The Better Mood Recovery Program, Week 5

COGNITIVE RESTRUCTURING: MAKING YOUR MIND YOUR FRIEND

“The mind is its own place, and in itself can make a Heav'n of Hell or a Hell of Heav'n.”

—John Milton

Men are disturbed not by events, but by the views they take of them

—Epictetus, said in 55 A.D.

Fifth Week Overview

In this week you will learn how to change your mood by changing the way you think about yourself and the world.

In the previous two weeks, we learned how changing our physiology through physical self-care and antidepressants can lead to a better mood. Just as changing our body's physiology can change the way we feel, so too can our thoughts. Every thought that you and I think produces a chemical reaction in the brain which in turn corresponds to a feeling. As one brain scientists explained it, every thought has a neurochemical equivalent! (see diagram below).

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To illustrate this principle, let us imagine the following situation. It is the middle of January and for the fifteenth straight day it's raining in Portland. Let's call this “an event.” In response to this event, person #1 complains, “These gray days are driving me nuts. Why did I ever leave California?” Meanwhile, person #2 exclaims, “Hooray for the rain! Now there will be snow in the mountains so my girlfriend and I can go skiing this weekend.”

 

How The Same Event Can Result in Different Feelings

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Notice that the same circumstance produced two entirely different feelings. Although we are taught to believe that events cause us to have certain feelings, it is not so. Rather, it is our interpretation of the event or how we think about it that elicits our feelings.

Looking at the illustration above, what would happen if the depressed person changed his thoughts about the rain? Wouldn't his feelings change, too? This principle is critical in managing depression, since people who are prone to becoming depressed tend to look at themselves and the world in a way that produces feelings of melancholy or anxiety.

Take a moment and complete the following sentences on a separate piece of paper or in your better mood journal:

I am…

Most people…

The world is…

When I think about my future, I see…

Do not stop after completing each sentence once. Complete the phrases over and over, and don't stop until you have run out of conclusions.

If the general tenor of your conclusions seemed bleak or gloomy, you are suffering from what psychiatrist Aaron Beck calls “the cognitive triad for depression.” It consists of:

1) A negative view of self.

2) A negative interpretation of the world.

3) Negative expectations for the future. Comedienne Lilly Tomlin echoed this mindset when she said, “Things will get worse before they get worse.”

Such a tendency to “see through a glass darkly” is usually caused by two things.

1) A person's brain biochemistry and temperament. In our chapter on depression, we learned that some infants come into this world with a temperament and personality that is more fearful, pessimistic and withdrawn. Childhood trauma can also adversely impact the brain chemistry and nervous system.

2) Our habits of negative thinking, most of which we learned through our upbringing and condition. (For example, a parent who worries a lot will inadvertently teach his or her child to worry, too.) Fortunately, psychologists have developed a process called “cognitive restructuring” which allows one to identify and release the negative thinking that feeds and accentuates depression.

At the center of cognitive restructuring are “cognitive distortions”—automatic negative thought patterns that people have about themselves, others and the world. These thinking errors distort reality, thereby contributing to feelings of loneliness, alienation, stress, anger, helplessness, distrust and fear. Synonyms for cognitive distortions are:

The process of cognitive restructuring involves becoming aware of our negative thoughts, challenging their assumptions, and then replacing them, as demonstrated in the following three-step process.

1. Become aware that your mind is engaging in negative thinking. Identify the self-defeating negative thought or self-statement. Then say out loud the words “CANCEL! CANCEL!”

2. Identify the specific distortion. Use the table on the facing page to locate the cognitive distortion behind each thought.

3. Replace the cognitive distortion with a more rational or realistic thought, and note how you feel.

For example, let's say that Henry is contemplating his upcoming job interview. As he waits for the interviewer to appear, Henry thinks to himself, “ I'll probably blow it. My mind will go blank and I won't be able to think of anything to say.” These thoughts send a signal to the brain that initiates chemical reactions which in turn create feelings of fear and anxiety.

Fortunately, Henry has been practicing cognitive restructuring. Suddenly, he becomes aware of his negative self-talk and repeats “CANCEL! CANCEL!,” Henry then identifies the cognitive distortion of “fortune telling/catastrophizing” (see item 6b from the cognitive distortion list). He then replaces the distortion with a more realistic assessment of the situation—e.g., “I have prepared extremely well for this interview. If I stay focused on what I know, I'll be fine.”

