Thoughts, behaviors & biological reactions — The Love Triangle

Arya Prasad

Cognitive behavior therapy (CBT) is a commonly-employed form of therapy that looks into bringing change in a person’s thoughts and belief systems. It understands those maladaptive ways of thinking lead to mental distress. Working with a person’s thoughts involves working with their beliefs about themselves, others, and the future. For example, a client with depression may feel that they are helpless (belief about self), that nobody else in this world can help them (beliefs about others), and that their future is uncertain (beliefs about the future). CBT is goal-oriented, time-bound, and requires active collaboration between the therapist and client.

CBT understands that people’s thoughts, emotions, behaviors, and biological reactions affect each other. For example, when Rahul, a student, said “good morning” to a professor, who did not reply, Rahul could possibly justify the lack of reply by assuming that the said professor was busy, and go on his own way. Alternatively, he could worry that the professor purposely did not acknowledge him, as they were upset with Rahul due to his poor performance in exams. This may cause him to be upset and uneasy throughout the day. Therefore the perception of the situation, and not the situation itself, led to the emotional and physiological reaction Rahul felt.

Therapists often work with automatic negative thoughts; they are called ‘automatic’ because they come to one’s mind very quickly during situations. For example, when Rahul’s professor did not acknowledge his “good morning”, Rahul might have thought that his professor hated him. Such automatic thoughts are mostly readily available to one’s consciousness. These automatic thoughts are said to be the gateway to understanding one’s belief systems. For example, if Rahul often worries about people not liking him, dialogues between him and his therapist could possibly bring to the fore Rahul’s concerns of him being unlovable. However, this is a gradual process, and therapists do not often jump from negative automatic thought to assuming their client’s belief systems.

A very common concept in CBT is cognitive distortions, which are errors in processing information from the environment. There are multiple types of cognitive distortions. Arbitrary inference is when people jump to conclusions; for example, when a student makes one mistake in their exam, they think that they did poorly and may fail the exam. Dichotomous thinking is when people view things in either a positive or negative manner and fail to consider the continuum between them; for example, one may feel their efforts are worthwhile only if they secure a promotion, anything else than that means that their efforts are in vain. Often “should” statements are employed, which speak about a rule that one upholds for oneself, which must be adhered to; for example; everybody should like me.

Homework is an essential part of CBT; clients may have therapy sessions every week or so, and homework allows them to be engaged in therapeutic tasks throughout the week that may help their progress. Moreover, clients may often forget what happened in between sessions; homework is a good way to record the events that happened. Therapists may ask clients to make a note of negative automatic thoughts or may even ask them to practice skills in their day-to-day life and note them.

There are various versions of CBT. Mindfulness-based Cognitive Therapy (Mb-CT) uses mindfulness skills such as noting distressing thoughts and not being judgemental towards them, along with other practices of CBT. Trauma-focused CBT (TF-CBT) is used to decrease the symptoms of trauma in clients and is especially helpful for clients with Post-Traumatic Stress Disorder (PTSD). Dialectic Behaviour Therapy (DBT) combines mindfulness practices with skills for emotional regulation and interpersonal problem solving; it has been proven to be remarkably efficient with clients with Borderline Personality Disorder (BPD).

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