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Cognitive Therapy for Depression

The tool of cognitive therapy means changing your thoughts to change the way you feel. Every thought that you and I think produces a chemical reaction in the brain, which in turn corresponds to a feeling. As one brain scientists explained it, every thought has a neurochemical equivalent!

To illustrate this principle, let us imagine the following situation. It is the middle of January and for the fifteenth straight day it's raining in Portland.  Let's call this "an event." In response to this event, person #1 complains, "These gray days are driving me nuts. Why did I ever leave California?" Meanwhile, person #2 exclaims, "Hooray for the rain! Now there will be snow in the mountains so my girlfriend and I can go skiing this weekend."

Notice that the same circumstance produced two entirely different feelings. Although we are taught to believe that events cause us to have certain feelings, it is not so. Rather, it is our interpretation of the event or how we think about it that elicits our feelings. 

Now, what would happen if the depressed person changed his thoughts about the rain? Wouldn't his feelings change, too? This principle is critical in managing depression, since people who are prone to becoming depressed tend to look at themselves and the world in a way that produces feelings of melancholy or anxiety.

Take a moment and complete the following sentences on a separate piece of paper:

I am ...
Most people ....
The world is ....
When I think about my future, I see ...

Complete the phrases over and over, and don't stop until you have run out of conclusions. If the general tenor of your conclusions seemed bleak or gloomy, you are suffering from what psychiatrist Aaron Beck calls "the cognitive triad for depression."  It consists of:

A negative view of self;
A negative interpretation of the world; and
Negative expectations for the future. Comedienne Lilly Tomlin echoed this mindset when she said, "Things will get worse before they get worse."

Fortunately, psychologists have developed a process called "cognitive restructuring" which allows one to identify and release the negative thinking that feeds and accentuates depression. 

At the center of cognitive restructuring are "cognitive distortions"--automatic negative thought patterns that people have about themselves, others and the world. Synonyms for cognitive distortions are:

Stinking thinking" (from Alcoholics Anonymous)
Irrational beliefs (from Rational Emotive Therapy)
ANTS--automatic negative thoughts
"junk thought"

The process of cognitive restructuring involves becoming aware of our negative thoughts, challenging their assumptions, and then replacing them, as demonstrated in the following three-step process.

  1. Become aware that your mind is engaging in negative thinking. Identify the self-defeating negative thought or self-statement.
  2. Then say out loud the words "CANCEL! CANCEL!" 
  3. Identify the specific distortion or negative thought.
  4. Replace the cognitive distortion with a more rational or realistic thought, and note how you feel. 

For example, let's say that Henry is contemplating his upcoming job interview. As he waits for the interviewer to appear, Henry thinks to himself, " I'll probably blow it. My mind will go blank and I won't be able to think of anything to say." These thoughts send a signal to the brain that initiates chemical reactions which in turn create feelings of fear and anxiety.  

Fortunately, Henry has been practicing cognitive restructuring. Suddenly, he becomes aware of his negative self-talk and repeats "CANCEL! CANCEL!"

Henry then replaces the distortion with a more realistic assessment of the situation--e.g., "I have prepared extremely well for this interview. If I stay focused on what I know, I'll be fine."

The Cognitive Restructuring Worksheet

To help you make the process of cognitive restructuring a regular part of your own life, you can create a cognitive restructuring worksheet. Divide a blank sheet of paper into three columns. 

Step 1: Describe the upsetting event or situation (it can also be an upsetting thought).
Step 2: Record your negative feelings.
Step 3: Use the three column technique to change your thinking.

In column 1, list the ANTS, the automatic negative thoughts.
In column 2, identify the distortion behind each negative thought.
In column 3, write a rebuttal in the form of a more realistic or rational thought.

You can use this bit of mental alchemy to significantly reduce your symptoms of anxiety and depression. Depending on the intensity of those symptoms, you may wish to practice cognitive restructuring several times a day, or several times an hour to keep yourself from drifting into negative thinking. With practice, you will begin to experience a better mood.

I wish you the best on your healing journey.

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