Cognitive Behavioral therapy, or CBT, is based on the principles of learning theory. If you are prone to depression, you tend to think globally and see catastrophes everywhere. Some common distortions in thinking are selective abstraction – noticing only the worst details; overgeneralization – seeing disaster everywhere from a single event; all-or-nothing thinking – magnifying bad events, and minimizing good events; personalization – attributing blame to yourself for neutral events; and extremes of idealization and devaluation of people important in your life -seeing them as either entirely benevolent and kind, or entirely bad and malicious.
Kareena would always see herself as falling short because she couldn’t meet her expectations at work. Whenever she was asked specifically what she needed to do to feel satisfied with herself, she would overgeneralize, and answer that she had ‘masses’ of reports to write, ‘masses’ of washing to do, ‘masses’ of people to call. She had to work with her therapist to translate her ‘masses’ into more realistic, manageable obligations.
Similarly, Sarah told her friend Ann that she felt she needed less advice and direction from her, and Ann became angry; she felt she had simply been helping. When Sarah reported this incident to her therapist, she insisted that Ann would never forgive her – even though they had been friends since secondary school, and had always enjoyed being together. Sarah was sure she’d lost her friend forever. This is an example of ‘all or nothing’ thinking, which is usually negative.
The ‘learned helplessness’ theory of depression, developed by Martin Seligman, a psychologist at the University of Pennsylvania in the United States, suggests how helpless or hopeless depressive Behavior can begin in humans. Behavior in experimental animals sometimes parallels human Behavior. Rats were placed on an electric grid that administered a shock to them. They were able to escape the shock by jumping to a part of the grid that was shock-free. They quickly learned to avoid the shock. However, some rats were first placed on a grid with no means of escaping the shock, no matter what they did. After several trials there, they were placed on the grid that allowed them to escape. But these rats never tried to escape the shock, though all they had to do was jump to the other side of the grid. Seligman speculates that something similar may happen to humans who are repeatedly exposed to failure; they lose heart and can no longer muster the strategies to escape their situation.
Dr Aaron Beck, an American psychiatrist and psychoanalyst who originated CBT, described the ‘negative cognitive triad’ of depression. You have a negative view of yourself, of the world (including other people), and of the future. You see yourself as defective, deprived or inadequate. You may feel that ‘Everyone would be happier if I were dead.’ You may tend to interpret all external events as negative, and you predict disasters and failures in the future. The therapist can deal with the defences you put up in your resistance to getting well, such as reluctance to reveal your thoughts and feelings, insistence on managing alone, or – paradoxically -expectation that the therapist should do all the work. You will begin to identify the thoughts that develop automatically whenever you are in stressful situations; these thoughts are often based on false premises, and new, more adaptive responses can be learned.
John visited the university health service at the beginning of April. He was in the second year of an honours BA in economics, but he was fearful that he wouldn’t do well on his upcoming exams. When questioned further, he also said that he had lost some weight, was not interested in going out with his friends, and was sleeping poorly. The counsellor began to see John weekly, to treat his depression with cognitive therapy. John wrote down what he was feeling when he was stressed and what he did about it, conscientiously recording his reactions and his accompanying thoughts. Eventually, he and the counsellor began to notice a pattern. Whenever John failed to achieve what he had set out to do, he berated himself for being a no-hoper and a failure, and told himself that he would never achieve anything worthwhile. At that point he would stop working. Together, John and his counsellor began to reframe his thoughts so that he didn’t give up each time he reached an impasse. John practised these new skills until he was able to complete what he had set out to do. He reached a point where he felt confident about passing his exams, and his depressive symptoms improved.
In cognitive Behavioral therapy, the therapist does not act as an expert and suggest Behaviors to you; this simply doesn’t work. Instead, through reflection, clarification, and questioning of your basic assumptions, the therapist tries to help you develop alternative ways of thinking, so that you can apply these to finding new, more positive ways of seeing yourself, others and the world.