What is CBT and how does it work?
Throughout my recovery, I learned that the more depressed and worried thoughts I had the easier it became to have them. Whenever we think connections are made in our minds and the more caught up we get with any thoughts the stronger those connections become.
Analogously, if I walk back and forth along a trail it will become flatter and more clear of grass and debris. While this trail may become easier to follow, other paths become underused and overgrown. Though now more difficult, I have to find ways to switch back to these older paths that lead out of depression.
As I became severely depressed during the fall of 2009, my negative thoughts became automatic and harder to get away from. This is the type of thinking that Cognitive Behavioural Therapy (CBT) tries to help with. My first exposure to CBT came from a course of weekly meetings. I have since researched and read more about CBT.
Three of the major concepts that stood out to me:
Challenging Negative Thinking
I did a lot of work with CBT to recognize negative thought patterns. I judged myself by standards I wouldn’t apply to anyone else and was doing so all day. Though I was conscious of these thoughts to an extent before CBT, I was not aware how pervasive and deep-rooted they had become.
Reading over lists like the following helped me realize how distorted my thoughts were.
I remember filling out worksheets, with lists like the one below, and ticking off every box. It became obvious how negative and far removed from reality my thoughts had become. Cognitive Distortion on Wikipedia, has detailed summary of the following with definitions and examples.
- All-or-nothing thinking
- Mental filter
- Disqualifying the positive
- Jumping to conclusions
- Magnification and minimization
- Emotional reasoning
- Should statements
- Personalization and blame
Reference: Burns, David D. (1989). The Feeling Good Handbook: Using the New Mood Therapy in Everyday Life. New York: W. Morrow.
After identifying these thoughts, CBT works by repeatedly challenging them with more appropriate ones so they instead become automatic.
Depending on how poorly I felt, I found this aspect of CBT to be the most difficult. It was one thing to see how twisted my thoughts had become but quite another to accept this and get them back on track towards recovery.
Thoughts, Feelings and Actions
Another core concept of CBT is that thoughts, feelings and actions are all interrelated. With this in mind, it’s easier to work on changing actions than it is trying to force overall thought patterns and emotions to get better.
In practice, this meant working on my eating, exercising and sleeping habits as well as making sure I did more social activities with friends and family.
At my lowest points, the only exercise I got came from short walks with my parents around my neighbourhood. It was good to get outside for sunlight, fresh air and exercise, but my thoughts were still very negative. I would spend much of the time thinking about how useless this was or how much I hated being depressed.
When I was first diagnosed with depression, I hadn’t been sleeping well for weeks. I was wound up with anxiety and had to start taking sleeping medication to get any rest. Since then I’ve continued to take sleeping medication at a lower dose. With CBT it was interesting to learn how much my diet and sleep affected me. After a poor night’s sleep, I expected to be tired the next day, but as I paid more attention I realized my anxiety was more on edge and my mood was often lower.
The same for sleep could be said for my diet. Though my appetite was very low at the time, I worked hard to eat more nutritious meals.
With thoughts and emotions there are so many factors in play that it’s not clear how much one day of exercise or one night of good sleep is really helping. It was discouraging not being able to see direct results and instead I worked on all aspects of my life for weeks and months with slow improvement.
Being more conscious of the interrelation of thoughts, emotions and actions, I was able to take a more comprehensive approach to re-establishing healthy lifestyle habits. This was a tremendous help in my recovery.
Setting Achievable Goals
In terms of CBT, this means breaking up tasks into smaller and more specific steps so a problem can be approached in an incremental and less overwhelming manner.
I wrote out goals for the week, like going to the gym at a specific date and time. I then broke this into smaller goals for how long I would spend there and what machines or weights I would use. I did this for every day of the week including simple things like checking my emails or eating breakfast. Later in the week I checked back to see what I had and hadn’t accomplished. All the small tasks that make up the day seemed like they should have been so easy, but depression sapped my motivation and energy turning each day into a long and arduous gruel. I lowered my expectations of what I could do, and tried not to judge myself.
Looking back I can see how depression affected my usual thinking patterns. Instead of facing a problem and planning out how to handle it (things I could normally do without explicitly writing out), my thoughts would shift immediately to ideas of failure and hopelessness.
Some of this material seemed patronizing in its simplicity as many of the concepts, of breaking up and prioritizing tasks, seemed obvious once suggested. Still I stuck with it.
Final Thoughts on CBT
It was difficult riding a stationary bike, going out for walks, or even doing regular self care like showering and shaving, as thoughts constantly derided myself and my attempts at recovery.
CBT allowed me to better identify when I had these distorted thoughts, but when challenging them wasn’t working I quickly exasperate the problem. The effort spent in trying to change seemingly endless negative thoughts left me exhausted and discouraged. I had created a new cycle of defeat.
Overall, CBT provided me with a more formalized set of skills to handle depression and a better understanding of how it was affecting all aspects of my life. In order to deal with more overwhelming thoughts and emotions, I searched for other strategies. What I learned from mindfulness will be the subject of next week’s post.
Read more posts in this series: Exploring my Recovery from Depression