Cognitive Behavioral Therapy Quotes

My mama always compared bad thoughts to a bird in a barn. If a bird flies into the barn, you can acknowledge that there’s a bird in the barn, but you don’t have to suddenly make a nest for it. Just let the bird fly in and it’ll eventually fly out.” Which is, in essence, cognitive behavioral therapy

Someone's got to do some more research, but I would really like to know: when a CBT therapist really gets distressed, who does he go see?

Our thoughts have prepared for us the happiness or unhappiness we experience.

my favourite emotions include 'brief calmness in good weather' and 'i am the only person alive

a kind of emptiness existed in the center of my bagel; really it was just the hole that's in the middle of all bagels; 'i need to go read my blog to find out what my politics are

Therapy that is focused on battling “irrational beliefs,” such as cognitive behavioral therapy (CBT), doesn’t work as well on Autistic people as it does on neurotypicals.[72] One reason for that is many of the fears and inhibitions of Autistic people are often entirely reasonable, and rooted in a lifetime of painful experiences. We tend to be pretty rational people, and many of us are already inclined to analyze our thoughts and feelings very closely (sometimes excessively so). Autistics don’t need cognitive behavioral training to help us not be ruled by our emotions. In fact, most of us have been browbeaten into ignoring our feelings too much.

note the similarities with buddhism a buddhist who has achieved nirvana is not sad primarily because it does not know the concept of sad [...]

Self-care is never selfish, but it may feel that way when you live a frenzied life.

as a teenager i experienced existential despair as an unsexy sensation of repressed orgasm in the chest; today i experience existential despair as a distinct sensation of wanting to lecture you on how i am better than you, without crushing your hopes and dreams

You have considerable power to construct self-helping thoughts, feelings and actions as well as to construct self-defeating behaviors. You have the ability, if you use it, to choose healthy instead of unhealthy thinking, feeling and acting.

We learn to become more empathic when we slow down, become present, and are fully committed to understanding another person’s uniqueness.

Awareness is the first step in rewriting old stories.

Critical race Theory’s hallmark paranoid mind-set, which assumes racism is everywhere, always, just waiting to be found, is extremely unlikely to be helpful or healthy for those who adopt it. Always believing that one will be or is being discriminated against, and trying to find out how, is unlikely to improve the outcome of any situation. It can also be self-defeating. In The Coddling of the American Mind, attorney Greg Lukianoff and social psychologist Jonathan Haidt describe this process as a kind of reverse cognitive behavioral therapy (CBT), which makes its participants less mentally and emotionally healthy than before.60 The main purpose of CBT is to train oneself not to catastrophize and interpret every situation in the most negative light, and the goal is to develop a more positive and resilient attitude towards the world, so that one can engage with it as fully as possible.

There’s no reason, on paper at least, why I need these pills to get through life. I had a great childhood, loving parents, the whole package. I wasn’t beaten, abused, or expected to get nothing but As. I had nothing but love and support, but that wasn’t enough somehow. My friend Erin says we all have demons inside us, voices that whisper we’re no good, that if we don’t make this promotion or ace that exam we’ll reveal to the world exactly what kind of worthless sacks of skin and sinew we really are. Maybe that’s true. Maybe mine just have louder voices. But I don’t think it’s as simple as that. The depression I fell into after university wasn’t about exams and self-worth, it was something stranger, more chemical, something that no talking cure was going to fix. Cognitive behavioral therapy, counseling, psychotherapy—none of it really worked in the way that the pills did. Lissie says she finds the notion of chemically rebalancing your mood scary, she says it’s the idea of taking something that could alter how she really is. But I don’t see it that way; for me it’s like wearing makeup—not a disguise, but a way of making myself more how I really am, less raw. The best me I can be.

Ask yourself if you’re taking the time to see beyond the surface.

that was bad; i shouldn't have done that to prevent you from entering a catatonic state i am going to maintain a calm facial expression with crinkly eyes and an overall friendly demeanor i believe in a human being that is not upset i believe if you are working i should not be insane or upset--why am i ever insane or upset and not working? i vacuumed the entire house this morning i cleaned the kitchen and the computer room and i made you a meat helmet with computer paper the opportunity for change exists in each moment, all moments are alone and separate from other moments, and there are a limited number of moments and the idea of change is a delusion of positive or negative thinking your hands are covering your face and your body moves like a statue when i try to manipulate an appendage if i could just get you to cry tears of joy one more time

Happiness is not dependent on the good or bad opinion of others, but instead upon your actions.   It

Doing good induces others to reciprocate.

When we give and receive empathy, transformation occurs.

