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Tuesday 9 October 2012

Cognitive Therapy: Do we ever REALLY get rid of our negative thinking?

Cognitive therapy targets our automatic, rapid-fire appraisals of situations, many of which operate outside awareness. Something happens, and we feel a reaction. A person in the bank lineup ahead of us reaches into his pocket, and we feel fear.
Here comes that "I'm going to drown!" thought again.

We may or may not be aware of thinking anything in particular about the event. But if we did not have any intervening thoughts (“Maybe he’s going for a gun”) it is difficult to explain the emotional reaction, or the fact that different observers have differing reactions.

We often discover that we distort reality a fair bit, based in large part on our past experiences. Our first partner was abusive, so we automatically view partners with deep suspicion. We were fired from an early job, and since then we have tended to overanalyze negative feedback for signs that we are about to be fired.

Much of cognitive work entails contemplating the situation and our reaction to it, and becoming aware of the process of appraisal that took place between the two. Then we can evaluate our reasoning and see whether there are any flaws in it, or whether we may have accurately assessed a part of the situation (“He really does hate me …”) but have missed other valuable information (“On the other hand, most people seem to like me”). We strive for a slow-fire reappraisal that is more fair, balanced, and useful than our automatic thinking.

But why bother?

The assumption is that by doing this we can achieve personal change. One change, obviously, is that we can finally stop torturing ourselves with these reconsidered situations. By discovering the truth about that breakup a year ago we can more readily set it aside and move on.

But we also want to appraise new situations with greater accuracy. We’d like to finally be able to go into our annual work evaluation without a sense of fatalistic dread. We’d like to go into the bank and not hit the dirt every time someone takes out their wallet.

By rethinking past events and rehearsing our more realistic thoughts when we find ourselves in new situations, we can weaken the old ideas. And, sure enough, some old catastrophic appraisals eventually vanish. We become able to fly without having any thoughts that the plane will crash. We can give a talk without worrying that someone will stand and call us incompetent frauds.

But does this always happen? Is this the only goal of cognitive work? What if we don’t reach it?

Our negative thinking frequently doesn’t evaporate as readily as we might like. The truth is, even with effective, competent, and diligent cognitive therapy, the negative thinking often continues to at least some degree. In fact, this is probably the most common outcome. We still think “I’m going to fail!” every time we go into an exam, “S/He’s abandoning me!” every time our spouse has an evening out with his or her buddies, “I’ll be fired!” when we discover a spelling mistake in an email we sent to the boss.

So was the cognitive work a waste of time? Not at all.

The other, less discussed outcome of cognitive work is a decreased identification with our negative thoughts. Initially we might think “They all hate me” when we go to social events. Over time, we recognize that thoughts like this come from experiences in our awkward adolescence, not our adult life, and that mostly people seem to quite like us.

The thoughts don’t entirely go away, but by knowing where they come from, or simply that they are usually “neural misfires”, we learn not to place too much trust in them. We drive to the party knowing that our brain will probably spout “They hate me” at some point, but we simply don’t care that much. It’s something the brain does, it doesn’t mean it's true. Likewise, though, we can’t assume that everyone loves us. We might acknowledge that we are not the greatest judge of what others think of us; our past has produced a systematic bias to anticipate rejection.

When describing this process of “disconnection,” I often use an example with which many can identify. You go the Customs desk and the thought occurs to you that you are smuggling something and are about to be caught, and you become anxious – even though you aren’t smuggling so much as a breath mint.

Over time you learn that this is simply something your brain does when you approach Customs desks, and you learn to ignore it. “Yup, I’ve got heroin, like always” you say to yourself, and roll your eyes. It no longer alarms you because you know it’s going to happen, and you know it’s a misfire. In effect, through awareness and mindfulness of our thoughts we install a buffer between our distortions and our reactions.

Both outcomes – cognitive change and this disconnection effect – occur in cognitive therapy, and both are valuable outcomes. The latter effect is as important as the former, and is at least as common if not more so.

Rather than remaking our craziness, then, the goal is often simply to recognize it, welcome it, allow it to speak, and be amused and interested by it. Self-knowledge rather than personal renovation.

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