Like the name suggests, CBT involves a mix of cognitive-focused and behaviour-focused interventions. In this section, we’ll look at some of the cognitive interventions.
Reframing To improve a difficult situation, you can either change your reality or lower your expectations. The closer reality and expectations and reality are to one another, the better you’re likely to feel.
Guided discovery with a therapist will help with this, but it’s also something you can do your own work on. When you have a mental illness, the reality of that typically isn’t going to budge, at least in the very short term, so adjusting expectations will probably be the easier side of this equation to work on. A common trap is expecting the same level of ability/performance as you’d have when you’re well. Yet most likely that’s completely unreasonable, and evidence of how people (both yourself and others) function when well is not the right evidence to address the issue of functioning when ill.
Vertical Descent
This strategy is used to uncover a line of implications leading down to core beliefs, and examine the probabilities of each successive event given previous events.
It begins with a negative automatic thought about a situation. You then consider the question “If this were true, so what? What would that mean?” You would then keep going until you reach the core belief that’s feeding into all the other negative thoughts.
Double Standard Method
This involves testing beliefs by considering what you’d think of another person who was in the same situation that’s activating for you. Often, we apply very different standards to others than we do to ourselves. Consider how you would evaluate a person close to you, or even a neutral acquaintance, in that situation. Would you evaluate and judge them the same way you evaluate yourself?
Worry Tree
While anxiety encompasses emotional, cognitive, and physical elements, worry is a mostly cognitive process that’s focused on potential problems in the future. While sometimes people believe that worrying is necessary in order to prevent a negative outcome, that’s actually not the case. Worry gets really caught up in the problem without taking that next step to problem-solve and identify solutions.
The worry tree is a basic tool to help you decide what to do with whatever worry you might be experiencing. If the worry is hypothetical, you could waste a lot of valuable cognitive energy on it, or you could let it go. Now, that letting the worry go part isn’t quite as easy as the worry tree implies, but the basic idea is still a good one.
The steps are:
• Notice that you’re worried and identify what the worry is about
• Decide if the worry is a hypothetical situation that may or may not happen, or if it’s a current problem you can act on
• If it’s hypothetical, there’s nothing you can actually do about it, so try to let the worry go and refocus your attention on something else
• If it’s something that you can act on, develop an action plan
• Can you do it now? Then go ahead and do it.
• Otherwise, schedule it for later.
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Scheduled Worrying
This involves scheduling a period of time during which you can worry all you want, and then restricting worrying at other times. You can make notes during the day of things you don’t want to forget about during your worry time.
This technique isn’t always going to be useful, and the result you get will likely have a lot to do with what you’re using it for. If you try to schedule your anxiety with the emotion-cognitive- physical full meal deal, you’re most likely not going to get very far. However, if you’re worrying about how you’re going to pay for expense X in 6 months, scheduled worrying is going to offer more potential benefit.
A variation of this can help if worries are coming up at bedtime. Keep a notepad next to your bed and write down exactly what you want to worry about in the morning, and that may ease the sense that you need to attend to the problem, and help slow your mind down a little.
Thinking in Shades of Grey
This is used to challenge all-or-nothing, black-and-white type cognitive distortions. It involves evaluating beliefs and appraisals on a scale from 0 to 100, but not allowing yourself to assign values from the extreme ends of the scale. Then consider what other shades of grey might contribute to the whole picture.
As an example, consider a task you’d set for yourself to clean the kitchen. Let’s say that while doing so you dropped a plate and it shattered. An all-or-nothing way of looking at this situation would be that because you broke the plate you were not 100% successful at your task, and that would mean you were 0% successful at your task of cleaning the kitchen. Approaching this in shades of grey, you couldn’t rate yourself as 0% successful. If you were even 10% successful, where might that 10% of success have come from?
Structured Problem-Solving
This clear, step-by-step approach can be useful when illness is causing difficulties with problem- solving and decision-making.
• Select a problem
• Open your mind to all solutions
• List pros and cons of each potential solution
• Verify the solution
• Enact a plan
• Decide if the plan worked
Prediction Logs
Keep a log of your predictions about how situations would turn out, and how they actually turned out. This way, you can start to accumulate evidence regarding the thoughts underlying the predictions.
Semantic Method
The semantic method involves substituting less emotionally charged language. Instead of slapping a label on yourself, use neutral, nonjudgmental language instead. Instead of using “shoulds,” drop the word “should” and frame the idea in a different way.
Reattribution
While it’s easy to conclude that you are responsible for everything that’s going on around you, that’s probably not the case, or at least not entirely. Reattribution is about looking for other factors that may have contributed to what’s going on.
For example, let’s say you tried to chat with a coworker, and it seemed like they brushed you off. While that may have had something specifically to do with you, what other factors can you come up with that may have contributed? Did the boss recently dump a bunch of extra work on them? Has their child been sick? Might they have a migraine?
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