Monday, July 14, 2008

Cognitive Therapy

It is important for all of us to know about Cognitive-Behavioural Therapy (CBT). It is a set of ideas and skills that ought to be part of an "instruction manual" for living a healthy life. The ideas contained within CBT are simple and, for the most part, common-sensical. CBT has been shown to be a very effective therapy for mood & anxiety disorders, and a wide variety of other life problems, including insomnia, marital discord, addiction, and even for psychosis.

Here is my nutshell account of the "cognitive" part of CBT: every symptom can be associated with a thought. So if you are anxious, or depressed, or fighting with someone, or craving a drug, or hallucinating, there will be a thought or a set of thoughts associated with that feeling. In cognitive therapy, the task is to pay attention to the thought, and write it down in a journal.

The next step is where cognitive therapy veers away from simple journaling. My recommendation for a cognitive therapy journal is to divide a journal page into at least two columns. The anxious or negative thoughts are recorded in one column. But then, it is your task to "talk back" to the negative thoughts, in the next column. In this column you might write down evidence for or against your negative thought, or you might write down some reassurances or calming statements, even if the negative thought was true. The negative thought no longer gets the last word. A gentle debate ensues instead.

This process must become a practice, much like a scholarly exercise. I have compared it to the process of learning a new language. The old language is the "negative talk" or "depressed talk" or "anxious talk" or "can't sleep talk". The new language must be painstakingly translated in the next column, and it will take a lot of work. The facility to use the "new language" will improve at the same rate that it takes to learn any other new language--so it will involve hundreds, or thousands, of hours of work.

As you begin cognitive therapy exercises, they may seem artificial, contrived, not very genuine. Just like learning your first few phrases of Russian or Greek. But after you have practiced hundreds or thousands of times, and have put in your hours, the phrases will become natural to you, just as you will gradually become fluent in a new language. Negative thoughts will be naturally balanced by a positive, reassuring, or soothing counterpart. You may always continue to have the negative thoughts, but they will lose their monopoly on your thoughts and feelings.

Cognitive therapists have come up with a lot of practical ideas about how to make the cognitive exercises more specific or effective, and have come up with a lot of examples about ways to "talk back" to negative thoughts. So it is worthwhile to read some books about cognitive therapy, including some hands-on workbooks. Many of these workbooks may seem like trite or shallow pop-psychology, but despite the stylistic limitations of some of them, it can be very important to actually sit down with one and work through it, cover to cover. The beauty of cognitive therapy is that all the work, and all the ideas that change you, are your own. The therapy style is just a frame, a structure in which to do the work.

I believe that cognitive therapy ideas could work very well in a preventative sense--so that if children in grade school were introduced to these ideas, it could help them deal with a variety of stresses and negative emotions, and reduce the rates of anxiety & mood disorders.

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