People who help others on a regular basis are ten times more likely to be healthy than people who do not.

To help people achieve the three basic REBT philosophies of unconditional self-acceptance, unconditional other-acceptance, and unconditional life-acceptance, cognitive, emotional, and behavioral methods, which are described in this monograph, are used.

Therapy that is focused on battling “irrational beliefs,” such as cognitive behavioral therapy (CBT), doesn’t work as well on Autistic people as it does on neurotypicals. One reason for that is many of the fears and inhibitions of Autistic people are often entirely reasonable, and rooted in a lifetime of painful experiences. We tend to be pretty rational people, and many of us are already inclined to analyze our thoughts and feelings very closely (sometimes excessively so). Autistics don’t need cognitive behavioral training to help us not be ruled by our emotions. In fact, most of us have been browbeaten into ignoring our feelings too much.

Authenticity soothes the soul.

Since you've had a reasonable amount of cognitive behavioral therapy, you tell yourself, I am not my thoughts, even though deep down you're not sure what exactly that makes you.

Cognitive behavioral therapy (CBT) sees depression as a triad of thinking patterns: a negative view of yourself, a negative view of the world, and a negative view of the future.

In projecting onto others their own moral sense, therapists sometimes make terrible errors. Child physical abusers are automatically labeled “impulsive," despite extensive evidence that they are not necessarily impulsive but more often make thinking errors that justify the assaults. Sexual and physical offenders who profess to be remorseful after they are caught are automatically assumed to be sincere. After all, the therapist would feel terrible if he or she did such a thing. It makes perfect sense that the offender would regret abusing a child. People routinely listen to their own moral sense and assume that others share it. Thus, those who are malevolent attack others as being malevolent, as engaging in dirty tricks, as being “in it for the money,“ and those who are well meaning assume others are too, and keep arguing logically, keep producing more studies, keep expecting an academic debate, all the time assuming that the issue at hand is the truth of the matter. Confessions of a Whistle-Blower: Lessons Learned Author: Anna C. Salter. Ethics & Behavior, Volume 8, Issue 2 June 1998 p122

When I force myself to utter the awkward phrase, "I am grateful," I actually start to feel a bit more grateful...It's basic cognitive behavioral therapy: Behave in a certain way, and your mind will eventually catch up with your actions.

I’m going to recommend a simple framework for evaluating and changing your behavior based on a combination of cognitive-behavioral therapy and ancient Stoic practices. It consists of the following steps: 1. Evaluate the consequences of your habits or desires in order to select which ones to change. 2. Spot early warning signs so that you can nip problematic desires in the bud. 3. Gain cognitive distance by separating your impressions from external reality. 4. Do something else instead of engaging in the habit.

Masha is a professional, qualified counselor and psychotherapist. Her techniques include cognitive behavioral therapy, neuro-linguistic program and hypnotherapy. Her background also includes teaching senior executives and makes them understand how to manage a major emergency.

Cognitive behavioral therapy is kind of the same thing: You examine your thoughts like a scientist so you can challenge the ones that don’t hold up. So let’s look at this fear, this belief or, or thought pattern you’ve noticed. Just because a feeling is real doesn’t mean it’s true.

In my research, I have discovered practical, effective ways to do so. I’ll explain more in chapter 11, but for now let it suffice to say that you can modify your Emotional Style to improve your resilience, social intuition, sensitivity to your own internal emotional and physiological states, coping mechanisms, attention, and sense of well-being. The amazing fact is that through mental activity alone we can intentionally change our own brains. Mental activity, ranging from meditation to cognitive-behavior therapy, can alter brain function in specific circuits,

For people who are depressed, and especially for those who do not receive enough benefit from medication of for whom the side effects of antidepressants are troubling, the fact that placebos can duplicate much of the effects of antidepressants should be taken as good news. It means that there are other ways of alleviating depression. As we have seen, treatments like psychotherapy and physical exercise are at least as effective as antidepressant drugs and more effective than placebos. In particular, CBT has been shown to lower the risk of relapsing into depression for years after treatment has ended, making it particularly cost effective.

The wound is the place where light enters you.

Thought challenging, also referred to as cognitive restructuring, is a process by which a person challenges the negative patterns of thinking that leads to anxiety.

Generous people are likely to receive more respect from their peers.

Empathy plays a crucial role in the reduction of stress from the moment of birth.

Doing good does us good.

Goodness makes our world a better place because human beings are kinder to each other when we feel safe and secure.

Empathy allows us to enter the world of another. It allows us to take a mental vacation from ourselves.

cognitive restructuring (borrowed from cognitive-behavioral therapy)

Values give rise to goals, and we reach those goals by planning and completing specific activities.

