Cognitive therapy presumes that psychological problems are associated with distorted thinking. Correcting or modifying this distorted thinking is an important part of alleviating the problems.

Cognitive therapy was initially conceived as a short-term treatment for depression. Since then, it's proven to be effective in the treatment of anxiety, obsessive-compulsive disorders (OCD), eating disorders, post-traumatic stress disorder (PTSD) and chronic fatigue, among others.

It differs from other forms of psychotherapy in that patients focus on current thoughts and beliefs rather than on past traumas or the subconscious mind.

As part of cognitive therapy, patients are taught to recognize the following common errors in their thinking…

  • All-or-nothing thinking. Situations are viewed in black and white rather than on a continuum if I'm not the best, I'm a failure.
  • Catastrophizing. You predict the worst, ignoring other more likely outcomes. Why look? I'll never find another job.
  • Discounting the positive. You dismiss your successes as insignificant or attribute them to blind luck. The promotion was no big deal—they'd have promoted whoever was in my position.
  • Emotional reasoning. You feel strongly that something is true, despite evidence to the contrary. Mary's always friendly, but I know she doesn't like me.
  • Stereotyping. You apply fixed and generally negative labels to yourself or others. Since I feel so unlovable, I must be unlovable.
  • Magnification/minimization. You unreasonably accentuate the negative and downplay the positive. My boss said I'm doing well but criticized my last memo. I'm so incompetent.
  • Mind reading. You believe you know what other people are thinking. My friends think I'm boring.
  • Overgeneralization. You draw sweeping conclusions that extend far beyond the current situation. James turned me down. No one ever wants to date me
  • Personalization. You assume that if others act negatively, it's your fault. My husband is in a bad mood-I must have done something to make him angry.
  • "Should" and "must" statements. You have a set notion of how you or others are supposed to behave and overestimate the impact of any deviation. I should always finish what I start—not to is unforgivable.

Because distorted thoughts generally spring from deep-seated dysfunctional beliefs about oneself, other people or the world, they tend to be automatic—and therefore, they go unquestioned. For some people, the distorted thoughts become so ingrained that they go completely unnoticed.

Cognitive Therapy Tools

Cognitive therapists teach their patients a collection of mental and behavioral exercises that can be used to defuse these toxic thoughts.

Even if you're not undergoing cognitive therapy, you can use the same tools.

  • Keep a dysfunctional thought record. Record each distressing thought, then subject it to the following scrutiny…
  • What evidence do I have for or against this thought?
  • Could there be an alternative explanation?
  • What's the worst that could happen? How would I cope?
  • What's the best that could happen? .What's the most realistic outcome?
  • What's the effect of my believing this thought? What if I changed my thinking?
  • What would I tell a close friend name someone specific) if he/she were in the same situation?

*If you suspect that you're experiencing psychological symptoms beyond your ability to cope, seek the advice of your doctor or a mental health professional.

  • Draft "coping cards." These cards-one per dysfunctional thought-serve to remind you of how to respond constructively to a recurring, distressing thought.

On one side of an index card, write down the thought—I'm a failure, for example.

On the other side, write down what you'd like to remember or do the next time you have this thought. I may have failed this time, but it doesn't mean I'm a complete failure. I've succeeded at x, y and z.

Coping cards are most therapeutic if used regularly rather than reserved for moments of distress. Read these cards three times a day... or as needed.

  • Construct a daily activities chart. Keep a diary of your activities. Rate each activity on a scale from 1 to 10 according to how much pleasure or sense of mastery you experience from participating in it.

Tracking your physical and emotional whereabouts helps you determine what you should be doing more—or less—of.

Activity charts can also be used to plan the week ahead. Schedule activities you enjoy as well as tasks you've been avoiding. Predict how each will make you feel, then track what actually happens.

  • Test negative predictions. Because reality almost always falls short of our worst-case scenarios, it's useful to put fears to the test.

If you think, I'm too shy, I can't talk to others, test this hypothesis by talking to three new people this week-if only to comment on the weather.

  • Break down large goals into smaller ones. If confronting a toxic thought all at once seems overwhelming, try approaching it in manageable steps.

Scenario: You find yourself thinking, I'm incompetent—no one will hire me.

To counter the thought, talk to a friend about it. Then update your résumé...write a practice cover letter...schedule an informational interview with someone in your field...scan the help-wanted ads and circle anything of interest...and apply for at least one circled job.

Treat each step as a discrete task. Give yourself credit as you accomplish each one.

  • Imagine yourself counseling a child. Picture a young child who shares your toxic thought. What would you tell him? How might you apply this advice or reassurance to yourself?
  • Act “as if." Changes in behavior frequently can lead to changes in thoughts or beliefs. Acting as if you're confident-even if you feel anything but can modify a thought such as I'm unlikable.

Troublesome Images

Distorted thinking sometimes occurs not as words, but as mental images.

A picture of yourself being hurt—physically or emotionally—flashes through your mind.

Here's how to cope with the resulting emotional distress...

  • Distract yourself. Put a rubber band around your wrist and snap it or engage in some other behavior that distracts you from the image.
  • Substitute a different image. Imagine that you are watching the distressing image on TV. Change the channel to one that shows you happy and relaxed.
  • Follow it to completion. Rather than trying to block or change the image, let it play out. Envision yourself dealing successfully with the situation.
  • Jump ahead. Imagine yourself at a time after you've faced the problem.

Example: You see yourself tongue-tied during an important presentation at the office. Jump ahead to the following weekend. Imagine yourself sitting peacefully in the park, the traumatic episode over.

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