April 27th, 2018

Feeling Good: Cognitive Behavioral Therapy 101

Reading Time: 3 minutes

David Burns’s psychiatry career started like that of many psychiatrists before him. He would meet with patients, assess their moods and lives, and prescribe medications to help even out the presumed chemical imbalances in their brains. He spent many years working this way. However, he rarely if ever saw his patients improve in any meaningful way, which was the industry norm… until Cognitive Behavioral Therapy was discovered.

When Cognitive Behavioral Therapy, or CBT, was in its infancy, Burns was skeptical but began to study it. Once he began using the techniques he learned at workshops on his patients, however, he knew CBT was what he wanted to dedicate his life to studying, using, and improving upon. He has been doing so ever since.

CBT argues that the power of our thoughts is what dictates our emotions more than anything else and, if we can change these negative thoughts, then our moods will change with them. Feeling Good was written to be a CBT manual for Burns’s patients and the general population and reading it may be just as effective as conventional therapy, according to a study Burns himself conducted.

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Negative Feelings Come from Negative Thoughts

Everyone is susceptible to negative emotions—they’re a normal part of the human experience—but persistent bad feelings can be life-ruining if they aren’t controlled, combated, and eliminated. But, if CBT is right that our feelings stem from our thoughts, we are in luck, as thoughts are extremely simple to change.

CBT has three main principles:

  1. All our moods are created by our thoughts.
  2. When we are feeling depressed or anxious it is because our thoughts are being dominated by a pervasive negativity.
  3. The negative thoughts that cause our emotional suffering nearly always contain gross distortions.

The third principle is the most important for us. These cognitive distortions cause us to perceive reality differently from how things really are and can lead to extreme emotional torment. But when we can identify them, we can overcome them.

Cognitive Distortions

All-or-Nothing Thinking. The tendency to view ourselves in extreme, black-or-white ways. Even minor imperfections are seen as total personal failures.

Overgeneralization. Arbitrarily concluding that a single negative event is a never-ending cycle of defeat. Words like “always”, “every”, and “never” are common.

Mental Filter. Picking out a negative detail in a situation and dwelling on it exclusively, leading us to perceive the entire event as negative.

Disqualifying the Positive. Transforming neutral or positive experiences into negative ones.
Jumping to Conclusions. Believing that a conclusion will be negative in spite of the facts. Mind reading—assuming the thoughts of others—and fortune telling, or assuming an unrealistic prediction of the future to be fact, are two examples of this.

Magnification. Also known as “catastrophizing,” involves blowing negative feelings about ourselves out of proportion.

Minimization. Inappropriately shrinking our positive qualities until they appear unimportant.
Emotional Reasoning. Using our emotions as evidence of reality.

Should Statements. Using “should” or “must” as a way of motivating ourselves.

Labeling and Mislabeling. Labeling means creating a negative self-image based on your personal errors. Mislabeling involves using inaccurate or emotionally loaded words to describe events.
Personalization. Assuming responsibility for a negative event when there is no basis for doing so.

Taking our emotions at face-value can be damaging to our self-esteem. Since our thoughts create our emotions, we cannot reasonably use our emotions to prove our thoughts are accurate.

Hunt Cognitive Distortions with the Triple Column Technique

Our inner critics will never go away entirely but that doesn’t mean we have to live in misery. CBT offers plenty of techniques to help us combat our negative self-talk and turn our internal dialogs into something more firmly based in reality.

The most important part of fighting our negative thoughts is being able to recognize them when they appear. For this, Burns recommends the Triple Column Technique:

Get a sheet of paper and divide it into three columns. Label them “Automatic Thought,” “Cognitive Distortion,” and “Rational Response.” The next time you have a negative thought, write it down and see if you can figure out the cognitive distortions are at play. Analyze your thought carefully and see if you can reframe it in a more neutral or positive light.

Understanding that our thoughts can be distorted and being able to recognize and fight these distortions are the backbone of Cognitive Behavioral Therapy. Burns offers many other exercises in Feeling Good for further study and practice.