One of our greatest mental gifts is our reasoning ability, which enables us to make decisions and judgments based on the evidence before us. Cognitive therapy can be used to harness our mental powers to improve our health and quality of life.
Psychologists use the term ‘cognition’ to refer to the information-processing ability of the brain. Cognition enables us to think, remember, analyze, learn, and negotiate our way through life. The way we experience physical pain also depends on cognitive factors. If it is a familiar pain, for example, you might decide that it will pass soon, and assessing the pain in this way reduces your distress. Unproductive ways of thinking are responsible for a great deal of mental suffering and even physical ill-health. You may know someone, for example, who always draws negative conclusions. If someone disagrees with them, they always assume it is a personal attack and waste time and energy worrying about it.
Discarding negative thinking
The primary purpose of cognitive therapy is to overcome ingrained negative attitudes of the mind and, thereby, the ill health that may result from this. The therapy focuses on encouraging new ways of perceiving and thinking about problems as a means of alleviating symptoms. Aaron T. Beck, who developed cognitive therapy, was originally a Freudian psychoanalyst. After analyzing the thoughts and ideas of his patients, he concluded that people affected by anxiety and depression viewed themselves and the world around them in a negative way that was not justified by the reality of their situation.
Beck discovered that the negative mindset of his patients had three main aspects, which he termed ‘ the cognitive triad. ‘ First, they had a negative view of themselves (‘ l am no good ‘). Second, they had a negative view of the world around them (‘ nothing ever goes right’). Finally, their attitude towards the future was negative (‘ things will never get better).
Cognitive therapy aims to break down these powerful, interlinked beliefs. Rather than attempting to deal with negative attitudes in general, specific elements of negative thinking are tackled by the patient and the therapist together. One of the first things to be confronted is what Beck called ‘automatic thinking – a tendency to jump to negative conclusions without thinking things through. For example, careful analysis might reveal that someone automatically thinks’ l am useless’ whenever things go wrong, although the person may not be aware of making this habitual response. Once exposed in therapy, however, such thoughts lose their power. People with negative belief systems tend to over-generalize – if one thing goes wrong, everything is wrong. So, if they argue with a colleague at work, they then assume that no – one in the office likes them. Cognitive therapy teaches them to consider alternative explanations that are less self-centered: if someone is rude at work, it may well be because that person is having a bad day.
Healing through reasoning
Mental health problems fuelled by negative thinking respond very well to cognitive therapy. For example, someone who is depressed will be encouraged to break the constant stream of self-criticism by hosting his or her daily successes, however small these may be. The achievements build up, day by day, gradually bringing the person back into the mainstream of life. Cognitive therapy has no set method or approach – often, simple, practical exercises are tried first. Most importantly, cognitive therapy facilitates a reasoned discussion that encourages individuals to assess whether their negative thought patterns are justified. Whereas psychodynamic therapies emphasize experience and unconscious motivation, cognitive therapy concentrates on present interactions.
Reprogramming Brain Circuitry
People with obsessive-compulsive disorder (OCD) are often ideal candidates for cognitive therapy. They are plagued by recurrent, unwanted thoughts (obsessions) that create a state of perpetual nagging anxiety. In attempting to deal with this, they typically carry out various repetitive rituals (compulsions), which can consume so much time and energy that they seriously disrupt everyday life. The most common compulsions are hand-washing and checking rituals, such as checking to see whether the gas has been turned off, which can be repeated so often they undermine the person’s thoughts and actions.
Brain imaging studies have shown that there is a specific brain circuit that is normally active only when we are performing routine tasks, such as having a shower, making a cup of tea, or locking the front door. Usually, this circuit is turned on and off as needed, but with OCD sufferers, the circuit fires all the time. Treatment with cognitive therapy can calm this overactive circuit down to its normal cycle of activity.
