How Negative Thinking Works

In Cognitive Behavioural Therapy, we give particular focus to the nature, force, frequency and content of negative thoughts.  Thoughts play a key role in determining how we feel and what we do.  If we interpret a situation negatively, it can profoundly influence the way we react.  This in itself is fairly obvious.  We have all been in situations where we have misinterpreted or misunderstood something, reacted in an unhelpful manner and then found that we had made an error of judgement.

Making mistakes in how we read and interpret situations is part of normal human behaviour.  We are not programmed to get everything completely right all of the time.  The world is a complex place and people are different.

The problem arises when we think in patterns that systematically lead to negative feelings and behaviours, where our thoughts automatically generate unrealistic or catastrophic outcomes, where we get trapped in a vicious cycle of negative appraisals and where we are unable to maintain a balanced and realistic perspective.  These negative thinking patterns can become reflexive and engrained, leading to unwanted negative emotions such as anxiety or depression and influencing our behaviour in self-defeating ways.

So How Do Thoughts Work?

In this article, we will discover how thoughts are structured and organised in layers, how different types of thought contribute to emotional distress and unwanted behaviours and finally how changing thinking can influence the way we feel.

Layers of Cognition

We can think of negative cognitions or thoughts at four levels – Negative Core Beliefs > Dysfunctional Assumptions > Irrational Rules > Negative Automatic Thoughts (NATS).  These different levels form a cognitive processing chain or schema for how we see ourselves, other people, the world and the future.

Unhelpful thinking patterns can also lead to compensatory and maladaptive behaviour as we act out or avoid our negative perceptions.

Negative Automatic Thoughts (NATS)

NATS are fleeting automatic thoughts that can be conscious or almost at the edge of our awareness. They form an internal monologue that can negatively influence how we automatically interpret situations and react to feelings.

Some typical examples include:

• I can’t cope.
• They don’t like me.
• I feel bad.
• I am going to get it wrong.
• It’s not fair.

Negative Rules

Negative rules are strict thinking principles that tend to be all or nothing, dogmatically applied and rarely tested.  They form an automatic protocol for interpreting situations and are usually based on demands or imperatives.  Rules are often formed in childhood where they may have made perfect sense, but provide over-rigid and often unrealistic standards in later life.

Examples include:

• I must always work hard.
• People can’t be trusted.
• I should always be strong.
• There is no point trying.
• I will ultimately fail.
• I should not be anxious.

Dysfunctional Assumptions

Dysfunctional assumptions are learned suppositions that over time form a reflexive way of interpreting and applying meaning in different situations.  They are usually conditional statements that provide a bridge   between core beliefs and negative thoughts and act as an automatic formula for interpreting or reacting to situations.

Examples include:

• If I am criticised, then it proves I am no good.
• When things go wrong, I can’t cope.
• If I don’t put in 100% all the time, then it proves I am a failure.
• If people ignore me, it means I am no good.
• If I can’t think of something interesting to say, people will think I am boring.
• If I always work hard, I will be a success.

Core Beliefs

Core beliefs are fundamental, absolute and generalized beliefs that we hold about ourselves, other people, the world and the future.  Inaccurate and negative core beliefs profoundly affect our self-concept and vulnerability to mood disturbance. Core beliefs typically centre around themes of Lovability, adequacy and helplessness.

Common examples include:

• I am not good enough.
• I am unlovable.
• I am incompetent / stupid.
• I am a bad person.
• I am a failure.
• I am worthless.

Compensatory Strategies

Although not strictly cognitions, compensatory strategies form the link between our thoughts and the action or behaviours we take.  These strategies basically tell us how to behave when our negative cognitions are activated.

Examples include:

• Over prepare / apply perfectionist standards.
• Attend to the problem by worrying about it.
• Seek approval, ask for reassurance or people please.
• Blame, criticise or attack.
• Continuously check or examine things to reduce uncertainty.
• Procrastinate, avoid or withdraw.

The above explanation briefly illustrates how different layers of thinking can be viewed and organised.  This provides a simple way of presenting the overall architecture or structure of our thinking processes.  Understanding how negative thoughts and behaviours are influenced by our rules, assumptions and core beliefs, is the first step towards changing and adapting our thinking to support our personal goals and values in life.