It takes enormous courage and humility to be open to others to find out who we really are.

The human feeling experience, much like the weather, is often unpredictably changeable. No “positive” feeling can be induced to persist as a permanent experience, no matter what Cognitive-Behavioral Therapy tells us. As disappointing as this may be, as much as we might like to deny it, as much as it causes each of us ongoing life frustration, and as much as we were raised and continue to be reinforced for trying to control and pick our feelings, they are still by definition of the human condition, largely outside the province of our wills.

Weight-loss methods aren’t marketed as diets but as “lifestyle changes,” “detoxes,” “cleanses,” and “cognitive behavioral therapy.” That shifting language allows the weight-loss industry to cloak its same old diets in the languages of holistic wellness and self-care. We may talk about diets differently today, but social mandates to become thin are as strong as ever.

The claim that patients can recover [from ME/CFS] as a result of CBT and GET is not justified by the data, and is highly misleading to clinicians and patients considering these treatments.

ACT uses acceptance and mindfulness processes and commitment and behavioral activation processes to produce psychological flexibility. It seeks to bring human language and cognition under better contextual control so as to overcome the repertoire-narrowing effects of an excessive reliance on a problem-solving mode of mind as well as to promote a more open, centered, and engaged approach to living.

For example, in order to identify these schemas or clarify faulty relational expectations, therapists working from an object relations, attachment, or cognitive behavioral framework often ask themselves (and their clients) questions like these: 1. What does the client tend to want from me or others? (For example, clients who repeatedly were ignored, dismissed, or even rejected might wish to be responded to emotionally, reached out to when they have a problem, or to be taken seriously when they express a concern.) 2. What does the client usually expect from others? (Different clients might expect others to diminish or compete with them, to take advantage and try to exploit them, or to admire and idealize them as special.) 3. What is the client’s experience of self in relationship to others? (For example, they might think of themselves as being unimportant or unwanted, burdensome to others, or responsible for handling everything.) 4. What are the emotional reactions that keep recurring? (In relationships, the client may repeatedly find himself feeling insecure or worried, self-conscious or ashamed, or—for those who have enjoyed better developmental experiences—perhaps confident and appreciated.) 5. As a result of these core beliefs, what are the client’s interpersonal strategies for coping with his relational problems? (Common strategies include seeking approval or trying to please others, complying and going along with what others want them to do, emotionally disengaging or physically withdrawing from others, or trying to dominate others through intimidation or control others via criticism and disapproval.) 6. Finally, what kind of reactions do these interpersonal styles tend to elicit from the therapist and others? (For example, when interacting together, others often may feel boredom, disinterest, or irritation; a press to rescue or take care of them in some way; or a helpless feeling that no matter how hard we try, whatever we do to help disappoints them and fails to meet their need.)

Action seems to follow feeling, but really action and feeling go together; and by regulating the action, which is under the more direct control of the will, we can indirectly regulate the feeling, which is

Cognitive behavioral therapy, counseling, psychotherapy—none of it really worked in the way that the pills did. Lissie says she finds the notion of chemically rebalancing your mood scary, she says it’s the idea of taking something that could alter how she really is. But I don’t see it that way; for me it’s like wearing makeup—not a disguise, but a way of making myself more how I really am, less raw. The best me I can be.

Anxiety, in a generalized sense, is a fear of “what if.” From a cognitive behavioral therapy perspective, to the anxious person, the fear that it could happen is as real as if it is happening.2 In the case of IAD, “I feel like I’m dying” can quickly and easily become “I am dying.” In a nutshell, this is how anxiety works: it ignores the present and often obscures the facts that might keep an individual feeling safe and secure.

Many of the benefits of CBT (cognitive behavioral therapy) can be obtained without going into therapy. There are a number of self-help books, CDs and computer programs that have been used to treat depression and some of these have been tested in clinical trials with positive results. I can particularly recommend these two books. One is 'Control Your Depression', the lead author of which is Peter Lewinsohn, a Professor of Psychology at the University of Oregon. ... The other book that I can recommend with confidence is 'Feeling Good' by the psychiatrist David Burns. 'Control Your Depression' emphasizes behavioral techniques like increasing pleasant activities, improving social skills and learning to relax. 'Feeling Good' puts greater emphasis on changing the way people think about themselves. But both books include both cognitive and behavioral techniques.

our ability to feel our feelings as they move as energy through our body with our ability to talk about what we feel. We can sit in therapy, tell sad stories, and talk about feeling sad without ever having the bodily experience of sadness. Psychology has historically focused too much on cognition and behavior while neglecting the process that underlies them both: emotion. But current neuroscientific research reveals emotion (also called affect in the scientific literature) as the central driver behind why we are the way we are, and how we develop and heal.2 We now know that most psychopathology, or mental illness, is the result of the inability to effectively regulate emotion.

