Cognitive Therapy

Healing with Positive Self-Talk

You're about to have your first job interview in years. You're as nervous as you can be. As you enter the office of your prospective employer, you're thinking:

(A) I'll never get this job. I'm so rattled that I'll blow the interview, and besides, they probably won't like me anyway.

(B) Plenty of people are this nervous when they're interviewed. And they called me right after they got my resumé--something about me must interest them.

If your answer is B, you already know a little something about cognitive therapy, a technique designed to chase away negative thoughts.

On the other hand, if you answered A, chances are you could benefit greatly from learning how to change your thinking habits.

UNCLOG YOUR "THINKING JAMS"

Cognitive therapy is an effective nondrug treatment for depression, anxiety and other common emotional problems. In contrast with long-term psychoanalysis, cognitive therapy is short-term and works by getting you to change your behavior and your general outlook and focus on the pres-
ent, not the distant past. Experts say cognitive therapy can help you help yourself out of the "thinking jams" that can short-circuit success and happiness.

"Consider cognitive therapy instead of lengthy psychotherapy when you're beset with emotional problems such as depression, anxiety or eating disorders," says Judith S. Beck, Ph.D., director of the Beck Institute for Cognitive Therapy and Research, clinical assistant professor of psychology in psychiatry at the University of Pennsylvania in Philadelphia and author of a textbook on cognitive therapy.

The idea behind cognitive therapy is that emotional problems arise or get worse when your outlook and perceptions about yourself are distorted.

"Cognitive therapy looks at problems that women have in the here and now," says Dr. Beck, whose well-known father, Aaron T. Beck, M.D., developed the therapy in the 1960s. "It's a commonsense way of problem-solving that helps women handle the kind of negative thinking that affects them emotionally when they are distressed or depressed."

BEST OUT OF FIVE

Psychiatrists, psychologists and other mental-health practitioners have an arsenal of therapeutic treatments at their disposal to deal with the vast array of emotional problems that sometimes concern women.

So-called biomedical therapies use drugs, surgery or electric shock to alter behavior; only a psychiatrist or other medical doctor can administer these treatments.

Traditional psychoanalysis, originated by Sigmund Freud, is the mother of all talk therapies and relies primarily on free association and dream interpretation to resolve unconscious conflicts that cause emotional disorder. Treatment can last for years--or, in the case of Woody Allen's characters, a lifetime.

Group therapy brings together several people (six to ten, usually) under the supervision of a group therapist. Based on the principle of transference (that is, the assumption that you will react to group members as you do to your family), group therapy aims to reveal the distortions that people experience in relating to others.

In behavioral therapy, the focus is on your behavior rather than on the subconscious thinking that causes your behavior.

Proponents say that for many women, cognitive therapy may be a better choice than these four classic approaches.

"Research simply doesn't support the fact that long-term, traditional psychotherapy is effective," says Dr. Beck. "Cognitive therapy, on the other hand, has been shown to work in over 100 rigorously controlled studies," she says.

According to various researchers, including Dr. Beck, cognitive therapy has been shown to be effective for a long list of emotional and emotionally related problems, including anorexia, anxiety, back pain, bulimia, chronic fatigue syndrome, depression, fibromyalgia (painful "trigger points" in muscles), high blood pressure, marital difficulties, overeating and weight problems, panic and unexplained physical symptoms.

What's more, a small study at the University of California at Los Angeles indicates that cognitive therapy may actually affect the chemistry of the brain and may be an effective therapy for obsessive-compulsive disorder (the uncontrollable urge to repeat a certain ritual, like hand washing).

YOU'RE IN COMMAND

"Cognitive therapy alleviates distress and suffering in a short period of time--commonly, 8 to 12 weeks--by helping people look closely at the problems that disturb them," says Dr. Beck.

Generally speaking, certain aspects of cognitive therapy are radically different than traditional psychotherapy. The most striking differences are the active involvement of the therapist and the kind of work that you're expected to do. For example, Dr. Beck says that if you opt for cognitive therapy, you'll be encouraged to participate in the following areas.

Team up with your therapist. "The therapist and the client work together actively, as a team," says Dr. Beck. You and your therapist will make decisions together, such as how often to meet, what to work on in each session and what kind of therapeutic homework you'll be assigned.

