Psybersquare: Cognitive and Behavioral Therapy

Cognitive and Behavioral Therapy
by Mark Sichel, LCSW

Human beings have always known about cognitive therapy, but it was not "named" or used as an official therapeutic technique until recently. Shakespeare said in Hamlet, "There is nothing either good or bad, but thinking makes it so." This concept is the basis of cognitive therapy: to change your feelings, you need only to change the way you're thinking about your situation.

We touched on this subject earlier in our lesson on catastrophizing, and in this module we'll get into the subject of cognitve perceptions in a deeper way.

Let's look at a person in the midst of a panic attack. We'll call her Alexa*. Alexa is a married woman of twenty-nine, with a 13-month-old daughter and she works full time selling advertising time for a television network. She's suffering from frightening feelings of panic, and despite a clean bill of health from her physician, keeps thinking she's suffering from a serious health problem of one kind or another.

Alexa worked to overcome her feelings of panic by focusing on how she was perceiving herself and others and making a concerted effort to be aware of and to change her unhealthy perceptions. To summarize Alexa's work on her panic disorder, let's look at some classic instances of unhealthy perceptions and show how dramatically the picture changes for Alexa when she chooses to view her situation differently.

ASSUMING THE WORST:

Perception: "My vision is blurry and my stomach is upset. I'm sure this must be symptomatic of a brain tumor or other cancer."

Reality: These are common symptoms of panic and overall, she is a very healthy young woman.

ALL OR NOTHING THINKING:

Perception: "There's something seriously wrong with me that I'm so anxious all the time."

Reality: You're not anxious all the time, only recently. Most people would be overwhelmed caring for an infant and working full time. It's a time in life when many people struggle with how to keep everything together given the demands of an infant and a job.

PERFECTIONISM:

Perception: "I can't believe I forgot to pick up the milk. I can't do anything right."

Reality: Forgetting to pick up an item on a grocery list happens to all of us. None of us are perfect. It's okay to make mistakes. You don't have to be "perfect" to be healthy and happy and functional.

CATEGORIZING:

Perception: "I'm a jerk for feeling this way."

Reality: Many people feel this way, and how big a jerk could you really be if you're doing your job well, and taking good care of your child?

PROJECTION:

Perception: "I must be such a disappointment to my husband."

Reality: Her husband is very understanding, has had his own struggles, and simply wants her to feel better.

BLACK AND WHITE THINKING:

Perception: "I'm always such a mess; I'm never any good to anyone."

Reality: She's had panic attacks for two weeks now, and most of the time she's highly functional.

LOOKING ONLY AT THE NEGATIVE:

Perception:"I'm a lousy mother; what's wrong with me that I can't take care of my child?"

Reality: She has continued taking care of her child without a hitch, although she very much needs a break and needs some extra help for the moment.

AMPLIFYING THE PROBLEM:

Perception: "Why do I always have so much trouble keeping a handle on things? I can't do anything."

Reality: She sometimes has trouble like anyone, but it's actually very rare. Most of the time she is highly functional.

TIME DISTORTION:

Perception: "This has been going on forever and will never end."

Reality: This just started a few weeks ago, and with her motivation to work on the problem will end shortly.

If any of Alexa's patterns of unhealthy perceptions sound familiar to you, you might want to create a log of your own. When you find yourself having extreme thoughts, write them down. Concentrate on them. See if you can understand what the reality behind your extreme perception is. Write it down. Do this exercise whenever you're feeling overwhelmed by negative thinking. Keep a log for yourself. As you get better and better at controlling irrational thoughts of panic, you will be less and less likely to succumb to regression and panic attacks will slowly become an element of your past.

If you would like to continue the Panic Disorder lessons and learn another therapeutic approach for dealing with panic, please read Psychoanalytic Psychotherapy.

If you would like to start at the beginning of the Panic Disorder lessons, please read What to Expect When You are Diagnosed with a Panic Disorder.

*The names of all clients have been changed to protect their identities.