Guide to Understanding Cognitive Therapy

General overview of cognitive therapy

Cognitive Therapy, known as CT, is a discipline that teaches us to manage our thoughts, rather than allowing distorted thoughts to overwhelm us and to dictate our actions. Strong emotion is natural during traumas, but if we give distorted thoughts free rein most of the time, it leads to negative habits that unsettle us and those around us.

Cognitive Therapy does not dig for deep emotional scars (although it is often used as part of such therapies). CT, in itself, only changes the way we think; to challenge thoughts that freely enter into our minds and to readjust them to a realistic level. The natural result of CT is that we have more positive power over our lives.

We tend to deceive ourselves into believing that we are always in control of our thoughts. This is not a failing, but rather the result of many factors that influence us. We may be unaware of our wayward thinking pattern, or be subconsciously aware of it and yet deny it.

The way we think (our thought process) can sometimes be extreme. It can be excessively cynical or way too optimistic. The ideal is to find the middle ground – a balanced, sensible way of thinking. One that gives us a realistic view of ourselves, our past, present and future, and events that affect us.

While some people are always negative, others may be too positive, exposing themselves to exploitation. Some may be over-confident and adopt manners that society finds deplorable. Still others are wounded by traumas, or haunted by irrational fears, or compelled by dark desires.

Misleading thoughts are due to the wrong interpretation of information. As a result, we formulate our own distorted conclusions about things and then we act according to these mistaken beliefs. We may even influence or try to force others to accept our biased opinions.

We may change facts to make them fit our unrealistic points of view. We can also be “mind-readers” who form our own assumptions about what others are thinking, without really knowing what their true opinions are. We can generalise and see everything as fatalistic and unavoidable.

Apart from emotional unease, wrong thoughts have other bad side-effects. It can saddle you with a distasteful reputation, cause fights, legal disputes, financial ruin, drug abuse, work and relationship problems, social isolation, poor health and a horde of other problems. At the least, it can rob you of the benefit of advancing your career or it can keep you from reaping other benefits that life offers.

Because everything you feel and do is always preceded by a thought, it follows that healthy thought processes will make you feel and act better and greatly improve your overall quality of life.

We are tempted to think that we can easily change the way we think, but it is much harder than people foresee. If you fail, you may, in fact, be even worse off.

Considering that good cognitive thinking skills add immense value to every aspect of your life, for the rest of your life, it follows that professional treatment is an indisputable option.

Definition of Cognition

Cognition is a mental process that enables us to be aware of our thoughts and to respond to them by using faculties like attention, memory, knowledge, experience, sensory input, analysis, reasoning, comprehension, evaluation and judgement.

Components of Cognitive Therapy

Awareness: Being conscious of the feedback from our senses of touch, taste, sight, smell and hearing, as well as being alert to emotions evoked by our thoughts.

Mindfulness: Identifying a thought for what it really is, rather than letting it mislead us into accepting it as an irrefutable truth. Allows us to marginalise and manage thoughts, instead of blindly allowing them to dictate our feelings or responses.

Living in the present: Allows you to subdue thoughts about the past and the future and to accept thoughts about the present as the only reality. By neutrally observing a thought, like a disaffected onlooker, you can evaluate it impersonally and decide if it is important in the here and now – if it is not, you can dismiss it.

Remedial learning: By acquiring the skills to change our disarrayed thoughts into more compliant ones, we can diminish anxiety, stress, depression and disenchantment. We can unlearn old habits and acquire new ones. We can learn to think and act more sensibly.

Some therapies that include cognitive modules:

Cognitive Therapy is incorporated into many other forms of therapy, such as:

Cognitive Behaviour Therapy (CBT): Empowers you to take control of your thoughts and teaches you how to deal with daily problematic events, your reactions and behaviours.

Cognitive-Behavioural Treatment for PTSD: Changes the way a person suffering from Post Traumatic Stress Disorder evaluates and responds to situations, thoughts, feelings and behaviours.