Cognitive restructuring is based on an ancient metaphysical principle known as “thought substitution,” described here by Emmet Fox:

One of the great mental laws is the Law of Substitution. This means that the only way to get rid of a certain thought is to substitute another one for it. You cannot dismiss a thought directly. You can do so only be substituting another one for it. If I say to you, “Do not do think of the Statue of Liberty,” of course, you immediately think of it. But if you become interested in something else, you forget all about the Statue of Liberty — and this is a case of substitution.1

The Cognitive Restructuring Worksheet

To help you make the process of cognitive restructuring a regular part of your own life, I have provided a cognitive restructuring worksheet which I adapted from David Burns’ Feeling Good Handbook, as well as an example of how one person completed the worksheet (see pages 224-225).

Here is a summary of how to use the worksheet..

Step 1: Describe the upsetting event or situation (it can also be an upsetting thought).

Step 2: Record your negative feelings.

Step 3: Use the three column technique to change your thinking.

You can use this bit of mental alchemy to significantly reduce your symptoms of anxiety and depression. Depending on the intensity of those symptoms, you may wish to practice cognitive restructuring several times a day, or several times an hour to keep yourself from drifting into negative thinking.

 

The Ten Thinking Errors Known as Cognitive Distortions

Painful feelings are often the result of distorted, negative thinking. Here are some common “cognitive distortions.”

1. All-or-nothing thinking. Seeing things in black-and-white categories—e.g., “If I don't do something perfectly, I'm a failure.”

2. Overgeneralization. You see a single negative event as a never-ending pattern of defeat by using words such as “never” or “always.” In response to finding some bird dung on his car, a depressed salesperson exclaimed, “Just my luck! Birds are always crapping on my car.”

3. Mental filter. Picking out a single negative detail and dwelling on it exclusively.

4. Disqualifying the positive. Rejecting anything positive that happens, insisting that it doesn't count.

5. Magnification or minimization. Exaggerating the importance of some things (such as your faults) and minimizing others (such as your desirable qualities).

6. Jumping to conclusions. Making a negative interpretation, even though there are no definite facts that support the conclusion.

a) Mind reading. Arbitrarily concluding that someone else is reacting negatively to you without checking it out.

b) Fortune telling. Being convinced that things will turn out badly—i.e., “I lost my job so I'm going to lose my house.” This is also called “catastrophizing” or “awfulizing.”

7. Emotional reasoning. Assuming that negative emotions reflect the way things really are—i.e., “It feels like this depression will never end, therefore it must be so.” Or, “I'm scared of flying, therefore it must be unsafe.”

8. “Should” statements. Using these on yourself produces guilt. Directing them toward others creates anger and resentment. Similar to “musts, “ought-tos” or “have-tos.”

9. Labeling and mislabeling. This is an extreme form of overgeneralization. Instead of saying, “I made a mistake,” you say, “I'm a loser.” Mislabeling can be directed at others as well—e.g., “He's a jerk.” This leads to dehumnization.

10. Personalization and blame. Personalization occurs when you hold yourself personally responsible for an event that isn't under your control—e.g., my son got a bad report card so I must be a bad parent.” Blame holds the other person responsible—“My marriage is bad because my spouse is a jerk.”

 

 

Disempowering Core Beliefs

The following are some of the common negative core beliefs that contribute to the negative thinking associated with depression and anxiety. Note which ones you identify with. For each belief, you may want to ask yourself 1) “Where did this belief come from,” and 2) “What more empowering belief can I put in its place?”

About Yourself:

About the World:

About Relationships:

 

 

Cognitive Model of Depression

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Working With Core Beliefs

One discovers that destiny can be directed, that one does not have to remain in bondage to the first wax imprint made in childhood. One need not be branded by the first pattern. Once the deforming mirror is smashed, there is a possibility of wholeness; there is a possibility of joy.

—Anais Nin

In practicing cognitive restructuring, we need to change not only our present negative thinking but also the dysfunctional assumptions and core beliefs that underlie that thinking (see diagram on the opposite page). Many of these negative beliefs were formed in early childhood when parents, teachers, relatives, our religious upbringing, society, television all gave us a model of who we were and how the world worked. Because young children have not developed the faculty of discrimination, this programming went directly into our brains unedited.

The way in which such programming can contaminate our thinking as adults is shown in the example on the opposite page. A young child who experiences criticism and rejection from the parents comes to believe, “I'm unlovable,” and “If I don't achieve I am worthless.” Years later, this person is involved in relationship break-up which activates these core belief and elicits cognitive distortions such as “Nobody loves me” (overgeneralization), “I can't live without him” (all or nothing thinking) and “I'll never find anybody like that” (fortune telling). The ongoing repetition of this thinking in turn elicits the symptoms of depression.

