"I'm good enough, I'm smart enough, and, gosh-darn it, people like me."
Stuart Smally, from the old Saturday Night Live skits may be the poster child for Cognitive Behavioral Therapy (CBT): the gold standard in treatment for numerous issues including anxiety, depression, intrusive thoughts, and low self-esteem, just to name a few. The premise behind cognitive behavioral therapy is that by altering your thought patterns, you can change how your body responds, essentially short-circuiting undesired physical symptoms such as the fight or flight response.
As an overview, scary thoughts cause physical symptoms and discomfort, leading to behavioral changes as people avoid the stressors that cause the symptoms.
The intrusive thought to behavioral change process looks like this:
I have a fear of alligators = I think about how alligators might eat me = I stay away from the water
Cognitive behavioral techniques work by interrupting the thoughts to stop the behavioral responses:
I find a way to convince myself that I don't have to fear alligators = I can go fishing
As another example, if seeing your mother-in-law leads you to experience anxiety, your response may be to run screaming from her cold, judgmental stare, or at least avoid her. Provided it is unlikely that she actually wants to hurt you--and this is not an assumption everyone should make--changing the thought may be beneficial. Using cognitive techniques, you may find yourself less likely to run and less affected by her presence overall.
It sounds easy, but it can be tricky. Everyone responds slightly differently to the types of reasoning used in CBT techniques, which means there are a ton of different approaches to changing the way people think. In addition, the numerous categories of techniques branch off into smaller categories depending on personality factors. This means that there are going to be a whole bunch of posts in this series.
I will be referencing two authors repeatedly (with a few others thrown in):
- Dr. David Burns, author of When Panic Attacks1
- Dr. Ronald Siegel, author of The Mindfulness Solution2
While they are certainly not the only authors who cover this subject matter, I believe they have provided two of the most comprehensive books on the market with regard to altering thought patterns.
But, first things first. How do you know you have a thought that needs changing?
While it may sound counterproductive, many people who are anxious or depressed find some benefit in their thought patterns, and may be afraid to lose them.
For some, specific scary thoughts are motivational:
"I'm terrified of failure, so I have to work 70 hours a week."
For others, anxiety producing thoughts are seen as penance:
"I hurt someone, so feeling guilty and being afraid that others will hurt me is reasonable. It will ensure I don't do that again."
Most don't see their anxiety or scary thoughts in these ways, and many don't have fear thoughts that are so cut and dried. But before challenging a thought, it doesn't hurt to convince yourself that the thought is actually worth getting rid of. For some people, simply understanding why the thought does not have merit is enough to short-circuit the response.
How To Do A Cost Benefit Analysis For A Scary Or Intrusive Thought
- Grab a pencil and paper and write out the thought (or feeling) on your mental chopping block. (The pencil and paper element may allow those who learn best through visual cues to see their arguments on paper.)
- Make two columns, one for advantages and one for disadvantages.
- Honestly assess what the thought is doing for you (and what it isn't).
Let's say my scary thought is: "I am afraid of alligators."
- This thought will keep me vigilant enough to avoid getting eaten
- I'd feel horrible if one of my kids got hurt by an alligator
- My cousin got bitten by an alligator, so the thought is justified
- It allows me to eat alligator without guilt
- It makes me feel like I have a reason to be anxious, instead of feeling like I'm going crazy if I have a panic attack on a boat
- I can't take the kids crab fishing...'cause there are fucking alligators
- The odds of getting attacked by an alligator are tiny
- Thinking about it might not help save me in the presence of an alligator
- I'm miserable every time others want to go to the bay, and I'm missing out on the fun
Many people are surprised at what advantages they get from negative thoughts. For some, simply having a reason to justify overactive physical systems is enough to make them feel a little saner. (More elaboration and examples of this technique can be found in When Panic Attacks.)
Whatever reasons you come up with, this technique should help answer the following:
- Is it true or rational? (This may or may not be relevant depending on how motivated one is to hold on to it.)
- What reasons do I have for keeping it?
- Is it beneficial to life improvement?
- Should it be changed?
If the answer is "Yes" to the last, you're one step closer to being able to change it using CBT techniques.
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- Lies Your Brain Tells You: Why We Have Scary Thoughts
- 8 Anxiety Symptoms You've Probably Experienced (and why they are surprisingly necessary for survival)
- How to Cope With Intrusive Thoughts: Introduction to Cognitive Behavioral Therapy and the Cost Benefit Analysis
- How to Stop Intrusive Thoughts: Cognitive Behavioral Therapy, Thought Replacement and Visual Substitution
- How to Deal With Fears, Phobias and Intrusive Thoughts: Exposure Therapy