What is cognitive therapy?
Cognitive therapy is a psychotherapeutic approach that focuses on how your thinking influences your feelings and behaviours. The idea is that it is your thoughts about things that happen - not the events themselves - that cause you to feel or behave in a certain way. This will be easy to understand if we look at an example.
For this example, recall a time when you failed a test at school. If you have never failed a test, try to imagine what it might be like. How did you feel? Sad? Angry? Disappointed? Ashamed? How is it possible that so many different feelings could be associated with the same objective event? The answer is that different people give themselves different messages about the event.
|Possible thought||Resulting emotion
|I am so stupid. Why can’t I understand such simple stuff?
|That teacher is useless. He/she cannot teach! Plus, he/she asks questions about things that were not even taught.
|That was harder than I expected it would be. I guess I should have studied harder.
|Wow, I am not good at calculus! I should get some extra help before the next test. It is a good thing I do not need to be a math whiz to major in history.
||Neutral. Probably a bit disappointed for a short time but not feeling bad about oneself
We call this the ABC Model.
Whether you are reacting to failing a test, winning a lottery, or living with chronic pain, the process is the same. Consider the following example of Paul, who is dealing with the fifth snowstorm of the season. Due to a back injury several years ago, he is not able to shovel his driveway. How might he feel in this situation? Let's see how having different thoughts leads to having different emotional reactions to the event.
|A: Activating event||B: Possible thought||C: Emotional consequence
|Unable to shovel
||I am so useless. I am the man of the house and my wife is out there shovelling the snow!
||Great, more snow. Just what we need. Now I have to pay to have the driveway plowed.
||Anger towards self, the snow, perhaps his employer if he was injured on the job
||My wife must be so mad that I cannot help her shovel. I’m sure she will end up leaving me when she realizes how useless I am.
||More snow! I’ll call to have it ploughed so that I can enjoy the afternoon with my wife and kids rather than having to recuperate from shovelling.
||Neutral, relief, happy
As you can see, it is not the inability to do something that makes you feel good or bad. It is the messages you give yourself that determine how you feel.
Changing the way you think
The great news is that you can learn to change the way you think, and in doing so change the way you feel. This is not simply about "thinking positive." Rather, it is about evaluating the evidence for your thoughts and then challenging the truthfulness of the thought.
The first step in challenging your thinking is self-monitoring. You need to become aware of the messages you routinely give yourself. This can be a little more difficult than it might first appear. The negative messages tend to be so automatic and routine that we not even be aware of them. Usually, you can quickly identify the activating event and the emotional consequence - you know what has happened and how you feel - but identifying the thoughts and beliefs that lead to the emotional consequence can be more challenging.
To identify the thoughts, you have to actually stop and examine them. So the next time something happens and you have a strong emotional reaction, take a few minutes to stop and record your thoughts. Simply ask your self the question "What am I thinking right now that is making me feel (angry, frustrated, sad, ashamed)?" Take out a piece of paper or keep a notebook handy and write down the event (A) and how you feel (C). Next, take a few minutes to write down all the thoughts you are having about the event (B).
The second step is to dispute your thoughts with more rational ones. You can download a useful worksheet here.
For example, consider the case of Angela who suffers from fibromyalgia. She wakes up Tuesday morning in a considerable amount of pain (A). She thinks, oh no, here I am again. This pain is awful, I can't go to work and I have so much to do. My boss is going to fire me this time. I just cannot deal with this anymore (B). As a result of these thoughts, she feels hopeless and depressed (C).
Having learned how to challenge her thoughts, however, she has an internal dialogue with herself. She replaces these thoughts with more adaptive thoughts. She tells herself the following: The pain is bad this morning but I know from past experience that it always improves after a hot bath and some stretching. I will call into work and let them know that I'll try to make it in this afternoon. My boss has always been understanding. He knows I'll do a good job this afternoon. It is going to be hard to catch up on the work, but I always manage.
After giving herself these messages, Angela feels more relaxed and better able to handle the pain and her work. She feels motivated to start her day with a hot bath.
Learning to dispute your irrational thoughts and replace them with more adaptive thoughts takes practice and effort. But if you stick with it and repeat the process for multiple events and emotions, you will get the hang of it and will see improvements in your mood. Soon you will be able to do it quickly and without the aid of pen and paper.
For more information on cognitive restructuring visit these websites:
- StressStop, where you can purchase the excellent workbook, "The ABCs of Cognitive Restructuring"