Thursday, June 21, 2007

Therapy = Cognitive Behavioral Therapy

First there was B.F. Skinner, the behavioral conditioning guru. A few years later, the rat in the maze concept didn't sit so well with the intelligentsia and Albert Ellis's rational emotive therapy got the nod.

On Ellis' heels, Aaron T. Beck engineered a fusion of the two that he called cognitive behavioral therapy or CBT, the Lexus of all individual therapies. We now feel that ALL talk therapies are really forms of CBT because talking is a behavior and listening is cognition.

But there are forms and there are forms. Is a dodo bird a dodo bird a dodo bird?

The relationship therapy I push here on the blog is heavily laced with old fashioned CBT. Using a relationship therapy to reinforce cognitive behavioral therapy is like having a freaking Rolls Royce.

I like driving the Rolls, but totally will accept CBT, the Lexus, if that's all they've got at Avis Rent-A-Car.

The National Institute of Mental Health knocked off the big study on affective disorders and determined that the best way to treat depression is to use a combination of psychotropic medication and cognitive-behavioral therapy (CBT).

Of course.

So you should learn it. You'll get better. You'll stop spleening me, Why aren't I better?

It's an interactive therapy that requires the patient to think and behave differently. One would think they're all like that, all therapies require you to think and behave differently, but this one has a nice structure to it, so anyone can learn it. No huge amount of psychobabble, no tricks. I use it to manage emotions. Yeah, mine, too.

So it can't hurt you to know the basics of CBT to help control your anxiety, anger or depression.
Everyone needs help with at least one of those. Tell me you don't.

The emphasis in CBT is on rationality.

is not nearly as sexy as emotionality so people resist it like crazy. But at some point you have to grow up.

The path to staying rational is countering irrational beliefs that make us emotional, especially those nasty core beliefs. Irrational core beliefs are deep. They're what makes us deep, all of us. People discover them in therapy, or if they're lucky, when their significant others and friends wriggles them out in intimate conversation.

Sometimes it's perfectly obvious to us, that a negative core belief is disabling, dis-empowering us. They're the windows that slow down our computers, the ones we forgot to close years ago. There may be only one or two programs running back there, using the ram we need for other things, but they're a real pain to shut down. They slow up the whole works.

Sample core beliefs: I'm a loser, I'll never amount to anything, I'm a charlatan, a fake, I'm not a good person.

Such beliefs (thinking) trigger automatic negative feelings. The feelings (always bad) don't let up. They feel unmanageable.

So there you are, feeling down and looking for something to do to feel better, searching for some coping strategy, some behavior to make you feel better. The chosen behavior, unfortunately, driven by uncomfortable arousal (anger or anxiety) or grinding depression, and negative thoughts, tends to be dysfunctional.

Sample dysfunctional behaviors: drinking, over-eating, sending a letter that shouldn't have been sent, having a tantrum, missing work, beating the spouse or kicking the dog, buying a boat.

The dysfunctional behavior fuels a feedback loop. STAY WITH ME HERE. IT'S NOT THAT HARD.

I'm a loser (thought). I feel bad because I'm a loser (feeling). I'll eat a pint of ice cream (behavior). I'm such a loser (thought for having eaten it), I feel bad I'm such a loser (feeling). . .repeated over and over, reinforcing the core belief.

The therapy is as simple as A-B-C.

A stands for affective, or feeling.
B stands for behavior,
C stands for cognition, or thinking

Intervene ANYWHERE, but intervene.

Docs like me have you go home and analyze the events of the day using the A-B-C s. I make you write stuff down, go over it, argue with your thoughts, think twice about your default behaviors. The doc's your worst nightmare, the new program in that computer.

But the doc disappears over time and you take charge of your life pretty soon. You do the therapy yourself. You won't just do it in your head, by the way, you'll have to put the ice cream back into the freezer and find something else to do. But you will challenge your beliefs, become your own advocate, the best lawyer in the hood. Your own best friend.

That said, it helps to have someone else, a friend or a family member help you. Or get a therapy doc. I'll give you some more examples in future posts, I hope. I'll leave out the ice cream, go for the nail biting, pen smashing. Maybe.

