Cognitive psychotherapy

Illustration of emotional balanceCognitive Psychotherapy started in the 50s with the “Rational Emotive Therapy” by Albert Ellis. Later Aaron T. Beck created “Cognitive Therapy” and simultaneously other schools began to emerge giving complementary visions for therapeutic work.

In their own words:

“Cognitive Therapy is based on the cognitive model which states that emotions and behavior of individuals are influenced by their perception of events. It is not a situation that determines what a person feels, but rather the way she interprets the situation (Ellis, 1962; Beck, 1964).

The way people feel is associated with the way they interpret and think about a situation. The situation itself does not determine directly how they feel, their emotional response is mediated by their perception of the situation. “(Beck, J., 1995)

That is to say, cognitive therapy is based on the principle that our emotions and behaviors are influenced by thoughts or interpretations that we generate from the situations we experience. In addition, these thoughts and interpretations are influenced by beliefs learned throughout our life.

An example would be:
SITUATION: Walking down the street I meet a friend who greets me faster than I would like and leaves.
In this situation I can have different interpretations:
Thought / Interpretation 1: He may be busy and does not have much time to chat with me.
Thought / Interpretation 2: He must be mad at me for some reason.

By having the first thought we would most likely respond calmly  while the second thought could generate worry, anxiety and even anguish.

In cognitive therapy therefore we will focus on identifying the irrational ideas and distorted thoughts we have and then modify them and thus balance our emotional responses and behaviors.

In order to clarify the kind of thoughts we work with during the psychotherapeutic process we will explain part of the teachings of Albert Ellis and Aaron T. Beck.

Let us begin with the vision of Albert Elllis:

Ellis’s theory is based on his observation that people do not suffer from the experiences of their lives, but by holding onto thoughts about those experiences.

On this basis he identified 11 irrational thoughts-ideas that are changed during psychotherapy.

Irrational thinking is irrational because … Rational Alternative

Irrational Idea nº 1: “I need to be loved and approved by everyone”

This is irrational because to be loved and approved by everyone is impossible. It´s never happened to anyone. Even if you tried to achieve love and approval from everyone by becoming a chameleon willing to adapt to the needs and desires of others, still there would be many who would not approve and who would not love your lack of self-esteem and insecurity.

Rational Alternative: It is normal to have the desire to be loved and approved of and you must accept that seeking to be loved and approved of by everyone or the majority is probably damaging for you. Not being approved of or loved by everyone can be frustrating but not necessarily horrible or catastrophic.

Irrational Idea nº 2: “To consider myself valuable I must be very competent and capable enough to achieve everything I want.”

This is irrational because  no human being can achieve perfection in everything they try. This is something that simply cannot happen.  Trying to be successful  is fine, but requiring yourself  to always be a success is the best way of making yourself feel a failure and incompetent.

Rational Alternative : It is important to accept the fact that human beings cannot be perfect. It is important to give a margin of error for any action we undertake in our life.

Irrational Idea nº 3: “A certain class of people is evil and should be severely blamed and punished for their wickedness.”

This is irrational because  we the people are limited beings that often act automatically and unconsciously without being “consciously evil.” An individual who performs badly in most cases, is an ignorant or disturbed person that is not aware of the true magnitude of the consequences that his behavior has on others.

Rational Alternative : Understand that your own mistakes and those of others are the result of ignorance or emotional disturbance. It is important to give and to hold responsibility and not to blame, which are two very different concepts which lead to two very different feelings.

Irrational Idea nº 4: “It is catastrophic and terrible that things do not go the way I want.”

This is irrational because there is no reason to think that things should be different from how they really are. Another thing is whether we like the way they are or not. Being deeply disturbed by our circumstances will not help us to improve them.

Rational Alternative:  Usually we magnify the negative of  the circumstances by using different expressions: “It’s terrible,” “I cannot stand it.” We must learn to change these catastrophic expressions to others that are more rational and realistic, such as: “My circumstances are negative but not catastrophic,” “I am confident that I can handle it.” When our circumstances are not okay it is important that we try to change them, but when this is impossible, the healthiest thing is to accept things as they are.

Irrational idea nº 5: “The human misery is caused by external causes and people have little capacity or none to control their sorrows and disturbances”

This is irrational because there are millions of people with the ability to manage their emotional states and to live a full life regardless of their external circumstances.

Rational Alternative:  We need to observe our painful emotions objectively to discover illogical thoughts and phrases that are associated with that emotion. And when we are able to change these irrationalities, we can transform our self-destructive emotions.

Irrational idea nº 6: “If something is or may be dangerous or frightening, I must feel terribly anxious about it and I have to constantly think about the possibility of this happening”

This is irrational because worrying too much about something dangerous or scary that could happen not only does not prevent it from occurring, but often leads to it happening. There are inevitable events such as illness or death, but there is no use worrying about them in advance.

Rational Alternative:  We need to understand that many feared events are much less catastrophic when they happen for real, and that the anxiety or fear that we generate previously is many times more painful than the feared situation itself.

Irrational idea nº 7: “It is easier to avoid facing certain responsibilities and difficulties in life.”

Is irrational because The process of deciding not to do something that is considered difficult but rewarding, usually is long and involves more suffering than the responsibility of doing what we have to do. Self confidence only comes from coping not from avoiding. If you avoid  existence will become easier but also will increase the degree of your personal insecurity and distrust in yourself.

