My therapist made me do it!!!

(A use case for cognitive behavioral therapy and mindfulness)

Sorry, I was just testing out new clickbait-y headlines for my writing.

This is a quick story about a guy who’s therapist used Cognitive Behavioral Therapy (CBT) during the course of his fiver-year long therapy sessions. This story is basically a colorful rant that “my friend” told me about some time ago. He said that is was quite helpful in his situation, but was only introduced and used for a few short months — as another means to explore treatment modalities in he/his therapy. Since (at the time) he recently started meditation practices for an overall “wellness plan,” this therapist (we’ll call her Dr. Strange) thought synchronizing and focusing the aspects of MINDFULNESS and CBT would be an overall net benefit to this friend’s psychotherapy.

Female version of Dr. Strange by @rossdraws on Instagram — Picture by @rossdraws from Instagram

MINDFULNESS is commonly thought of as “getting out of your own head” and of simply being in the moment rather than constantly thinking, worrying and stressing in the moment. More specifically in this case, Dr. Strange suggested that mindfulness could be used to help with “cognitive restructuring” (apparently not as painful as it sounds), which is an aspect of CBT concerned with the “reprogramming” of thoughts (which is NOT the same thing as brainwashing, by the way).

Lawrence Harvey as Raymond Shaw in 1962’s The Manchurian Candidate, United Artists

The idea behind cognitive restructuring is to deconstruct a patient’s beliefs, thought patterns and feelings regarding certain matters that might be negatively affecting their mental health (in this case I think with this person it was probably something like the fear of getting the least amount of medals/decorations during a particular deployment). Cognitive restructuring offers an opportunity for one to notice these maladaptive thoughts as they’re occurring, and then practicing to reframe those thoughts in more accurate and helpful ways.

Model of cognitive behavioral therapy (CBT)

So, with such a fear or ailment as I outlined above, the therapist could very well have used a well-studied talk therapy approach like cognitive behavioral therapy to combat such a phobia. When someone suffers with a fear/phobia, often they will find themselves having illogical, destructive and/or self-defeating thoughts regarding that particular trigger. In our example here, this friend, we jest, would have some significant FOMO (fear of missing out) affliction and would be potentially triggered when others would win medals and not he/him. The job of the therapist would be to have him realize that if he were to simply do his job to the best of his ability (and with a little luck, knowing the right people, and having a boss that was good at writing award packages) that this friend would fall in the category of those much more likely to gain “official recognition” from leadership circles.

Deep Thoughts: “I hope they never find out that lightning has a lot of vitamins and minerals in it, because, do you hide from it or not?”

Dr. Strange likely had my friend talk more logically through some of these “cognitive distortions” he held inside until they eventually interrupted or redirected those negative thoughts. Some commonly cited cognitive distortions could be things like:

· Black-and-white thinking

· Catastrophizing

· Overgeneralizing

· Personalizing

A drawing of a person meditating or engaging in mindfulness practices.

A crucial step in cognitive restructuring would be to assess the nature of one’s thoughts and to identify the specific damaging ruminations that would be leading to health issues. SELF-MONITORING and MINDFULNESS work together here as a powerful tool: One would simply sit quietly and allow himself to experience thoughts as they occurred, noting their appearances, then letting them drift by as if they were simply clouds of thought. Likewise, a therapist like Dr. Strange might help this friend assess the kinds of thoughts he often found himself wrapped up within while in the midst of phobic/fear-inducing situations.

Graphic that says, “challenge assumptions.”

From there, the process of cognitive restructuring would truly begin. This would be accomplished through an exercise called QUESTIONING ASSUMPTIONS wherein this friend would simply ask himself how likely his beliefs were to being accurate. In this example/case, would he really be overlooked completely when it came time for “awards season?” The therapist would like use Socratic teaching techniques here by getting the patient to ask things like:

Is this thought based on emotion or facts?
What evidence is there that this thought is accurate?
What evidence is there that this thought isn’t accurate?
How could I test this belief?
What’s the worst that could happen? How could I respond if the worst happens?
What other ways could this information be interpreted?
Is this really a black-and-white situation or are there shades of grey here?

A nondescript figure holding a large magnifying glass as is to be looking through it.

GATHERING EVIDENCE was also important in this cognitive restructuring. As we have seen, cognitive distortions are biased and inaccurate, but they can also be deeply embedded. Dislodging and replacing them would require evidence about how rational those distortions were. For another example, if one personalized other people’s actions, this person could often blame himself for things that weren’t his fault. In this case one might benefit from looking at evidence that indicated that certain actions had nothing to do with the patient at all.

A graphic that shows a hand writing on a whiteboard with the word “solution” circled and then four options, listed A through D to the right of it.

A final piece of that cognitive restructuring puzzle would also be GENERATING ALTERNATIVES to the distorted mindset. Part of the practice involves coming up with alternative explanations that are rational and positive to replace the distortions that have been adopted over time. I’m running out of things to say with the example from that “friend,” so I’ll present a different example now. Let’s say a person did not score well on a given test. Instead of generalizing that one is “terrible at test-taking,” one might explore ways to change study habits, right? Another generated alternative could be to explore some relaxation techniques to try before the next possible test, in order to perform better the next time around.

Being able to identify and change one’s negative thought patterns has many benefits. It may very well help to:

· Lower your stress and alleviate anxiety

· Strengthen your communication skills and build healthier relationships

· Replace unhealthy coping mechanisms like substance use

· Rebuild self-confidence and self-esteem

Let’s say that this friend in the story above also suggested that he learned that The American Psychological Association recommends CBT (and also mindfulness practices) to help with issues like:

· Eating disorders

· Depression

· Anxiety

· PTSD

· Substance use disorder

· Mental illness

· Marital problems

In any life situation where negative thought patterns would be likely to develop, CBT/cognitive restructuring and mindfulness could benefit the patient by helping to challenge and change unhelpful thoughts, interrupting and eventually replacing them with something more positive, logical and reasonable.