Wednesday, February 15, 2012

Cognitive-Behavioral Therapy: Common Thinking Errors

One of the most useful and teachable psychotherapy theories is Cognitive-Behavioral Therapy (CBT). Research on CBT has shown that it is often the method of choice in addressing a wide variety of issues including: Social Anxiety, Traumatic Stress Disorders, Panic Disorder, Obsessive-Compulsive Disorder, Agoraphobia, Depressive Disorders and general issues of stress and low self-esteem. Additionally, CBT can be utilized in individual, couples, family and group therapy modalities. And finally, the usefulness and power of CBT derives from it being a modal that can be easily taught to clients so that they might use it on their own to deal with the ongoing issues in their lives.

In this blog post I will not attempt to describe the full extent of the CBT model, but rather to offer a brief look at three useful components of the theory that you might use without ever attending an actual therapy session. These components are: mindfulness, the Socratic method and thinking errors.


CBT maintains how we THINK about things determines how we feel about them, and can ultimately lead to behavioral choices. Thus, if we think negatively about ourselves, we then may feel depressed, and when we are depressed we can sometimes choose self-defeating behaviors that lead to a downward spiral of depression. But what if our thoughts are wrong? What if we have developed negative “thinking habits” that keep us locked into depressive or anxious feelings and behaviors?

CBT urges us to develop “mindfulness,” an ability to consistently observe the “automatic thoughts” that routinely flow through our heads. If you think about it, our minds never stop thinking. Thoughts flow through our brains in an unceasing manner and often times we are not even paying attention to them! Thus, they can be affecting the way we feel or behave without our ever critically assessing them! The CBT model has clients keep a record of their automatic thoughts to search for patterns that may reflect inaccurate thinking habits. It labels these inaccurate thoughts “thinking errors” and instructs us to use a series of analytical or rational response questions to assess the validity of our thoughts. This kind of questioning comes to us up through the ages from the ancient Greek philosopher Socrates and is called the Socratic method.

Ok, sounds good on an abstract level, but what does this process look like in reality? I will demonstrate it by identifying 4 of the most common thinking errors I have observed affecting clients in over 20 years of psychotherapy practice and then offering real life examples of them and the appropriate rational response questions.

Mind Reading

Mind reading occurs whenever we assume others are responding negatively to us without any evidence that this is actually the case. It is the most prevalent of all the thinking errors and I have yet to meet anyone, including psychotherapists, that don’t slip into this bad habit. Bars, nightclubs and gym scenes are notorious for creating the opportunity for some especially nasty moments of mind reading. How often have we turned our heads away so that a person we find attractive doesn’t catch us looking at them? Countless clients of mine have responded to this behavior by thinking “He/She must think I am...too fat, too skinny, unattractive.” If we are being mindful, the rational response to this negative self-thought is “What is the evidence that this is true?” Of course there is no evidence as the other person may have turned away due to their own fear of rejection, or their glance may have been turned when they see someone they know. Whatever the case, in the absence of any real evidence, the thought must be checked and disregarded, thus preventing any resulting negative emotional response.

Black and White (dichotomous) Thinking

Another prominent thinking error, black and white thinking, occurs when we view things in terms of two mutually exclusive categories with no “shades of grey” in between. The classic example of this is when we believe ourselves to be either a success or a failure based on one piece of work. Examine the all or nothing quality to the words success and failure. They are all encompassing in nature. I often ask baseball fans who are falling prey to this thinking error “what is a really good bating average?” A perfect average would be batting a thousand. In reality an excellent average falls between 250 and 300! Future hall of famer and short stop for the New York Yankees, Derek Jeter batted a 297 in the 2011 regular season. That means this all star’s failing average was 703. Is Jeter a success or failure? I’ve had graduate students who believed they were failures because I gave them a B grade on ONE paper assignment! The rational response question here would be “What is another way of looking at the situation?” A B grade is hardly a failing grade and doesn’t even mean their final grade will not be an A!

Fortune-Telling

We can fall prey to fortune-telling when we react as though our negative expectations about future events are established facts. I had client whose partner had a busy week at work and missed a few mid-day check in phone calls as was their routine. During their next couples session the client nervously asked, “Are you leaving me?” to the shock of their spouse. The relevant rational response questions in this case are first, “What is the evidence?” followed by “What are all of my options for reacting?” What if the couple had not been in therapy? What if the fearful client did not ask the question, but instead acted as if it were true? This could lead to behaviors that might create a self-fulfilling prophesy.

Catastrophizing

Albert Ellis coined this term while developing his rational-emotive therapy, a forerunner to today’s CBT. He observed his clients responding to negative events as if they were intolerable catastrophes, instead of attempting to keep a healthy perspective. As many of my clients know, I have enjoyed training in Brazilian Jiu Jitsu. Injuries come with the territory in the form of deep bruises or groin pulls that seem to take forever to heal. My sparring partners and I have shared the torment of being sidelined from a form of play we love and admitting that we had to beat back thoughts such as “What if I will never heal” or “What if I can’t ever train jiu jitsu again?” These thoughts can trigger a real sense of grief and loss about an event that not only has not occurred, but for which there is no evidence! With some disciplined perspective one might instead say to themselves, while being sidelined with an injury sucks, it does not mean I won’t heal.

Albert Ellis, a man known for his sense of humor, provides the example of clients struggling with social anxiety. The clients might worry about any number of embarrassing events and think to themselves, “I won’t be able to stand it!” Ellis points out the appropriate rational response question would be “So what if it happens? So what if the worst occurs?” Confronting this thinking error leads one to the conclusion that, while feelings of embarrassment can be very uncomfortable, they are not life threatening. Ellis would give his clients assignments to do something embarrassing on purpose to help them discover experientially that in fact they can stand it. He would have them go to a hardware store and ask if they sell flowers, or go to a crowded mall and shout out the time of day.

In conclusion, cultivating the art of “mindfulness” by paying attention to our automatic thoughts can help us identify “thinking errors” before they can foment uncomfortable feelings or behaviors that might lead to a self-fulfilling prophesy. This is just one aspect of the usefulness of CBT. If you have questions about this powerful type of therapy, feel free to comment on this blog post or ask me questions on my professional facebook page (Search “Ken Voorhees, LCSW – Psychotherapist). I would be happy to answer your questions.

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