The therapy is always about thinking, feeling, and behaving, and how these processes constantly reinforce one another.

Doesn't matter where you begin. Begin anywhere. It'll be work. Sorry about that.

Any questions?

Copyright 2007, therapydoc


Anonymous said...

Is there a book you can recommend as a started kit for starting to confront emotionality for rationality?

I think I often do the reverse and use rationality to justify my emotionality.

therapydoc said...

Aaron Beck's daughter, Judith Beck wrote a book on cognitive tx for depression which is for therapists, but I think it's relatively accessible for lay folks.

Funny, isn't it, that what seems so natural is so bad for us?

Anonymous said...

great post!

therapydoc said...

Actually, I spoke too soon. Sometimes people grow up in homes that don't permit them to express any emotion. In these families learning to feel, learning to express emotion is the goal. It's almost the opposite of CBT, and we try to keep it emotionally safe.

Midwife with a Knife said...

Ah! Interesting. I learned in school that depression=therapy+meds, but nobody ever bothered to explain to us what the therapy part really was or what it did. Thanks!

therapydoc said...

It's not SO complicated, right?

Aldana said...

Loved your post and not complicated at all. Couldn't have come at a better time. Thanks again for sharing your knowledge.

Anonymous said...

7 of your 1st 8 paragraphs used figurative language or analogy, 8 if you don't include Of course. Then came the Windows references.

therapydoc said...

You're so welcome.

The Discovering Alcoholic said...

Morning therapydoc,

I followed you over from your comments over at my friend Erin’s site here:

But commenting on this thread seemed more relevant.

I agreed with your comments there and I have seen from experience where pregnancy can be just as powerful as rehab in changing what a person lives for/priority. The kicking-in of maternal instinct can almost be considered a recovery program itself. Unfortunately this is not always true, and rarely if ever for those with long term addictions.

What I feel you left out of your comments about pregnancy in relation to addictions and recovery is that many with addictions and even those new to recovery are often looking for something to act as a quick fix to their pain. To fill what they feel is missing from their life, or the old fresh new start “tomorrow is a new day everything will be different because I am pregnant, bald, unemployed, divorced, in a new state, fill in the blank…”
When viewed in this manner, thoughts of or even worse actually becoming pregnant could be considered an example of dysfunctional behavior.

Thought-I feel miserable because I abuse drugs/alcohol
Feeling-Something is missing in my life, maybe becoming pregnant will solve this
Behavior- Becoming pregnant
Thought- I feel miserable because I can’t support my kids and drugs/alcohol
Feeling- My kids are making me miserable
Behavior- Uh-oh

Quick fixes or ill-planned measures to “fix” one’s addiction reinforce the core belief that the addiction is all powerful because they rarely have any chance of actually working or to address the core problem: That I am an alcoholic or addict and I need to get sober first!

As you said, the key stems for affective thinking. Those in the throes of addiction rarely experience this because they typically live in a very traumatic or disturbed environment. Usually, only removal from this environment and a period of sobriety will give the person a chance for affective thinking and hopefully they will also have access at this time to someone with trained in CBT.

I have enjoyed your site, take care.

therapydoc said...

Thanks for that example, BRILLIANT,, exactly the kind of thing that presents so often in therapy. And Uh, oh, by the way, is right. Stop by on July 10 for the next Carnival of All Substances, better yet, submit something if you haven't already (I haven't started going over submissions yet)

Midwife with a Knife said...

I love the pregnancy example. In fact, one of the things I love about taking care of pregnant women is that pregnancy is one of the few times where you can really get patients invested in taking care of themselves. Whether it's getting them motivated to take care of their diabetes, lupus, substance abuse, whatever, sometimes I feel that pregnancy is a huge opportunity to help people.

therapydoc said...
This comment has been removed by the author.
therapydoc said...

Aldana, the Your welcome was for you.

Impressed but Distracted


Unknown said...
This comment has been removed by a blog administrator.
therapydoc said...

You sound so angry, Micky.

Better Things-- Seeing Ghosts