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Cognitive Behavioral Therapy
"Cognitive Behavioral Therapy" is the major school of thought for assisting with mental health and fitness in the world today.
It arose out of the work of Aaron T. Beck, and it both stands in opposition to and is entirely predicated upon, the earlier "behavioral" work from the likes of B.F. Skinner, Hans Eysenck, Ivan Pavlov.
The Book that is the most "New York Times Bestseller" of all, in this field, is "Feeling Good" by David D. Burns.
This book sold at a record breaking pace, all over the English speaking world -- with translations in many other languages (wiki ed: how many?)
With its distinctive yellow cover and blue title, it sold so many copies back in the day that it's readily available and easily spotted in most any second-hand bookshop.
A coffee table did not recognise itself if it did not have a copy of feeling good left face down on it, some notepaper nearby scrawled with the many charts and lists that doctor burns describes. (I was going to say prescribes, but he's kinder than that word would imply.)
Toowong Library
I stormed out of the office that day, I did.
I don't know why.
I couldn't put into words what it was that was bothering me.
I was working, creating software for clients, expecting something to do something or expected to do something, or struggling in some way, to convey or overcome some vague, oh fuck it, it was all too difficult, the whole thing was like a polygonal structure folding in upon itself. So I strode, I stepped, I marched to that damn library, desperate to escape what was inside my own head.
I hit that library.
I did a thing that I confess I've done many times before, and many times since ---
I verily stormed into that library, thinking those angry, swirling, toadish, angry, mocking thoughts. Yes I said "angry" twice, what of it? Fuck you. I had angry mocking thoughts, and now I was just daring the books, absolutely daring the books to bring something forth, something that I could scoff at and deride.
Feeling Good was a book I had never read, but I had known something about that book for as long as I'd been alive.
Like the beatles, or led zeppelin, or brabra streisand, it has always been there. And I'd given it a kind of sad if sardonic side eyed chuckle as i'd pass it.
"Ah," i would say to myself. -- "that piece of crap book from the 70's with it's 'THINK HAPPY THOUGHTS' bullshit"
Now, with my library fury bubbling over, I picked up that book, in that Toowong library that day, and I was ready to read that book. I was going to read like the wind. Read like there was no tomorrow. I was looking forward to this, I cackled, this. ought. to. be. good.
One day I picked it up, just to flick through it and laugh at how stupid it was. Within a minute or so I was deeply engrossed.... this wasn't some 'think happy thoughts' bullshit... this was much deeper than that... this stuff understood the human brain in a way that was way beyond any bumper slogan.
The heart of classic CBT is this:
- Your feelings are caused by your thoughts. (That's a pretty big deal!)
- If you feel bad (anxious or depressed for example) then the thoughts you are currently thinking are bound to contain distortions or flaws, that are known as "cognitive distortions". Eliminate the distortions, and the thoughts will be improved. Because of point 1 (above), the feelings will inevitably improve as well.
Eliminating the distortions from your thoughts is about "reframing" your thoughts. CBT (and the book Feeling Good) provide a series of techniques to re-frame your thoughts from their current sad-making form into a form that is more true and less sad-making.
From the point of view of a computer programmer like me, this is analgous to debugging or refactoring the brain itself, on the fly, without taking the system offline. It's an ambitious and powerful idea.
The top 10 cognitive distortions from this book are:
- All-or-nothing thinking
- Overgeneralization
- Mental filter
- Disqualifying the positive
- Jumping to conclusions
- Magnification of the negative (and minimization of the positive)
- Emotional reasoning (It feels true so it must be true)
- Should statements (I should feel better by now)
- Labeling and mislabeling ("I'm such a piece of shit" <-- "shit" is a label.)
- Personalization (Blaming yourself for things that are outside your control)
There are many techniques which Doctor Burns spells out for identifying your thoughts (simply noticing your own thoughts is the first challenge...) then identifying which of the cognitive distortions are present in a given thought and then writing out a revised version of the thought.
Feeling Good has chapters focused on:
- Self esteem
- Do-Nothingism
- Criticism
- Anger
- Guilt
- Approval
- Love addiction
- Your Work is Not Your Worth
- Perfectionism
But CBT did not stop with that book -- and there have been many upheavels in the world of psychology since then (and will be many more in the future too).
The major heir to the throne of non-pharmacological assistance with Mental Health and Fitness is now a particular branch of CBT called "ACT", which stands for "Acceptance and Commitment Therapy" and is pronounced "Act".
ACT, in contrast to classic CBT, concedes that you can't necessarily eliminate bad feelings, and you can't necessarily eliminate or re-write harmful thoughts. Their general attitude to classic CBT is: "Give it a go, by all means, maybe you will reduce some of your bad feelings, quite a bit, and maybe you'll succeed at rewriting some harmful thoughts -- that's great! But when you still feel bad and when you still have unhelpful thoughts... you haven't failed at CBT... it's just time for ACT to get involved."
The A in ACT is "Acceptance". We need to accept that thoughts and feelings will arise, and not expend all of our energy in a futile quest to "control" our moods or "control" our thoughts. Equally, we can't control the past, and must accept it. What we can control is our behavior: the way we choose to act. And we can act despite our moods, despite our feelings and our negative thoughts. But to do this takes commitment (the "C" in ACT). If we manage to do this, to act in a way that is in accordance with our values, then whether we felt good or not is of less importance. That's my summary of the thing.
Some of the crucial concepts in ACT are "mindfulness", "values" and "defusion".
While my favorite 'classic CBT' book is 'Feeling Good' -- my favorite 'ACT' book is 'The Happiness Trap' by Dr. Russ Harris (an Australian). It's available as a book, a paper back, a pocket-cartoon version and more.
Here is a short movie from Russ Harris, demonstrating one of the concepts. There are many more of these:
Nicky Case, a brilliant programmer and mental health advocate has made a 'zine version' available, which you can find by clicking on this image:
...then print and carry around, ready for when the glums attack you.
External references
- Nicky Case: Happiness Trap as a zine
- Amazon: The Happiness Trap
- Open Sourcing Mental Illness — "Changing how we talk about mental health in the tech community"