Acceptance and commitment therapy, a variant on cognitive therapy, attempts to teach people to accept rather than change their emotions and make decisions within the context of what they value, as opposed to letting negative feelings control their behavior.

The way in which I do this, the tools that I use, derive from a school of psychology known as dialectical behavior therapy, or DBT, developed in the 1990s by Marsha Linehan. Based on the principles of cognitive behavioral therapy, which seeks to teach patients new ways of thinking about or acting on their problems, DBT was developed to help individuals with more serious and potentially dangerous issues, such as an inability to regulate their emotions and a propensity to harm themselves or even attempt suicide.

The hamster friend said being able to do front rolls didn't make the hamster as good as Bruce Lee, which was not a true statement and not an untrue statement, because the word 'good' is meaningless until defined within a context and a goal, and hamsters when enjoying the company of other hamsters rarely define or think about contexts and goals, because to do so would make them aware of certain things about the universe that would make them feel a kind of emptiness or 'neutrality of emotion' that is usually desirable only in situations where the hamster wants to stop his or her self-perpetuating cycle of negative thinking, in order to fight severe depression or crippling loneliness. In a situation of severe depression or crippling loneliness caused by a period of time of uncontrollable negative thinking this 'kind of emptiness'--effected by an understanding (of the arbitrary nature of the universe) that is attained by thinking comprehensively about context, goals, and meaning--can be used to neutralize the hamster's automatic and self-perpetuating pattern of negative thoughts, at which point the hamster can form new thoughts, that will cause new behaviors, that will cause new patterns of thought, with which the hamster can better function in life and in relationships with other hamsters.

As a physician bedridden with myalgic encephalomyelitis (ME) for more than a decade who is totally dependent on others, all thanks to a major relapse caused by GET, I am in a unique position to answer how harmful GET and cognitive behavioral therapy (CBT) really are. The basis of these therapies is false illness beliefs, meaning that it is all in the mind. These beliefs ignore all of the evidence that ME is a physical disease, such as intracellular immune dysfunctions, which not only restrict exercise capacity but also worsen with exercise (2).

Cognitive Therapy Instead of behavior, cognitive therapy emphasizes changing thoughts and beliefs. Cognitive therapists believe that irrational beliefs or distorted thinking patterns lead to social anxiety so they teach patients to think in more rational, constructive ways.

Self-compassion practice can be fruitfully compared to the techniques of cognitive behavioral therapy (CBT). This is a highly respected form of treatment, with a considerable amount of evidence that it is effective for many individuals. An important aspect of the therapy, as described in the popular book Feeling Good by the psychiatrist David Burns, is challenging irrational thoughts. For instance, if you make an overly broad generalization, like “I’m such a loser,” you might dispute it by trying to recall situations where you demonstrated poise and accomplishment.

If for example you are diagnosed with depression, then your clinician might prescribe therapy to reduce your depression and or recommend anti-depressant medication. As we have discussed previously though, reducing the symptoms of mental illness does not seem to reduce the probability that someone will make a suicide attempt. Two treatments in particular, dialectical behavior therapy DBT and cognitive behavioral therapy for suicide prevention, CBT-SP, have demonstrated the ability to reduce the probability of suicidal behaviors in multiple studies conducted by multiple research teams. Other treatments that share many of the same characteristics and components as these treatments via attempted suicide.

CBT is a much publicised and debated psychotherapeutic intervention for ME/CFS….The premise that cognitive therapy (eg. changing ‘illness beliefs’) and graded activity can ‘reverse’ or cure this illness is not supported by post-intervention outcome data. In routine medical practice, CBT has not yielded clinically significant outcomes for patients with ME/CFS.

One of the most common mental habits that makes us feel out of control is catastrophizing—otherwise known as making a mountain out of a molehill. A simple way to help kids avoid catastrophizing is to teach them to ask themselves, whenever they’re upset, “Is this a big problem or a little problem?” In cognitive behavioral therapy, kids are taught to distinguish between a disaster (like famine) and something that’s temporarily frustrating or embarrassing, between “I’ll die if this happens” and “I’ll be disappointed but I probably won’t die.” If it’s a little problem, the first line of defense is to use self-soothing mechanisms, like a cool-down spot, deep breathing, or Plan B thinking, to calm themselves down. For most problems, these tools will be enough. When problems feel too big, we want kids to seek help.