Rational Alternative:  Develop an attitude of coping and facing conflicts. Accept life with its difficulties. Understand that avoiding the problems only serves to enlarge them.

Irrational Idea nº 8: “I must depend on others and I need someone stronger to trust.”

Is irrational because the more we depend on others, the more we lose the ability to be ourselves and discover our strengths and potentials, thus losing self-confidence and self-esteem.

Arriesgarnos a hacer  y cometer errores por nuestras propia elecciones es mejor que demandar continuamente una ayuda innecesaria de los demás.Es positivo aceptar la ayuda de los demás cuando es necesaria, pero no por sistema e indiscriminadamente.

Rational Alternative:  Accepting the fact that internally we are alone in the world is important to rely on ourselves and make our own decisions. Risking to make mistakes because our own choices is better than constantly demanding unnecessary help from the others. It is positive to  accept help from the others when its needed, but not when its is not really needed.

Irrational Idea nº 9: “My past completely determines my present and my future. If something distress me in the past it will continue indefinitely affecting me. “

Is irrational because if a person has suffered a traumatic event in the past, does not mean that  20 years later must keep suffering it.  Those destructive emotions we hold within us from the past we can get rid of them in our present.

Rational Alternative:  We exagerate the importance of the past when instead of saying          “Because of my past I find it hard to change the present, we say ”  Because of my past is impossible to change the present. ” We need to be conscious of this difference

Irrational idea nº 10: “One should be very concerned about the problems and disruptions of the others”

Is irrational because the problems of the other people often have little or nothing to do with us and there is no reason why we should be over concerned about them. The vast majority of the time as much as we worry about the behavior of others, this concern wont change it. Being over involved with the problems of others is often used as an excuse to not face our own problems.

Rational Alternative:  Accept the fact that we dont have either the power nor the right to change others. The others change on the basis of their own motivation and effort.  We need to learn to discriminate when our help can be really useful. “Invariablemente existe una solución precisa, correcta y perfecta para los problemas humanos, si esta solución perfecta no se encuentra ocurrirá una catástrofe”

Irrational Idea nº 11: “Invariably there is a accurate, correct and perfect solution for human problems, if we don’t find this perfect solution there will occur a catastrophe”

Is irrational because there is no security, no perfection or absolute truth in the world. The search for security and a perfect solution only creates anxiety and false expectations.

Rational Alternative:  When faced with a problem, it is convenient to think about several possible solutions, and choose the most feasible and not “perfect “one, knowing that any solution has its advantages and inconvenients.

In 1977 Ellis synthesized these 11 ideas irrational in three basic irrational ideas:

In relation to:

Oneself “I must do well and earn the approval of others for my actions.”
The Others “Others must act nice, considerate and fair.”
Life or the world “Life should offer good conditions and be easy so I can get what I want without much effort and with comfort.”

Meanwhile Aaron T. Beck taught us to identify and work on different cognitive distortions. Beck expose that patients tend to make systematic errors in their thinking.

The most common cognitive distortions are:

Thinking “all or nothing” / “dichotomous thinking” or “black and white”: It is manifested in the tendency to classify life experiences in two opposite categories. Ex: If you do not love me is that you hate me. If I am not perfect it means I am a failure.

Guessing “catastrophizing” systematic tendency to imagine the worst possible outcome, no matter how unlikely it is that it will occur that way. Ex: I bet that if I go on vacation it will rain.

Disqualify or exclude the positive: The positive is systematically dismissed.  Example:  Somebody makes a nice comment about me and I automatically reject it.

 Arbitrary Inference: Tendency to reach a particular conclusion in the absence of real evidence. Example:  I think that my boss will fire me when there is not evidence about it, and I haven’t failed to fulfill my duties.

Emotional reasoning (“I feel …”): Tendency to judge a situation based on how I feel ignoring other facts that might contradict my feeling. Ex: Im walking down the street and I see a dog apparently calm and with its owner. This dog certainly scares me, I feel is dangerous and will attack me.(The evidence is only my feeling not the reality of the situation).

Labeling : It is a type of overgeneralization. You create an stereotype and believe that it will always remain unchanged. Ex: Any kind of stereotype: women only think about spending money, men only think in sex. Or with regard to oneself: I’m no good and I cannot be.

The Must trap: Tendency to pay more attention to what you think it “should” be rather see how things usually are. You have rigid rules that you think you should apply regardless of the context. Ex: You should always be young and beautiful.

Magnification / minimization: Tendency to magnify the negative and minimize the positive.  Ex: I got a 9 on a test “I’ve been very lucky,” I got a 4 on another “I’m no good to study.”

Mental Filter / selective abstraction / Tunnel Vision:
Tendency to focus on the facts that confirm our beliefs and ignore those that might contradict them. Ex: If I think my brother is  selfish  Ill  give all the importance to the situations in which he behaves selfishly and I wont give importance to those situations when he behaves generously.

Generalization or overgeneralization: Tendency to draw a general conclusion from one or few isolated incidents. Ex: My girlfriend has disappointed me. “You cannot trust women.”

Personalize: Self-centered tendency whereby the person attributes to himself  external phenomena  when there is no real basis for making such a strong connection. Ex: I cut my hair and I dont like how I look, Im walking down the street and I see some people laughing, automatically I think they are laughing at me.