Cognitive Behavioural Therapy

For my anxiety, I have been through Cognitive Behavioural Therapy – CBT. Twice. Once in 2014 and once again in 2017.

It is not my intention to critique CBT here. I found the first time I attended therapy more effective than the second, which I suppose should be expected. Neither was a silver bullet, but both gave me coping mechanisms substantially healthier and more effective than those I have built outside of CBT. What I am going to do here is use my blog to share what I learnt – mainly with myself, to be honest. This blog is another form of therapy after all.

The idea of CBT is not at all dissimilar from the practise I learnt as an evangelical Christian of questioning thoughts. As a Christian I was taught that thoughts came from three sources: God, Satan and me. It was my responsibility to discern the source of a thought and disallow entry to my brain to thoughts which were not edifying. It’s actually a rather useful practice.

So effectively I re-learnt to “cast down imaginations, and every high thing that exalts itself against the knowledge of God, and bring into captivity every thought.” 2 Corinthians 10:5, if you’re interested, and of course the verse does not end there but finishes, “to the obedience of Christ.”

We’ve established that I am an atheist, but babies and bathwater; there is much about religion that should not be abandoned along with faith. This concept of questioning how edifying a thought is is definitely worth hanging on to.

Just as a Christian might use Biblical morality to challenge thought, CBT offers its own helpful yard-sticks for whether or not thoughts are going to help or hinder the anxious mind. It is also helpful to realise that thoughts are not simply ideas that enter the mind – they include established thought patterns, learnt mental behaviours and that general sense of how we see the world.

Perhaps the most interesting and helpful technique for examining thoughts confronted what my therapist called “rules”. A rule is a statement which my mind believes to be true. Most often, rules are established by experience. Rules equate to the computer-programmer’s IF… THEN… ELSE logic: IF something happens THEN the result will be this ELSE the result will be that. And it is that binary aspect of a rule which requires challenging.

In my case, I have a rule which states, “I must be liked to be successful.” Experience has taught me that if people like me, I do well, be that in business or in a social situation or anything else. This rule is stated as an absolute, and it also has the negative equivalent: if I am not liked, I will fail.

It is the binary way in which the rule is stated that is dangerous and, also, quite illogical. It uses the same illogic as, “all generalisations are wrong.” The idea is to soften the way the statement is put. Because it is simply not true that I will fail if I am not liked, the rule should be re-stated as, “Being liked is useful to success.” This allows me to be disliked without being anxious that I will fail as a result. Rules need to be flexible.

Then we come to the concept of failure itself. I also see failure as binary when it simply isn’t. It’s not like there are just two options: failure and success. There is a sliding scale with success at one end and failure at the other. Unless the outcome is actual death, failure is not complete, surely? Any situation can be repaired, no matter how desperate. And most of the time, “failure” is a lot tamer than that.

Which dovetails into the third concept: worst case / best case / most likely outcome. The anxious mind will fixate on failure. The idea that failure is not absolute can be challenged when examining the actual worst-case scenario. What is it? And then, most importantly, how likely is it? Does it represent complete failure? No, simply because there is no such thing. And it is usually quite unlikely as an outcome anyway, since it is worst case. Also, is the best-case the only success? Would the most likely outcome not qualify as on the success side of the sliding scale?

Fourthly there is “worry management”. Some scenarios are likely to have a negative outcome. Okay then: is this a practical scenario? Is it real? Will this thing I am worrying about ever actually happen? Comes back to worst-case / best case / most likely outcome. If I am anxious about a hypothetical scenario – losing my job, for example – how helpful is it to worry about it? Am I in any real danger of losing my job?

If the worry is practical, then can I deal with it? If yes, do so. If no, accept that life has risks, do what you can to mitigate them, and then move on. If the worry is hypothetical, acknowledge that and treat the thought with the derision it deserves. This is almost like the Harry Potter spell ridiculus. Turn your fear into something laughable whenever you can, and this is most easily done for the hypotheticals.

Another way of looking at all of this is “what if?” What if a thing happened? Well: flexible rules mean the thing can happen without necessarily causing a negative outcome, a negative outcome is almost never the end of the world anyway, the scenario may be pretty unlikely and it may even be completely hypothetical. See?

Well, it helps me.