Evan Fertel, PhD
Post-Doctoral Fellow (2022)
Many people approach The Evidence Based Practice (The EBP) expressing interest in Cognitive Behavioral Therapy (CBT). This is hardly surprising because the fundamental principles of CBT underlie almost all modern evidence based psychological interventions. Thus, it makes a lot of sense to come to The EBP seeking CBT!
But what exactly is CBT?
In the simplest terms, CBT capitalizes upon the relationship between our thoughts (also known as our cognitions), our behaviors (or actions), and our experience (e.g., our mood, feelings, emotional state), to promote psychological well-being. Consider a person who is afraid of flying. How effective would it be to simply insist they not be afraid anymore?
For most of us, it would seem absurd to order someone to stop being afraid. That is like telling a person experiencing depression to just get over it! So how do we help our fearful flyer? If we cannot change the fear directly, CBT suggests getting at the fear through adjustments in our thoughts and behavior. Here we are going to focus on the thought pathway and leave the behavior piece for another blog entry.
Powerful Thoughts
Around 1960, psychiatrist Aaron Beck and psychologist Albert Ellis, each independently building upon the work of psychology icon Alfred Adler, developed models promoting modification of thoughts as a means of alleviating psychological distress. Beck and Ellis asserted that our cognitive perspective dictates our experience. In the case of our petrified airline passenger, we would examine the thoughts that are associated with their experience of fear. Generating thoughts about stories or images of horrific airplane crashes and thinking that every bump of turbulence is an indicator of impending doom is likely to stoke feelings of anxiety. By learning to challenge those thoughts and consciously modify them accordingly, one can alter their emotional experience. After scrutinizing and restructuring those thoughts, one might adopt the perspective that airline travel is one of the safest modes of transportation and even safer than automobile travel, so much so that part of the reason plane crashes garner news attention is not just because they are terrible and scary, but because they are so rare. Further, one could accurately view turbulence as a normal part of air travel and extremely unlikely to be a cause for concern. Taking this cognitive perspective can promote feelings of security and calm as opposed to terror. As simplistic or even far-fetched as this process may seem to some, decades of research support the efficacy of what has come to be known as cognitive restructuring in the management of depression, anxiety, and a wide array of psychological disturbances (Butler et al., 2006).
The framework described above grants great power to our thoughts. It is the thoughts we have that control our experience. Therefore, our own thoughts have a profound impact on our life.
Powerless Thoughts
The most recent wave of CBT-based therapy models incorporates an alternative way of approaching our thoughts. Rooted in ancient philosophies and practice, the concepts of mindfulness and acceptance are core components of contemporary CBT approaches such as Acceptance and Commitment Therapy (ACT) and Dialectical Behavior Therapy (DBT). Rather than working to evaluate and alter our thoughts, this perspective entails simply observing our thoughts and treating them as mere brain messages that do not have to be tangled with, even the scary ones. In this view, there is no reason to engage with and edit our thoughts, nor is there a need to avoid or deny them; they are just thoughts! It makes no difference whether we consciously generate a thought, or it just spontaneously pops into our head. We notice our thoughts and even acknowledge their existence, but we just let them be. They do not have to exert influence over us. Picture your thoughts as a flowing stream of bubbles. You do not try to dodge them nor swat them away. Rather you just watch them, describe them, or even just notice them and pay them no mind. Thoughts may carry messages, but those messages are not necessarily true or false. It could be that our brain is sending us messages to help us, even when those messages are misleading. Thinking that flying through some bumpy air is a reason to worry, might be our brain erring on the side of caution and trying to keep us alert to potential threats to our safety. At the same time, such an overestimation of risk can lead to being a nervous wreck on the plane. When such a thought arises, we might even thank our brain for the gesture of trying to keep us safe and then allow that thought-bubble space to float around us or even away. However sensible or ridiculous it might sound to just exist with your thoughts without struggling with them, especially the troubling ones, there is a body of compelling research highlighting the utility of this approach in managing psychological distress (Goldberg et al., 2018),
This second perspective disempowers our thoughts thereby limiting their impact on our experience. Here, thoughts are essentially powerless.
A Seeming Contradiction
If you are perceiving a contradiction, you have a point! One view is holding our thoughts up as the cornerstone of our experience where the other treats our thoughts as largely inconsequential, with both perspectives falling under the umbrella of CBT. So which is it? Are thoughts all-powerful or powerless? And which approach is going to be more effective at helping us?
Like the answer to many complicated questions, it depends. Some of us may consider the notion of manipulating our thoughts an impossible task. Others may not even be able to wrap their head around the idea of observing our thoughts and sitting with them without engaging them. So, it may be a function of choosing the outlook best fit for you and even developing your capacity to experiment with new psychological skills. Moreover, some of us may find benefit from applying a particular approach based on what seems to work best in a given set of circumstances. In fact, some CBT treatment models such as Mindfulness-Based Cognitive Therapy (MBCT) include teachings of both perspectives about our thoughts.
Sure, this is a seeming contradiction in theory or logic residing under the CBT tent. But how much does it really matter how we see our thoughts in terms of their power when there is evidence that both stances are effective at enhancing our mental health? In the end, the question as to whether thoughts are all-powerful or powerless may be a distinction without a grand difference. Ultimately, it is us who has the power to choose how we treat our thoughts and in turn how much power we give them. So, the power is yours. Feel free to use it wisely!
References:
Beck, A. T. (1979). Cognitive therapy and the emotional disorders. Penguin.
Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26(1), 17–31.
David, D., Music, L. (Creators). (1972-1978). The Bob Newhart show. MTM Enterprises.
Ellis. (1962). Reason and emotion in psychotherapy. L. Stuart.
Goldberg, S. B., Tucker, R. P., Greene, P. A., Davidson, R. J., Wampold, B. E., Kearney, D. J., & Simpson, T. L. (2018). Mindfulness-based interventions for psychiatric disorders: A systematic review and meta-analysis. Clinical Psychology Review, 59, 52–60.
Linehan, M. M. (2018). Cognitive-behavioral treatment of borderline personality disorder. Guilford Publications.
Luoma, J. B., Hayes, S. C., & Walser, R. D. (2007). Learning ACT: An acceptance & commitment therapy skills-training manual for therapists. New Harbinger Publications.
Segal, Z., Williams, M., & Teasdale, J. (2018). Mindfulness-based cognitive therapy for depression. Guilford Publications.