Although we had no control over our early programming, as adults we have both the power and the responsibility to change unwanted patterns. The first step in releasing our core beliefs is to become aware of them, to make what is unconscious conscious. You can begin this process by filling in the following sentences:

I am…

You are…

The world is…

If your limiting core beliefs arose from early trauma or abuse, it may be necessary to grieve the loss in therapy and do other related healing. Ultimately, you can use affirmations (which we will be covering in Week 7) in order to program your mind with new and more empowering beliefs.

This Week's Goals/Assignments

Here are your assignments for the upcoming week:

1. Fill out the “Assessing My Habits of Thinking” Inventory.

2. Over the next week, record any upsetting events or feelings in your daily mood log (page 226). Note how your negative thoughts about events produce distressing feelings.

3. Take at least one of these events or feelings and use the cognitive restructuring worksheet to identify and release the negative thinking that led to the upsetting mood. Share this process with your coach/buddy during your weekly check-in.

Ongoing Self-Care Activities

 

Assessing My Habits of Thinking

Please take a few moments to answer the following questions as a way of assessing the quality of your thinking habits. You can write in the space provided or in your Better Mood Journal.

1. Do I notice when I engage in thinking errors known as cognitive distortions? Which ones are my favorites?

2. When I become aware of my automatic negative thoughts, how quickly do I replace them with more realistic, rational ones?

3. Much of our negative thinking grows out of “core beliefs” about ourselves and the world that we learned in early childhood. Examples of negative core beliefs include, “I am unlovable,” “Life is about struggle,” “I am incompetent,” “My worth is based on what I accomplish,” “Big boys don't cry,” etc.

What core beliefs or attitudes do I have that contribute to my negative thinking? You can refer to the Disempowering Core Beliefs list on page 219 to see some examples.

 

 

Cognitive Restructuring Worksheet

STEP ONE: Describe the situation or event

________________________________________________________________

________________________________________________________________

STEP TWO: Record your upsetting feelings (sad, angry, afraid, helpless, etc.)________________________________________________________________

________________________________________________________________

________________________________________________________________

STEP THREE: Use the 3-Column technique to change your thinking

A B C
Automatic Negtaive Thoughts (ANTS) Cognitive Distortion Rebuttal: Substitute Realistic Thought
 

















  

















  

 

 

Cognitive Restructuring Example

STEP ONE: Describe the situation or event

Henry is contemplating his upcoming job interview.

STEP TWO: Record your upsetting feelings (sad, angry, afraid, helpless, etc.): Henry feels anxious, fearful, and worried. He is also a bit agitated.

STEP THREE: Use the 3-Column technique to change your thinking

A
Automatic Negtaive Thoughts (ANTS)		 B
Cognitive Distortion		 C
Rebuttal: Substitute Realistic Thought
“I'll probably blow it. My mind will go blank and I won't be able to think of anything to say.” Fortune-telling I have prepared well. Just breathe during the interview and all will be okay.
“He's probably just giving me the interview because he knows my father.” Mind reading I really don't know what the boss is thinking.
“I don't really have very much to offer. He probably has other applicants who are more qualified that I am.” Discounting the positive and jumping to conclusions I have a lot of qualifications for the job. Otherwise, I wouldn't have gotten the interview.
“I'll probably make a fool out of myself.” Labeling and fortune-telling In the past, I have done well at interviews.
“If I blow it, it would be a disaster. Magnification, catastrophizing This is not the only job out there. Not getting the job could be a learning experience.

 

 

ABC Daily Mood Log

Use the daily mood log to keep track of the events and circumstances in your life that trigger negative thoughts which lead to painful feelings. I have provided some examples to get you started.

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My Goal Sheet for Week 5

This week's starting date_____________My coach/buddy ____________________

Date/time we will connect _____________________________

Goal or Goals _______________________________________________________

___________________________________________________________________

___________________________________________________________________

Benefits of attaining this goal____________________________________________

___________________________________________________________________

___________________________________________________________________

Action plan _________________________________________________________

___________________________________________________________________

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Ongoing goals (check off the ones as you accomplish them)

______ Read my vision statement daily (upon awakening or before bed)

______ Chart my moods in the Monthy Mood Diary

______ This was my average mood on the better mood scale.

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How was my mood this week?

Record your moods below for each day of the week.

  Day Mood    Comments
  Mon    
  Tue      
  Wed    
  Thu    
  Fri      
  Sat    
  Sun    

 

1 From “The Key of Destiny,” by Emmet Fox, http://emmetfox.wwwhubs.com/foxspks.htm.