However one may interpret this culturally, the upshot is the same: people carry within them a great number of wishes to which they react passively and which they hide. Stoicism, in our day, is not strength to overcome wishes, but to hide them. To a patient who, let us say, is interminably rationalizing and justifying this and that, balancing one thing against another as though life were a tremendous market place where all the business is done on paper and tickertape and there are never any goods, I sometimes have the inclination in psychotherapy to shout out, “Don't you ever want anything?” But I don't cry out, for it is not difficult to see that on some level the patient does want a good deal; the trouble is he has formulated and reformulated it, until it is the “rattling of dry bones,” as Eliot puts it. Tendencies have become endemic in our culture for our denial of wishes to be rationalized and accepted with the belief that this denial of the wish will result in its being fulfilled. And whether the reader would disagree with me on this or that detail, our psychological problem is the same: it is necessary for us to help the patient achieve some emotional viability and honesty by bringing out his wishes and his capacity to wish. This is not the end of therapy but it is an essential starting point.

Albert Ellis, who founded Rational Emotive Behavior Therapy, a precursor to cognitive behavior therapy, taught me the extent to which we teach ourselves negative feelings about ourselves—and the negative and self-defeating behaviors that follow from these feelings. He showed that underlying our least effective and most harmful behaviors is a philosophical or ideological core that is irrational but is so central to our views of our self and the world that often we aren’t aware that it is only a belief, nor are we aware of how persistently we repeat this belief to ourselves in our daily lives. The belief determines our feelings (sadness, anger, anxiety, etc.), and our feelings in turn influence our behavior (acting out, shutting down, self-medicating to ease the discomfort). To change our behavior, Ellis taught, we must change our feelings, and to change our feelings, we change our thoughts.

This is not an argument with psychiatry. Mental and physical illness are equally real and horrible. As with any long-term illness, some people with ME/CFS will develop comorbid depression and other mental health problems – where CBT can be of help alongside good quality general management. The argument here is with a flawed model of causation assuming efficacy for CBT and GET while taking no significant account of varying clinical presentations and disease pathways.

For five years, I have been sick and I have been trying to will myself to be better. To think harder about being better, to improve more. To become a better breather, reactor, meditator, hoping that if I just try hard enough, the symptoms will go away and I’ll feel like myself again, like a self I remember as if out of a rearview mirror except with this one, the objects are smaller than they appear. I have tried to force myself to be more clearheaded, energetic, grounded. Tried yoga, acupuncture, cognitive behavioral therapy, talk therapy, and long walks in the woods. And every few months, when I finally felt I’d reached a zenith of my abilities with yoga, CBT, or talk therapy, I would give it another shot: go to another doctor, a Western doctor, one with an M.D. and a white coat, and I would tell him or her my symptoms (for the gender of the doctor does not matter only, it would seem, my gender), and hope that once again, the doctor would pay attention, would take my case, would try to help me so that I didn’t have to so deeply and fervently try to help myself.

A useful first step is to reverse engineer the situation back to the triggering event and to define the specific problem you are facing. You can then determine options for handling it. The various manifestations of anger reflect a sense that something is “not fair,” which is related to a should statement, such as “this should not happen.” Dealing with “shoulds” involves acknowledging that you obviously are not happy that something happened, but that you must still face the fact that it did happen. Thus, the task then turns to dealing with the situation.

ME/CFS has been classified as a neurological disease by the WHO since 1969 [59] and a growing number of researchers theorize that ME/CFS might be a neuro-immunological condition [60–63]: yet the BPS framework does not account for ME/CFS as a neurological or immunological disease – instead, much of the pro- BPS model literature on ME/CFS adopts what Nassir Ghaemi terms the ‘eclectic approach’; whereby everything appears important, all bio, all psycho, and all social factors [33]. Yet in clinical practice (the BPS framework), there is strong emphasis on psychological interventions (CBT and GET).

Two powerful factors drive avoidance of activities: 1An immediate sense of relief from dodging what we think will be difficult 2Not experiencing the reward from engaging in the activity, thereby further diminishing our motivation for it Behavioral activation is designed to break these patterns. Lead with Action Like Beth, many of us are waiting to feel better so we can get back to the things we used to enjoy. However, it’s much more efficient to gradually start doing rewarding activities, even if we don’t feel like it. The interest in the activities will follow. This approach is the foundation of behavioral activation for depression.

