stupid ). 9. Rigid rules (perfectionism). Having a precise, fixed idea of how oneself or others should behave, and overestimating how bad it is when these expectations are not met. Often phrased as "should" or must statements. CFIRSTSTEPCOUNSELINGONLINE

17 10. Unfair judgments: Holding oneself personally responsible for events that aren't (or aren t entirely) under one s control, or blaming other people and overlooking ways in which one might have also contributed to the problem. 11. Name-calling: Putting an extremely negative and emotionally-loaded label on oneself or others. It is an extreme form of magnification and minimization, and also represents a gross overgeneralization. In addition to the above list which is largely influenced by Aaron Beck s version of cognitive therapy, Albert Ellis produced a similar list that highlights what he called irrational beliefs (which consist of faulty assumptions and unreasonable rules about life). CFIRSTSTEPCOUNSELINGONLINE

18 Where do these distortions come from, and what purpose do they serve? Frequently, cognitive distortions develop in childhood as the result of unfortunate and difficult life experiences and/or being taught to use them by significant others (e.g., parents and peers). We also become more prone to cognitive distortions when under stress, because under pressure we are apt to take more cognitive shortcuts resulting in less accurate and more extreme interpretations and reactions. Cognitive distortions can also serve the function of trying to protect us from harm. For example, when a depressed or anxious person thinks, I can t do it, it justifies inaction and protects the person from possible failure. Of course, this strategy is ultimately selflimiting and defeating, and keeps people stuck in old patterns that don t work very well. CFIRSTSTEPCOUNSELINGONLINE

19 Cognitive Behavior Therapy CBT is not saying that all negative or painful emotions are bad and that we should always think positively. Emotions such as fear, anger, and sadness can be very appropriate and even useful. Fear can tell us there is danger, and motivate us to protect ourselves. Anger can inform us that our rights are being violated, and we need to take action to assert our rights. Sadness can be the result of losing something or someone important to us, and can indicate that we need to take the time to grieve. What is important is not whether an emotion is positive or negative, but whether it is adaptive or maladaptive. Negative and painful emotions can be adaptive if they are based on accurate thinking and guide an appropriate response. Maladaptive emotions are driven by distorted thinking and cause unnecessary suffering and inappropriate responses. One way of defining mental health might be the extent to which one can recognize the difference between adaptive or maladaptive emotions. CFIRSTSTEPCOUNSELINGONLINE

20 2 nd part of Cognitive Restructuring The second part of cognitive restructuring involves evaluating your automatic thoughts and perhaps developing a new perspective that is more accurate and useful. Instructions: Choose one or more hot thoughts to work on. It is best to focus on only one or two of these thoughts at a time. 1. Identify any cognitive distortions: Identify if the thought contains any cognitive distortions (refer to the list of common cognitive distortions). 2. Evaluate and modify: Evaluate the accuracy and usefulness of the thoughts, and if warranted, modify the thoughts in a more accurate and useful direction CFIRSTSTEPCOUNSELINGONLINE

21 3. Summarize your new perspective: Summarize or highlight the key points you discovered as a result of the work you have done. 4. Go back and re-rate your degree of belief in the hot thoughts and the intensity of your original emotions. Note whether there has been a change in your emotions. The following is an example of a worksheet completed by a semi-fictional 20 year-old male college student. He has come to counseling to get help with his depression, low self-esteem, and social anxiety (e.g., fear of being judged negatively by others). In particular, he is unhappy because he has never had a girlfriend. This is largely because he has never initiated relationships with females because he sees himself as undesirable and likely to be rejected. The thought of initiating a relationship makes him very anxious. In actuality, he is handsome, smart, personable, and caring toward others. CFIRSTSTEPCOUNSELINGONLINE

22 RATINGS: NONE A LITTLE MEDIUM A LOT MOST I EVER FELT However, like many people with low self-esteem and depression, he cannot see these positive characteristics in himself. In this example, I selected two of his upsetting thoughts, identified some of the his primary emotions, and then evaluated and modified his thoughts using the procedures described above. SITUATIION EMOTIONS/RATING AUTOMATION THOUGHTS/RATING THINKING ABOUT NOT HAVING A GIRL FRIEND. SAD/DEPRESSED/ ASHAMED-70% BEFORE AFTER 40% I M UNDESIRABLE. I M A LOOSER. 95% BEFORE 45% AFTER NAME CALLING, UNFAIR, MAGNIFYING EVAUATE/MODIFY THOUGHT DOES NOT HAVING A GIRLFRIEND EQUAL A LOOSER? DOES NOT HAVING A GIRLFRIEND MEAN I AM UNDESIRABLE? CFIRSTSTEPCOUNSELINGONLINE