Although we are evolved to self-doubt, question, look for problems and simplify our experiences, we also have the capacity to think and behave in a way that is consistent with a healthy and emotionally balanced perspective.

When you are experiencing emotional distress, ask yourself:

What do I notice about my thoughts - step back and just observe what's happening? How does thinking this way help me? What's a more realistic interpretation? Are these just thoughts?  Am I really defined by my thoughts?  Tolerate the uncertainty and discomfort - make the NATs less relevant.  Shift my focus on to helpful and rational things.

Busting Common Myths About Cognitive Behavioural Therapy

Getting straight facts about psychotherapy and how to choose the right approach can be difficult and confusing. Over recent years, some therapists from the psychoanalytic and psychodynamic fields have attempted to undermine Cognitive Behavioural Therapy by claiming that CBT is superficial, that it’s less affective at treating long-term problems and that it provides a one size fits all approach.

These claims have almost always been levelled by therapists who have no formal CBT qualifications and are usually from other psychotherapeutic traditions.

Common criticisms have included bias research methods, that CBT outcomes are exaggerated and that there is a system-wide conspiracy against other forms of psychotherapy.

Drawing on the hundreds of Randomised Control Trials and meta-analyses conducted over the last 40 years, this blog will attempt to cut through some of the myths and misconceptions, outlining some simple facts about CBT and how it works.

Is CBT Superficial?

Whilst it is true that a CBT Psychotherapist will not ask you to enter into open-ended therapy for months or even years, the process does involve a thorough assessment of the problem and a highly structured plan to specifically address the client’s goals.

Unlike some of the other talking therapies, CBT provides a hands-on practical approach to problem solving and change. This means that the techniques and exercises are designed to be applied in a practical way that directly influences how we think, feel and act in day-to-day life. This helps to convert the psychological work done in therapy sessions, into real improvements in people’s personal, social and working life. 

We find that when clients approach us to start CBT, they want more than personal insight. In other words, they want to understand and actually take practical steps to change or improve the problem. Understanding the background factors that have contributed to the development of the problem is also an essential step in this process. 

Far from being superficial, CBT teaches clients how to convert personal insight into tangible improvements in dealing with distress, solving problems, improving relationships and changing behaviour. CBT is oriented to helping people to manage problems and live a more meaningful and fulfilling life.

Can CBT Deal with Deeply Rooted Problems?

The claim that CBT can’t deal with deeply rooted or long-term problems is an ill-informed criticism often levelled by therapists from other approaches. This claim ignores the wide range of scientifically acknowledged research studies undertaken since the 1970s on deeply rooted psychological problems including the treatment of childhood trauma, long-term depression, psychosis and personality disorders. It also overlooks the contribution made by CBT models like Schema Therapy which is designed to integrate deeply rooted attachment and relational factors.

The fact is that CBT is successfully used as both a short-term intervention or as a longer-term approach. In spite of criticisms from other less researched therapies, CBT has been used to treat long-term problems with depression, deeply rooted anxiety, trauma and problems with self-esteem since its inception in the early1950s and 1960s. 

CBT actually provides a flexible model that can be right-sized to meet the specific needs of the client. This means that problems like panic disorder or stress can be successfully treated in as few as six sessions, but that deeply engrained and complex issues such as long-term depression, trauma, personality disorders, psychosis and eating disorders have more clinically involved protocols. 

The bottom line is that the approaches used in CBT have been clinically tested and shown to have a positive outcome for short-term and long-term problems alike.

Does CBT Provide a One-Size-Fits-All Approach?

Another common criticism is that CBT is overly simplistic. This claim demonstrates the fundamental misconception that Cognitive Behavioural Therapy is just one simple model. Again, this criticism tends to be made by therapists or organisations with a lack of training, knowledge or experience of the wide range of CBT interventions and models.

CBT is not just one simple approach, it is an umbrella used to cover a wide range of clinically proven Cognitive and behavioural therapy models. it is a therapeutic tradition focused on the relationship between cognitive, behavioural, emotional, physiological and environmental factors.