To Greg, who had suffered from bouts of depression throughout his life, this seemed like a terrible approach. In seeking treatment for his depression, he—along with millions of others around the world—had found that cognitive behavioral therapy (CBT) was the most effective solution. CBT teaches you to notice when you are engaging in various “cognitive distortions,” such as “catastrophizing” (If I fail this quiz, I’ll fail the class and be kicked out of school, and then I’ll never get a job . . .) and “negative filtering” (only paying attention to negative feedback instead of noticing praise as well). These distorted and irrational thought patterns are hallmarks of depression and anxiety disorders. We are not saying that students are never in real physical danger, or that their claims about injustice are usually cognitive distortions. We are saying that even when students are reacting to real problems, they are more likely than previous generations to engage in thought patterns that make those problems seem more threatening, which makes them harder to solve. An important discovery by early CBT researchers was that if people learn to stop thinking this way, their depression and anxiety usually subside. For this reason, Greg was troubled when he noticed that some students’ reactions to speech on college campuses exhibited exactly the same distortions that he had learned to rebut in his own therapy. Where had students learned these bad mental habits? Wouldn’t these cognitive distortions make students more anxious and depressed?

I’m going to recommend a simple framework for evaluating and changing your behavior based on a combination of cognitive-behavioral therapy and ancient Stoic practices. It consists of the following steps: 1. Evaluate the consequences of your habits or desires in order to select which ones to change. 2. Spot early warning signs so that you can nip problematic desires in the bud. 3. Gain cognitive distance by separating your impressions from external reality. 4. Do something else instead of engaging in the habit. In addition, consider how you might introduce other sources of healthy positive feelings by: 1. Planning new activities that are consistent with your core values. 2. Contemplating the qualities you admire in other people. 3. Practicing gratitude for the things you already have in life.

What was I doing right before I felt like that? Where was I when I felt like that? Are there places where I never have those feelings? How was I acting just beforehand? What was I thinking about before those feelings started? Are there certain beliefs I hold that seem to increase those feelings? Whom was I with when I felt like that? Do I feel like that with everyone? ​For example, some people may feel sad and hopeless in relation to a fear that they will be alone their whole lives. Focusing on that situation, you could notice the fact that this feeling might arise more often when home alone late at night, but rarely feel this way when spending time with friends. You might realize that you think things like “I will never find a girlfriend/boyfriend” based on negative beliefs about your desirability as a partner.

We can see that there are many ways in which we actively contribute to our own experience of mental unrest and suffering. Although, in general, mental and emotional afflictions themselves can come naturally, often it is our own reinforcement of those negative emotions that makes them so much worse. For instance when we have anger or hatred towards a person, there is less likelihood of its developing to a very intense degree if we leave it unattended. However, if we think about the projected injustices done to us, the ways in which we have been unfairly treated, and we keep on thinking about them over and over, then that feeds the hatred. It makes the hatred very powerful and intense. Of course, the same can apply to when we have an attachment towards a particular person; we can feed that by thinking about how beautiful he or she is, and as we keep thinking about the projected qualities that we see in the person, the attachment becomes more and more intense. But this shows how through constant familiarity and thinking, we ourselves can make our emotions more intense and powerful.

…we encourage you to trust your coping plan over the long haul. It is useful to acknowledge your small and daily successes, such as facing things you would typically avoid. There will likely be daily examples of slipups, too, but, similar to looking at a garden, we encourage you to focus on the flowers as much, if not more so, than you do the weeds. As an aside, both of us have taken up bike riding in the past few years. In our appreciation of the multiday, grand stage races in Europe, such as the Tour de France, we have seen a metaphor that helps to illustrate the goal of coping with ADHD. These multiple stage bike races last from 3 or 4 days on up to 3 weeks. Different days are spent climbing steep mountain roads, traversing long flat stages of over a hundred miles that end in all out sprints to the finish line, and individual time trials where each rider goes out alone and covers the distance as quickly as possible, known as “the race of truth.” The grand champion of a multiday race, however, is the rider whose cumulative time for all the stages is the fastest. That is, if you ride well enough, day-in and day-out, you will be a champion even though you may not be the first rider to cross the finish line on any single day’s race. Similarly, managing ADHD is an endurance sport. You need not cope perfectly all day, every day. The goal is to make progress, cope well enough, handle setbacks without giving up, and over time you will recognize your victory. Just keep pedaling.