23 WHAT IS CAUSING THAT EMOTIONAL THOUGHT? What is going through my mind as I am feeling this emotion? What am I telling myself about this situation? What am I afraid might happen? Instructions: When you are experiencing a negative emotion use the following procedures to identify the emotion-causing thoughts. 1. Situation: Briefly describe the situation that led to the emotions. 2. Emotions / ratings: Identify the emotions you are experiencing and any physical sensations. Emotions can be described by single words, such as sad, nervous, afraid, angry, guilty, or ashamed. CFIRSTSTEPCOUNSELINGONLINE

24 3. Automatic thoughts / ratings: Identify the thoughts or images connected to the emotions and record them in brief simple declarative sentences or statements. On a scale of 1 10, with 1 meaning Not at all and 10 meaning Most I have ever felt, rate each of your thoughts connected with these emotions. It is important to know the intensity of your emotions. Once you have identified a number of thoughts, put a star by one or two of the thoughts that seem to be producing the most emotion ( hot thoughts ). The second part of cognitive restructuring involves evaluating your automatic thoughts and perhaps developing a new perspective that is more accurate and useful. Instructions: Choose one or more hot thoughts to work on. It is best to focus on only one or two of these thoughts at a time. CFIRSTSTEPCOUNSELINGONLINE

25 1. Identify any cognitive distortions: Identify if the thought contains any cognitive distortions (refer to the list of common cognitive distortions). 2. Evaluate and modify: Evaluate the accuracy and usefulness of the thoughts, and if warranted, modify the thoughts in a more accurate and useful direction. CFIRSTSTEPCOUNSELINGONLINE

26 Some questions can help you evaluate the accuracy of a thought: What is the evidence that supports or contradicts this thought? Is there an alternative explanation? Is there another way of looking at it? Am I overestimating the probability of the negative event occurring? What is the worst that could happen? What is most realistic? Am I overestimating the severity of the consequences of the event (should it occur)? Is it really a terrible catastrophe if X happens? Could I cope with it? Does X have to = Y (e.g., Does not having a dating partner = being a loser? ) If a friend had this thought, what would I tell them? CFIRSTSTEPCOUNSELINGONLINE

27 Some questions can help you evaluate the usefulness of a thought: What are the advantages of telling myself this? And what are the disadvantages? What might be a more useful or helpful way of thinking about this? To the degree that this belief is true, what should I do about it? Be sure to record any data that contradicts the thought, and the more rational thoughts you may have composed. CFIRSTSTEPCOUNSELINGONLINE

28 . Summarize your new perspective: Summarize or highlight the key points you discovered as a result of the work you have done. 4. Go back and re-rate your degree of belief in the hot thoughts and the intensity of your original emotions. Note whether there has been a change in your emotions. CFIRSTSTEPCOUNSELINGONLINE

29 COGNITIVE RESTRUCTING WORKSHEET SITUATION EMOTIONS AUTOMATIC THOUGHTS BOYFRIEND TELLS OLD GIRFRIEND HE WANTS TO CRAWL IN BED WITH HER. BETRAYED, ANGRY HURT HE CAN NOT LOVE ME. BELIEF EVALUATE MODIFY THOUGHT IF YOU LOVE ME, YOU WON T HURT ME. WHAT ARE THE ADVANTAGES OF THINKING THIS? HE IS NOT HUSBAND MATERIAL. Save self from future pain. WHAT ARE THE DISADVANAGES OF THINKING THIS? The relationship is gone. Trust is gone. Love is action. Feeling is just attached. CFIRSTSTEPCOUNSELINGONLINE

30 The distorted thoughts serve a purpose, and people can be reluctant to let this go. Remember that distorted thoughts often are an attempt to protect a person from negative consequences. It can be helpful to ask, What are the advantages and disadvantages of believing this thought? Often, there are some advantages, but they are frequently outweighed by the disadvantages. Often cognitive restructuring is not enough on its own, and a person needs new learning experiences to convince them of what is true at a deeper level. This means engaging in new behaviors, often of the type that the person has been avoiding due to pessimism or anxiety. This can be where CBT techniques such as behavioral activation (for depression) and exposure (for anxiety) can be very helpful. Finally, it is helpful to remember that it may have taken a lifetime to develop these patterns of thought, and takes time and hard work to change them. CFIRSTSTEPCOUNSELINGONLINE