In addition to the mainstream version of CBT originally developed by Ellis and Beck in the 1950-s and 1960s, CBT now includes a wide range of approaches developed to treat different types of psychological, emotional and behavioural problems. Some of the more well-known approaches include:

• Rational Emotive Behaviour Therapy (REBT); developed in the 1950s and combining an active-directive therapy with a philosophical perspective to change behaviour and emotion in the service of living a more meaningful life.
• Cognitive Therapy; Developed in the 1960s and introducing the concept of how thoughts directly influence emotions and behaviours. This work has also been proven to have a direct influence on the structure and architecture of the brain itself. 
• Schema Therapy; this enriches short-term CBT with developmental approaches from Attachment Theory, Object Relations Theory and Gestalt Therapy. Schema Therapy provides a contemporary analytical approach to CBT by exploring and changing early formed beliefs and unhelpful patterns of behaviour. 
• Dialectical Behaviour Therapy (DBT); originally developed in the 1980s and shown to be highly affective for severe mood regulation problems. DBT is used in the treatment of personality disorders, bipolar depression and other mood regulation issues including eating disorders and anti-social behaviour.
• Compassion Focused Therapy (CFT); This was developed to support people suffering from treatment resistant issues often involving shame, disgust and high levels of self-criticism. CFT combines our understanding of western neuro-science, evolutionary psychology and mindfulness based philosophical practices.
• Acceptance and Commitment Therapy (ACT); This is a modern form of CBT focused on the development of psychological flexibility. Rather than changing negative or unhelpful thinking patterns, ACT focuses on reducing the struggle and unhooking from negative thoughts and feelings. ACT uses six key psychological processes in therapy to normalise and reduce resistance to distressing experiences in the service of living a richer, meaningful and fulfilling life.
• Mindfulness Based Cognitive Therapy (MBCT); This integrates Eastern perspectives and meditation techniques into modern Western scientific approaches to stress reduction and emotional resilience. Mindfulness has been scientifically proven to improve recovery from a wide range of psychological and physical problems including pain management, stress, depression and anxiety conditions.

So, in summary, far from providing a simplistic one size fits all approach, CBT is a sophisticated model of therapy involving a wide range of scientifically tested interventions. These different models of CBT are commonly linked by their focus on thoughts, feelings, behaviours, physiology and the relationship to the environmental context.

What is a BABCP Accredited Psychotherapist?

CBT Psychotherapists qualified and accredited to the rigorous standards laid down by the British Association of Behavioural and Cognitive Psychotherapy (BABCP), have been required to demonstrate post-graduate level academic qualifications, observed assessments and ongoing supervised clinical practice. In most cases an accredited CBT therapist will have undertaken additional advanced psychological training for three-five years to achieve the depth of knowledge and expertise required to be a BABCP accredited CBT Psychotherapist.

For clarity, this is not the same as BACP registration or accreditation. Although confusing the BACP (as opposed to the BABCP), covers counsellors and therapists from other fields.

In spite of the frequent criticisms levelled by members of the counselling community, there are many counsellors offering CBT without the necessary training, experience or professional post-graduate qualifications. The fact is that BABCP accreditation sets a highly rigourous standard of assessment and observed practice which is difficult to achieve.

BACP registration/accreditation does not mean that you are working with an accredited  CBT expert. If in doubt, ask your therapist for confirmation of their qualifications and check your therapist using the UK register at http://cbtregisteruk.com/AccreditedMemberSearch.aspx

In the final analysis our advice is to follow the evidence when choosing therapy. Whilst this blog does not seek to attack other models of therapy, it encourages the reader to think for themselves and separate facts from opinions. This in itself is a key skill in CBT.

You can find out more about our approach to CBT and explore a wide range of free Cognitive Behavioural Therapy resources and assessments by visiting https://www.thinkcbt.com

The Good Therapy Checklist – Select the Right Therapist

Whilst research evidence demonstrates that Cognitive Behavioural Therapy (CBT) is a highly effective treatment for a wide range of anxiety and depression related problems, it’s also important to ensure that a number of “Good Therapy” factors are in place before engaging in any form of talking therapy.

This article outlines our top ten “Good Therapy” factors and provides those considering therapy with a simple check-list to use when selecting a therapist or counsellor.