Cognitive-Behavioral Therapy There are almost no pure cognitive or behavioral therapists. Instead, most therapists use a combination of both techniques. This is known as cognitive-behavioral therapy. It is generally recognized as the best therapy for social anxiety. In cognitive-behavioral therapy, a therapist helps you identity maladaptive thinking patterns and replace them with new ways of thinking. He or she also teaches you relaxation techniques and new behaviors that make you feel more comfortable in social situations. Cognitive-behavioral therapy uses many of the same techniques that we explored in the previous chapter. Although you might make great strides on your own, sometimes it is easier and faster to have someone guide you. Often it is difficult for people to explore hidden beliefs about themselves. A professional therapist is experienced in working with people who are trying to change. Often a therapist will see connections in your situation that you cannot. Carlos was terrified of speaking in class. Whenever the teacher called on him, his heart raced, he blushed, and his stomach felt upset. His therapist first had him focus on his thoughts during class. As an experiment, she had him purposely answer a question incorrectly during biology class. To his surprise, the teacher didn’t make a big deal out of it, and the other students didn’t laugh. As a result, Carlos realized that his imagined consequences for making errors were greatly exaggerated. He also realized that he held himself to a higher standard than other people, including the teacher, did. Next, his therapist showed him various relaxation techniques to lessen the physical symptoms of anxiety. Soon, he felt more comfortable and even volunteered to lead a discussion group.

There presently exist three recognized conceptualizations of the antisocial construct: antisocial personality disorder (ASPD) as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013), dissocial personality disorder in the International Classification of Diseases (ICD-10; World Health Organization, 1992), and psychopathy as formalized by Hare with the Psychopathy Checklist—Revised (PCL-R; Hare, 2003). A conundrum for therapists is that these conceptualizations are overlapping but not identical, emphasizing different symptom clusters. The DSM-5 emphasizes the overt conduct of the patient through a criteria set that includes criminal behavior, lying, reckless and impulsive behavior, aggression, and irresponsibility in the areas of work and finances. In contrast, the criteria set for dissocial personality disorder is less focused on conduct and includes a mixture of cognitive signs (e.g., a tendency to blame others, an attitude of irresponsibility), affective signs (e.g., callousness, inability to feel guilt, low frustration tolerance), and interpersonal signs (e.g., tendency to form relationships but not maintain them). The signs and symptoms of psychopathy are more complex and are an almost equal blend of the conduct and interpersonal/affective aspects of functioning. The two higher-order factors of the PCL-R reflect this blend. Factor 1, Interpersonal/Affective, includes signs such as superficial charm, pathological lying, manipulation, grandiosity, lack of remorse and empathy, and shallow affect. Factor 2, Lifestyle/Antisocial, includes thrill seeking, impulsivity, irresponsibility, varied criminal activity, and disinhibited behavior (Hare & Neumann, 2008). Psychopathy can be regarded as the most severe of the three disorders. Patients with psychopathy would be expected to also meet criteria for ASPD or dissocial personality disorder, but not everyone diagnosed with ASPD or dissocial personality disorder will have psychopathy (Hare, 1996; Ogloff, 2006). As noted by Ogloff (2006), the distinctions among the three antisocial conceptualizations are such that findings based on one diagnostic group are not necessarily applicable to the others and produce different prevalence rates in justice-involved populations. Adding a further layer of complexity, therapists will encounter patients who possess a mixture of features from all three diagnostic systems rather than a prototypical presentation of any one disorder.

Catastrophizing. Predicting extremely negative future outcomes, such as “If I don’t do well on this paper, I will flunk out of college and never have a good job.”   All-or-nothing. Viewing things as all-good or all-bad, black or white, as in “If my new colleagues don’t like me, they must hate me.” Personalization. Thinking that negative actions or words of others are related to you, or assuming that you are the cause of a negative event when you actually had no connection with it. Overgeneralizations. Seeing one negative situation as representative of all similar events. Labeling. Attaching negative labels to ourselves or others. Rather than focusing on a particular thing that you didn’t like and want to change, you might label yourself a loser or a failure. Magnification/minimization. Emphasizing bad things and deemphasizing good in a situation, such as making a big deal about making a mistake, and ignoring achievements. Emotional reasoning. Letting your feelings about something guide your conclusions about how things really are, as in “I feel hopeless, so my situation really must be hopeless.” Discounting positives. Disqualifying positive experiences as evidence that your negative beliefs are false—for example, by saying that you got lucky, something good happened accidentally, or someone was lying when giving you a compliment. Negativity bias. Seeing only the bad aspects of a situation and dwelling on them, in the process viewing the situation as completely bad even though there may have been positives. Should/must statements. Setting up expectations for yourself based on what you think you “should” do. These usually come from perceptions of what others think, and may be totally unrealistic. You might feel guilty for failing or not wanting these standards and feel frustration and resentment. Buddhism sets this in context. When the word “should” is used, it leaves no leeway for flexibility of self-acceptance. It is fine to have wise, loving, self-identified guidelines for behavior, but remember that the same response or action to all situations is neither productive nor ideal. One size never fits all.  Jumping to conclusions. Making negative predictions about the outcome of a situation without definite facts or evidence. This includes predicting a bad future event and acting as if it were already fact, or concluding that others reacted negatively to you without asking them. ​Dysfunctional automatic thoughts like these are common. If you think that they are causing suffering in your life, make sure you address them as a part of your CBT focus.