31 COGNITIVE BEHAVIOR BY ELLIS & BECK Cognitive by Lazarus, Ellis, Beck, and others. CBT is often employed by psychologists, counselors and psychotherapists in the treatment of fears, anxiety, depression, dysphoric moods, and disturbed emotional reactions. Cognitive behavioral treatment is used to eliminate psychological symptoms, change the thoughts or behaviors that support dysfunctional reactions, and create more adaptive behaviors. behavioral therapy is widely known as CBT, refers to behavioral and cognitive techniques and treatments developed. CFIRSTSTEPCOUNSELINGONLINE

32 Cognitive Therapy (CT) Aaron Beck's Cognitive Therapy is also premised on the notion that how one thinks determines how one feels and behaves. Dysfuntional thoughts inevitably result in bad consequences. Cognitive and behavioral methods are used to modify dysfunctional thoughts and beliefs. The therapist and client engage in a laid back, collaborative process of testing the validity of dysfunctional thoughts. The objective of treatment is to change the client's dysfunctional worldview, self concept, automatic negative thoughts and distorted cognitive processes. CFIRSTSTEPCOUNSELINGONLINE

33 Cognitive therapy clients are helped to identify and change the elements of their belief system (world view, self concept) and the cognitive distortions (errors in reasoning like catastrophic thinking) that lead to negative automatic thoughts. CFIRSTSTEPCOUNSELINGONLINE

34 CITATIONS 1. This vignette was adapted from: Mind over mood- Change how you feel by changing the way you think, by Dennis Greenberger & Christine Padesky. 2. This list of cognitive distortions was partially adapted from: The feeling good handbook, by David Burns. Plume, These lists of questions were adapted from: Cognitive therapy: Basics & beyond, by Judith Beck. 4. This semi-fictional male college student is a representative composite of several clients I have worked with over the years. References Beck, A.T. (1967). Depression: Clinical, experimental, and theoretical aspects. New York: Hoeber. Republished as Depression: Causes and treatment. Philadelphia: University of Pennsylvania Press). Ellis, A. (1991). Reason and emotion in psychotherapy. New York: Carol. Ellis, A. (1993). Reflections on rational-emotive therapy. Journal of Consulting and Clinical Psychology, 61, Ellis, A & Dryden, W. (1997). The Practice of Rational Emotive Behavior Therapy. New York: Springer Publishing Company, Inc. CFIRSTSTEPCOUNSELINGONLINE

35 CITATIONS Ryan C. Martin, Eric R. Dahlen. "Cognitive emotion regulation in the prediction of depression, anxiety, stress, and anger". Science Direct (November 2005): Cooper, P.J., & Steere, J. (1995). A comparison of two psychological treatments for bulimia nervosa: Implications for models of maintenance. Behavior Research and Therapy, 33, Harvey, L., Inglis, S.J., & Espie, C.A. (2002). Insomniacs' reported use of CBT components and relationship to long-term clinical outcome. Behavior Research and Therapy, 40, Taylor, S., Woody, S., Koch, W.J., McLean, P., Paterson, R.J., & Anderson, K.W. (1997). Cognitive restructuring in the treatment of social phobia. Behavior Modification, 21, Hope, D.A., Burns, J.A., Hyes, S.A., Herbert, J.D. & Warner, M.D. (2010). Automatic thoughts and cognitive restructuring in cognitive behavioral group therapy for social anxiety disorder. Cognitive Therapy Research, 34: Hope, D.A., Burns, J.A., Hyes, S.A., Herbert, J.D. & Warner, M.D. (2010). Automatic thoughts and cognitive restructuring in cognitive behavioral group therapy for social anxiety disorder. Cognitive Therapy Research, 34: Kanter, J.W., Schildcrout, J.S., & Kohlenberg, R.J. (2005). In vivo processes in cognitive therapy for depression:frequency and breif. Psychotherapy Research, 15, Pull, C.B. (2007). Combined pharmacotherapy and cognitive- behavioral therapy for anxiety disorders. Current Opinion in Psychiatry, 20, CFIRSTSTEPCOUNSELINGONLINE