Focus on goals. In your very first session with a cognitive therapist, she will probably ask you to verbalize your problems and set specific goals for solving them. As you do, your therapist will begin to identify the mental roadblocks that make problem-solving difficult for you.

Structure your sessions. In traditional psychoanalysis, patients spend the whole session free-associating--just talking about whatever comes to their minds when the therapist throws out a series of words. In cognitive therapy, you'll have input into the structure of the sessions. Most likely, you and your therapist will:

* Briefly review your week

* Set a session agenda

* Give feedback on your last session

* Review your therapeutic homework

* Discuss agenda items

* Set new homework

* Summarize the session

* Provide feedback on this session

Work in the here and now. In most cases, your therapist will help you focus on solving whatever problems currently trouble you. Discussions of childhood events are explored to identify mind-sets you learned as a child, as in: "If I don't get good marks, then I'm a failure."

Apply new thinking to your daily life. As you learn about how your thoughts influence your emotions and behaviors, you'll also learn how to apply what you learn to prevent relapses from occurring.

Get results in months, not years. Dr. Beck says that most people with simple anxiety or depression require 4 to 14 sessions, although she notes that some patients who have personality disorders may need a year or two, or possibly longer, to change long-standing, rigid, dysfunctional beliefs and behavior patterns.

Identify dysfunctional thoughts and beliefs. By using a process that Dr. Beck refers to as guided discovery, your therapist will frequently ask you what your thoughts mean and will help you to see whether in fact they are valid. (Remember: "If I don't get good marks, then I'm a failure.") This will help you uncover underlying beliefs about yourself, your world and other people.

QUICK FIXES FOR COMMON DISTORTIONS

According to Dr. Beck, cognitive therapy empowers women by enabling them to help themselves out of depression and other emotional problems.

"There are certain classic distortions that people make in their thinking," says Dr. Beck. "Labeling these distortions is one way that therapists help you avoid some of the traps that can get you into emotional hot water."

Recognizing--and avoiding--these common distortions can go a long way toward easing emotional turmoil.

Black-and-white thinking. Viewing situations as being all black (bad) or all white (good) with no grays establishes unrealistic expectations and doesn't allow for partial satisfaction. Example: "If I don't do an outstanding job, then I'm a total failure." Instead, tell yourself: "So I made one little mistake. I'm human. It didn't ruin the entire project."

Catastrophizing. Don't assume the worst about a situation. Instead, consider positive outcomes. Example: "I'm so nervous; I know I'll blow the interview." Instead, tell yourself: "Everyone is nervous during interviews. She interviews hundreds of nervous applicants, so she's used to it and most likely won't count it against me."

Mind reading. Don't assume that you know what others are thinking--and don't assume that it's always negative. Example: "The man I met recently hasn't called because he thinks that I'm unattractive." Instead, tell yourself: "There could be hundreds of reasons for why he hasn't called. I'm not him. I can't know how he thinks."

Tunnel vision. Avoid the tendency to see only the negative aspects of a situation. Example: "The holidays will be a total disaster because I'll be at my in-laws' house." Instead, think: "So it's not my favorite place to be. At least the food is always good."

Personalization. Don't assume that you are the cause of others' actions. Example: "The repairman was gruff because I did something wrong." Instead, think: "That repairman needs an attitude adjustment. There's no excuse for being nasty to a customer."

Mental filtering. Avoid the temptation to focus on one negative detail instead of seeing the big picture. Example: "I got one low rating on my performance evaluation. I must be doing a lousy job." Instead, tell yourself: "Even though I need to improve my punctuality, my boss really likes the way I handle clients."

Overgeneralizing. Resist the habit of making sweeping negative statements that overlook the reality of a situation. Example: "I'm uncomfortable at parties. I don't have what it takes to make friends." Instead, think: "I always feel more comfortable when I socialize with people I have something in common with."

Writing off positive outcomes as dumb luck. Don't dismiss your achievements by telling yourself, "I'm not good--just lucky." In other words, don't fall into the trap of telling yourself that your positive qualities, deeds and experiences don't count. Example: "I didn't get that job because I earned it. I was just in the right place at the right time." Instead, say: "It takes more than being in the right place at the right time. It takes having the right stuff. If I didn't have what they wanted, they wouldn't have hired me."