1. Professional Accreditation and Training

The first thing to check before booking therapy is that the therapist or counsellor is accredited with the relevant professional body and that they hold the recognised professional qualifications to practise as a psychotherapist. For Cognitive Behavioural Therapy, you should ensure that the therapist is accredited with the British Association of Behavioural and Cognitive Psychotherapy (BABCP). BABCP accreditation means that you can trust that the therapist has reached the rigorous standards of training and assessed practice laid down by the lead professional body for CBT. You can view the national CBT register at www.cbtregisteruk.com This allows you to check your therapist by name.

Other key accreditation bodies include the HCPC and BPS for Chartered / Registered psychologists as well as the UKCP and BACP for general counsellors and psychotherapists.

At Think CBT our therapists are accredited with the BABCP, hold professional indemnity, have completed a DBS assessment and are registered with most of the large private insurance providers. You can check our team profiles by visiting www.thinkcbt.com/psychotherapist-cbt-counselling. You can also search the independent UKCBT specialist registration here https://cbtpages.com/

2. Knowledge of the Research Evidence / Techniques for Treating the Problem

As a consumer, it’s important that you have confidence in your therapist and that the therapist has a clear understanding of the relevant research, established techniques and latest developments in the treatment of the problem. We have supported many clients who have previously wasted time and money working with unskilled therapists using irrelevant or inappropriate approaches.

We always recommend that clients follow the evidence and consult the published research data and NICE guidelines where possible. NICE publish a wealth of independently verified recommendations for the treatment of a wide range of psychological problems including depression, anxiety, PTSD, OCD, Social Phobia and eating disorders. You can check the NICE guidance by visiting www.nice.org.uk. therapist should be aware of the recommended psychological treatment for the problem and professionally trained in its application.

At Think CBT we will only work with a client if we are confident that we can help and if we have relevant subject matter training.

3. A Proven Track Record Working with the Presenting Problem

Having the relevant training does not in itself mean that you will get the best therapist to support you through the problem. Like most professions, having practical experience is also essential and you should always check that your therapist has successfully worked with similar issues. Whilst a therapist will not disclose confidential information about work with other clients, they are professionally obliged to declare relevant experience when asked as part of the initial contact. This is usually specified in codes of conduct and professional ethics. Don’t be afraid to ask your therapist for specific examples of whether they have worked with the same problems or conditions.

At Think CBT our therapists have over 250 years combined experience and hands-on exposure to a wide range of psychological, behavioural and emotional problems. All our therapists are additionally required to undertake a minimum of 90 minutes clinical supervision each month, to ensure that their practice is professionally focused and relevant.

4. An Initial Assessment and Assessment Report

Completing an initial assessment sets the foundation for undertaking good therapy. This usually involves a thorough and systematic assessment of the presenting issues and a clear set of recommendations on the proposed approach.

During CBT your therapist will also usually undertake a process known as formulation, which involves creating a model of past and current factors that trigger, maintain and influence your experience of the problem. Obtaining a written assessment report and talking to your therapist about their understanding of your problem is an important initial step before starting therapy. This ensures that you share a common understanding of the problem and that you agree with the proposed approach.

At Think CBT your therapist will always write to you following a structured initial assessment, confirming the problem and outlining the proposed approach and timescales.

5. Clear Goals for Therapy

Agreeing clear goals or therapeutic outcomes is an important initial stage in the therapy or counselling process. This helps to ensure that you have identified realistic expectations for therapy and that you have a basis for judging how therapy is working throughout the process. Entering into open-ended therapy without a clear set of goals encourages little more than passive exploration and can contribute to therapeutic drift. This is where the therapy process loses focus and a clear sense of purpose.

At Think CBT we tend to use a version of SMART goals (Specific, Measurable, Adaptive, Rewarding and Time-focused). In combination with work on personal values, this helps to ensure that therapy is targeted and relevant.

6. A Structured Therapy Plan

Having a therapy plan helps to ensure that you will follow a transparent and well-ordered process. This means that you can be confident that therapy is being planned and prepared in advance and that your therapist is applying techniques in a well-integrated and logical manner. Having a therapy plan helps to avoid ad hoc approaches and unplanned sessions.