Cognitive Processing Therapy for PTSD: Teaches how to evaluate and change disturbing thoughts you get after exposure to a serious traumatic event.

Exposure Therapy for PTSD: Reduces fear, anxiety and avoidance by willfully and repetitively exposing you to the very things you fear most, acclimitising you and reducing their impact.

Mindfulness-Based Cognitive Therapy (MBCT): For people who suffer from recurring depression.

Acceptance and Commitment Therapy (ACT): Based on the principle of not escaping from or avoiding painful thoughts, but to accept and manage it.

Dialectical Behaviour Therapy (DBT):  For personality disorders, mood disorders, relationship problems, self-harm, suicidal tendencies and substance abuse.

Treatment for Eating Disorders like Anorexia, Bulimia and Obesity: CT is a powerful tool used in conjunction with other therapies to influence thinking that results in extreme eating disorders.

Treatment for Harmful Behaviour: CT is a powerful preventative component of therapies aimed at uncovering emotional triggers that lead to self-inflicted wounds and suicide.

Treatment for Substance Abuse, including Alcohol, Drugs and Medication: Most treatments for these are based on PTSD and focus on entrenched emotional wounds. CT is incorporated to help patients in coping with painful memories and to strengthen their resistance to future relapses.

How do we develop unhealthy thinking patterns?

We are all born with a measure of awareness and a tendency to worry, but these are limited to our natural needs and usually well controlled. Extreme thoughts are the products of patterns that we adopt, or learn, after we are born. These are some of the life experiences that can mould our thought processes:

Physical exposure to a specific incident: Being the victim or witness of a terrible accident, assault, rape, murder, war, earthquake, or any other terrifying physical event that leaves a lasting impression of horror. Post traumatic trauma, where a person relives the horror in their minds, is a serious condition that leads to an array of other problems, such as anxiety, depression and addiction.

Exposure to a dysfunctional family home: Children, who are impressionable and have no control over a dysfunctional home, suffer most. Emotional wounds form when parents abuse drugs or alcohol, or have flaws that force the children to assume roles that expose them to mental anguish. Their maladapted thought patterns become fixated and they carry the processes into adulthood.

Long term exposure to a sick person: When caring for or sharing a home with an ill person for a long period, you can be negatively affected by the person’s suffering. Melancholic or heavy-hearted patients accustom you to their negativity. Even if the person puts on a brave display of positivity, just observing their suffering can steer you to negativity.

Learning from others: We learn through exposure and repetition. If we share our living or working space with any negatively-minded person for a reasonably long time, we can inadvertently learn or adopt their ways of thinking and acting.

Repeated exposure to dreadful events: People in some professions, like ambulance personnel, police, firefighters, soldiers, medical workers, funeral services, etc., are repeatedly exposed to scenes that can demoralise them and establish negativity or anxiety as intrinsic emotions.

The daily news: The human mind is naturally alert to anything that seems like a threat. Television, the movies, mobile phones, the internet, newspapers and magazines exploit this and bombard us endlessly with news designed to trigger a shock response. The daily overdose conditions us to gloomy expectations.

Success and looks: The paparazzi news about celebrities can have a negative effect. Some idols are exceptionally attractive, and this leads people to link success to beauty. If an average person does not match an idyllic image, they may feel hopeless. They may even starve themselves in an attempt to gain beauty and, thus, success.

Social media bullying: With the internet and mobile connectivity, came the rise of mass access to social media. While it is a great source of communication for the average person, it can also be abused by reckless people to spread false, harmful gossip about innocent people.

Abuse of drugs, alcohol and medication: Unhealthy thinking may lead to substance abuse, but the opposite is also true. Abusers often start taking substances for reason other than unhealthy thinking, but once they are caught in the web of addiction, depression and a general negativity can set in as a secondary symptom.

Why do we develop unhealthy thought patterns?

Songs reflect trends in society. When the Beatles sang; “What would you do if I sang out of tune? Would you stand up and walk out on me?”, they touched on an acute problem of modern society; a habitual trend to think and act harshly and negatively.