Therapy plans do not negate the need for responsive and innovative sessions; a good therapist can hold the balance between adapting and improvising in real-time during the session and following a sound therapy plan.

At Think CBT clients agree their therapy plan and discuss proposed techniques with their therapist at an early stage in the process. This helps to ensure a collaborative approach to therapy; it's easier to engage in the process when you understand and contribute to the planned approach.

7. Feedback and Monitoring

Regular two-way feedback throughout the therapy process is essential to ensure that therapy remains relevant and on course. You should check that the therapist has a clear basis for monitoring feedback and that agreed measures are in place to assess progress at the end of therapy.

At Think CBT we use a wide range of recognised psychometric measures and personalised monitoring processes to ensure that the client is provided with regular feedback on progress throughout the therapy process.

8. Lapse Planning

In the final stages of therapy, your therapist should spend some time discussing how potential lapses might be triggered and how this could be managed in the event of something going wrong. It’s important to remember that therapy is not a magic bullet and that life can often throw up unexpected or negative events. The purpose of good therapy is to equip you to manage potential problems in a healthy and sustainable manner. Therapy is not a basis for stopping bad things from happening, it’s about developing the personal insight, skills and resilience required to bounce back effectively. A good lapse plan provides a personalised backup in the event of future problems.

At Think CBT we provide our clients with a therapy journal to document progress throughout the process, to act as a primer for key tools and techniques and to provide the basis for developing a good lapse plan at the end of therapy.

9. Post-Therapy Follow-Up

The therapy plan should normally be organised to space out the last few sessions, so that the client has more time to practice and test-out the new techniques and approaches learnt during therapy. Similarly after the completion of therapy, clients can benefit from follow-up at agreed intervals to ensure that the new approaches are continuing to prove effective and that where necessary, any booster sessions can be agreed.

At Think CBT, your therapist will agree follow-up intervals with you and you will be provided with the opportunity to maintain email and telephone contact where relevant. We are also interested in post-therapy feedback to ensure that we continuously learn and improve on our approach.

10. A Good Therapeutic Relationship

Whatever form of therapy you decide to engage in, the quality of the therapeutic relationship is key in determining successful outcomes. Finding the right therapist is paramount and working with someone that you can get on with and trust will significantly influence your progress. Therapists often refer to the “Core Conditions” for good therapy. These are empathy, congruence and unconditional positive regard. This basically means that your therapist demonstrates a sense of connection, a shared understanding of the problem and a willingness to support you without judgement. The initial stages of therapy can sometimes feel clunky or awkward, but you should use your own common sense in deciding on whether you can work closely with the therapist.

Like all people, therapists possess their own personality and interpersonal style. We have worked with some clients who described their previous therapist as difficult to get on with, overly directive, not very good at listening and sometimes just plain odd. Make sure that you can connect with and feel confident about your therapist.

At Think CBT we always organise an initial free telephone consultation, to ensure that the basic relationship is right, that the therapist has the relevant experience and to undertake some basic fact finding before the first paid session.

If you choose to work with a Think CBT therapist, you can confidently rely on all ten points in our good therapy check-list, however always talk to your therapist about any issues or questions that you may have before starting the process.

The Good Therapy Check-List

To summarise and simplify our Good Therapy recommendations, we have produced a simple ten point check-list that you can use to help find the right therapist. This checklist can be downloaded here or you can copy it from the following list:

1. Is the therapist professionally qualified and accredited by their lead UK body?

2. Does the therapy offered follow the published research and NICE recommended treatment for the problem?

3. Does the therapist have specific practical experience of working with the problem?

4. Does the therapist provide a structured initial assessment and written assessment report?

5. Are therapy goals and measures used to guide and monitor progress?

6. Will there be a structured therapy plan and timescales?

7. Is there an agreed feedback process to refine the approach / address problems during and following therapy?

8. Does the therapist offer a lapse plan at the end of therapy?

9. Are there follow-up / contact arrangements / booster sessions available following the completion of therapy?

10. Do I feel confident, supported and comfortable with the therapist?

To find out more about our services or to talk to a BABCP accredited Cognitive Behavioural Psychotherapist, contact info@thinkcbt.com or view our website at www.thinkcbt.com.

© Think CBT Ltd. W J Phillips