We are constantly presented with calamities in modern life. Daily doses of bad news from the media; rampant crime; drugs; divorce; dysfunctional families; the pace of technology; the demands of working in an overpopulated, highly competitive and impatient world – things like these evoke high levels of unease.

We also get caught up in crushing memories of the past and dreadful visions of the future. It fills our minds with fixed, unpleasant opinions and speculations. Like a bucket filled to the brim with muddy water, it leaves no space for refreshment.

Furthermore, as a protective measure, our minds are always scanning for danger signs. When it spots a threat, it triggers us to take cover, run for safety or prepare for a fight. Even when it senses a minor or purely potential problem, it exaggerates it and insists on a reaction.

Simply because good things, the healthy positives, do not threaten us, our minds tend to ignore them and this robs us of the cheer that we need to function at our best. Instead, our muddy thoughts condition us to expecting the worst, based almost exclusively on unpleasant negatives.

Children from dysfunctional family homes usually develop emotional wounds that stay with them into adulthood. They are especially vulnerable to emotional disorders and take their wounds and habits with them when they set out on their adult voyage.

Other people have endured physical traumas like rape, mugging, accidents or emotional forms of abuse. Another group, often ridiculed and misunderstood, suffers from phobias, such as irrational fear of open spaces, birds, cats, socialising and other things that do not worry average people.

Modern society dictates that we must groom ourselves for success. Gone are the days when modesty was a virtue. We now have to promote ourselves to be competitive. Doing this repetitively, can, conversely, cause people to develop over-confidence in themselves and make them act in a way that others find unpleasant.

When we immerse ourselves in unhealthy thoughts, we nurture a simmering habit that dishes up bad feelings, bad decisions and bad actions. Unless treated, it sentences us to a lifetime of suffering in all the spheres of our lives.

Motivation for Treatment

It is a given fact that cognitive thinking affects our emotions, judgement, behaviour and, ultimately, every aspect of our lives. Cognitive Therapy is the key to unlocking the door to success for many of us. Not only for those carrying the burden of addiction, but also the unfortunate victims of emotional wounds, behaviour disorders and suicidal thoughts.

A very specialised therapy, Complex Post-Traumatic Stress Disorder therapy, which is a major new breakthrough for the treatment of most mental disorders, is now being introduced in South Africa and it incorporates advanced cognitive remedies as part of the treatment process. If you suffer from addiction or any form of emotional anguish, you should contact a rehabilitation centre where these advanced techniques are available.

Signs and symptoms of unhealthy thinking

Signs of negative thinking:

• Having repetitive, intrusive, negative thoughts
• Inability to manage intrusive thoughts
• Constantly mulling over the past or future
• Looking for new problems when old ones pass
• Being cynical or pessimistic most of the time
• Being dissatisfied with life in general
• Believing all changes are for bad reasons
• Never satisfied with results, even good ones
• Nitpicking for weak points in good items
• Inflating weak points and ignoring the good
• Being too vigilant against possible betrayal
• Looking for a conspiracy in every event
• Always suspecting hidden motives
• Being pedantic about others’ opinions
• Always blaming others for problems
• Blaming failure on negative circumstances
• Poor concentration, confusion, indecision
• Poor problem solving, fear of responsibility
• Poor performance in private life and work
• Low self-esteem, hopelessness, anxiety
• Frustration, irritation, anger, violence
• Insomnia, nightmares, poor eating habits
• Loss of interest in positive activities
• Inability to be contented, happy or excited
• Social isolation, distancing from others
• Irrational anticipation of danger, harm
• Intense distress about a past trauma
• Flashbacks, reliving traumatic events
• Strong emotions caused by music, odours
• Keeping yourself busy to avoid worrying
• Avoiding apparently harmless situations
• Avoiding talk about feelings, emotions
• Being nervous, easily startled
• Abuse of drugs, alcohol, medications
• Eating disorders, excessive weight loss
• Indulging in gambling, risk taking
• Preyed upon by drug dealers
• Prone to self-harm, suicidal thoughts

Examples of Biased Thinking

Examples of cognitive biases that cause distorted thoughts and irrational responses:

Actor–observer asymmetry: Blaming your own faults on unavoidable circumstances, but blaming the faults of others on personality weaknesses.

Anchoring bias: Relying too heavily on a single fact, or grabbing the first thought that enters your mind, and acting on it without thinking it through.

Authority bias: Willingness to accept the opinions of authoritative figures, but not those of lay persons.

Attentional bias: Endlessly brooding over the same negative, worrying thoughts, without attempting to manage or diminish the thoughts in any way.

Attribution asymmetry: When optimists claim that successes are due to their own efforts, but failures are not their fault, while pessimists feel that the opposite is true.

Backfire effect: Clinging to misinformation that was previously learned, even if it has since been exposed as false or misleading. Also known as the continued influence effect.

Bandwagon effect: Believing something simply because other people share the same believe. Also known as the herd effect.

Base rate fallacy: You ignore the fact that errors are sometimes made and blame it on neglect, incompetence or willfulness, because unintentional errors are just excuses.

Behaviour confirmation: When your prediction is fulfilled because you behave in a way that delivers the outcome that you predicted.

Belief bias: To reject an argument, solely because of your own beliefs, rather than any facts.

Below-average effect: To believe that we are not as good as others at carrying out difficult tasks.

Bias blind spot: To regard yourself as less biased than others or to blame others of being more biased than you are.

Change bias: After putting in an effort to achieve change, your recall the effort as a lot more difficult than it really was.

Choice-supportive bias: To recall or remember the good reasons for an option that you chose and to ignore or downplay the positive elements of the other options that you could have chosen.

Confirmation bias: Favouring information that confirms your argument and ignoring facts that support the opposite.

Cognitive Dissonance: To start liking someone that you previously disliked, after you have done the person a favour, to justify the favour you performed.

Cognitive inertia: Unwillingness to change your views, even in the face of new evidence.

Conservative bias: To expect too much, either good or bad, about the result of a future event when you are uncertain about what is going to happen.

Consistency bias: To believe that a person will always be the same, and thus predictable, though we all actually change over time, even in the short term when affected by an issue.

Contrast effect: Making an item or issue more attractive than it really is, by comparing it to something that is much worse.

Courtesy bias: Offering a false opinion, just because it is politically or socially correct and you want to avoid upsetting others.

Declinism bias: Believing that people, products, ethics, morals, or the world in general, are in a negative, degenerative downward spiral.

Defensive attribution: A tendency to blame others for causing their own misfortune, unless the blamer is the victim of a similar misfortune, in which case they show empathy for the other person.

Dunning-Kruger effect: A theory that most incompetent people overvalue themselves, whilst the competent usually underestimate themselves.

Egocentric bias: An exaggerated opinion of yourself and over-estimation of your importance in any situation.

Empathy gap: When you underestimate the intensity of your own or other peoples’ emotions.

Escalating commitment bias: Seeing an event as the first step in a calculated process that will inevitably lead to a series of further steps.

Exaggerated expectation: Assuming that a situation or outcome is going to be much better or much worse than indicated by the facts on hand.

Fading affect bias: When unpleasant memories are quickly forgotten, but pleasant memories are not forgotten. Recollection of positive events is stronger than that of negative events.

False consensus bias: Believing that most people would agree with you, without evidence that they would, and that people who disagree with you, are deceiving themselves.

False memory: When someone remembers things that never happened, and then believes that it happened. Important aspect of many mental disorders, such as Post Traumatic Stress Disorder.

Focusing effect: Over-focusing on one negative issue and ignoring the possibility that the overlooked positive aspects offer at least an equal chance of a good outcome.

Framing effect: Creating different opinions, based on the same information, by presenting it in different ways.

Gambler’s fallacy: A believe that the probability of success in the future increases if most of the previous outcomes were failures, though in reality the probability of failure remains the same as before.

Group attribution error: To believe that one person is representative of an entire group or that all members of a group share the same fault or bias.

Groupthink: When an opinion is accepted simply because a group of people agree with it.

Hindsight bias:  A believe that you had known in advance how an event would turn out, although the thought actually only occurred to you after the event.

Halo effect: If a person likes one aspect of something, they have a positive attitude about everything concerning it. If they dislike something, they have a negative view of everything about it.

Illusion of asymmetric insight: When a person believes they know themselves better than any other person knows them, but they know other people better than those people know themselves.

Illusion of control: Underestimating future developments, because you believe you have more control over it than you actually have.

Illusion of external agency: When someone underestimates their own abilities and gives credit for a successful task to an outside entity.

Illusion of transparency: A tendency to overestimate how well we understand each others’ feelings or mental states.

Illusion of validity: Overvaluing your ability to comprehend and predict the future when you actually lack the facilities to do so.

Illusory correlation: Imagining and convincing yourself that there is a relationship between people or events, when there is none.

Illusory superiority: A person overestimates their own qualities and undervalues the same qualities in others.

Illusory truth: Believing that a suspicion or rumour is true, simply because it is easy to believe or has been repeated many times.

In-group bias: A tendency by people to give preference to people who are members of their own group.

Just-world hypothesis: A tendency to believe that the world is just and fair, and that victims of injustice deserve what they get.

Mere-exposure effect: Clinging, adhering, committed to something, or forming a habit, because you have become used to it.

Moral luck: When someone is morally blamed or praised for something even when the person did not have control over the situation.

Motivated Distortion: When an uncertain event, scheduled for a future date, leads to exaggerated speculation that evokes anxiety in the present time.

Naïve cynicism: A believe that you are reasonable and unbiased, but that others are biased when they disagree with you.

Naïve realism: A firm belief that your views are based on reality and that rational people will agree with you, and that anybody who disagrees with you is wrong.

Normalcy bias: Avoidance or procrastination to plan for a crisis that one has not experienced before.

Optimism bias: Overestimating the chances of positive future outcomes and underestimating the likelihood of negative consequences, despite evidence indicating the opposite.

Ostrich effect: Consciously denying a problem or a risk and believing that it does not exist or will not happen if you continue to ignore it.

Overconfidence effect: Believing too much in your own opinions and being insensitive to other opinions, despite a lack of objectivity on your part.

Pessimism bias: A depressive trait to always expect the worst and to spontaneously offer negative advice and opinions at every opportunity.

Prospect theory: Basing your opinion or decision solely on whether you perceive something as a threat or an opportunity for you.

Pseudocertainty effect: When you opt for a safe choice if you are certain of a positive result, but take unnecessary risks when you anticipate a negative outcome and want to avoid it.

Reactance: To resist attempts by others to influence you, and to do the opposite of what they want, because you feel their actions will affect your freedom to do what you want to do.

Restraint bias: Having an overblown perception of the efficacy of your own ability to resist temptation.

Selective perception: Leaving out, or not mentioning, facts that you do not consider important.

Self-serving bias: A way to promote and protect your self-esteem by taking credit for successes, but rejecting criticism and blaming others for failures.

Shared information bias: To waste time discussing issues others are aware of, but not mentioning issues others are unaware of.

Source credibility bias: Rejecting an opinion because you do not like someone and choosing the opinion of someone that you prefer.

Status quo bias: A desire to maintain the status quo and to resist change. Any change is seen as threat or a loss of something that you value.

Survivorship bias: Focusing on people who survived the same problems that you experience and conveniently ignoring the ones that did not survive it.

System justification: Resistance to change. A desire to defend and keep things as they are, despite the advantages that a change will bring.

Trait ascription bias: To view yourself as a flexible person who adjusts to circumstances, but seeing others as rigid and predictable.

Triviality bias: Elevating insignificant, trivial issues to a status of exaggerated importance.

Wishful thinking: A wish, need, urge or want to see something in a positive light.