cognitive behavioral therapy

Yet where this idea really hits home is with the breath, the one response over which we have control and which, in turn, exerts control through the alarm system that is the autonomic nervous system. Porges says he realized a long time ago—because he is a musician, specifically a horn player—that the act of controlling the breath to control the rhythm of music and at the same time engaging the brain to execute the mechanics of music works like a mental therapy. To his mind, it has all the elements of pranayama yoga, a form of yoga that stresses breath control. Breath control is common in most of yoga but also in meditation, and even in modern-day “evidence-based practices” like cognitive behavioral therapy. Relax. Take a deep breath. This

In cognitive behavioral therapy we call this defusion. Becoming aware of this difference de-fuses—creates a distance between—the part of you that is hyperreactive to threat and the rational part of you that can notice your thoughts, emotions, and bodily sensations, and learn to override them when necessary.

​Cognitive theory outlines three levels of thoughts and beliefs: automatic thoughts, assumptions, and core beliefs.

Often, automatic thoughts overestimate threats and underestimate our ability to deal with problems. Sometimes they become distorted, but we continue to accept them as true. These thoughts are the result of dysfunctional beliefs about ourselves, others, and the world, and they can be exaggerated by depression or anxiety. These thoughts can be identified, challenged, and replaced with more reasonable thoughts.

​The second level, known as intermediate beliefs or assumptions, consists of views about the world that are less situation specific than automatic thoughts. They are essentially a type of rule or generalization that individuals develop as they process and categorize the patterns and information around them. These beliefs shape thoughts, which then influence behavior. Like automatic thoughts, assumptions can become distorted. For example, “If I am successful in the business world, I will be loved” and “If I do not make myself more physically attractive, I will never find a spouse” are dysfunctional assumptions.

core beliefs are foundational beliefs about the world that we usually form in childhood. These are reinforced throughout life by our perceptions. They are generalized and absolute, though they can be completely false. People tend to focus on new information that confirms existing beliefs and ignore information that contradicts them, making core beliefs hard to change. Negative and dysfunctional core beliefs can act as drivers for dysfunctional assumptions and negative thoughts. For example, a core belief that “I’m unlovable” may lead to assumptions about the success or appearance needed to ensure love from others. Core beliefs often relate to achievement and relationships with others. Assumptions and core beliefs can be challenged and altered with a similar approach to automatic thoughts.

In the absence of effort the OCD pathology drives the brain’s circuitry, and compulsive behaviors result. But mental effort, I believe, generates a directed mental force that produces real physical effects: the brain changes that follow cognitive-behavioral therapy for OCD. The heroic mental effort required underlines the power of active mental processes like attention and will to redirect thoughts and actions in a way that is detectable on brain scans. Let me be clear about where mental effort enters the picture. The OCD patient is faced with two competing systems of brain circuitry. One underlies the passively experienced, pathological intrusions into consciousness. The other encodes information like the fact that the intrusions originate in faulty basal ganglia circuits. At first the pathological circuitry dominates, so the OCD patient succumbs to the insistent obsessions and carries out the compulsions. With practice, however, the conscious choice to exert effort to resist the pathological messages, and attend instead to the healthy ones, activates functional circuitry. Over the course of several weeks, that regular activation produces systematic changes in the very neural systems that generate those pathological messages—namely, a quieting of the OCD circuit. Again quoting James, “Volitional effort is effort of attention…. Effort of attention is thus the essential phenomenon of will.

Despite the objection from his mother he had decided to visit a clinic with the woman. He knew, he would forever be obliged to her. He had found a job, but he could not keep it because of his addiction. He had no money. The woman paid the expenses. She introduced him to people who would understand his problem and help him deal with it. She made him join Sex Addicts Anonymous. She helped him deal with his urges. He had started to believe that sexual addiction was real. Suddenly, everything made sense. He was not a freak, he had a serious problem. He suffered from a disorder. He had the option to set things straight. He underwent Cognitive Behavioral Therapy, which he benefited from. A prostitute had set him free. - from story 109 of You Me & Stories

What about the claim, by the PACE trial, that Graded Exercise Therapy and CBT can treat ME? This is a trial where you could enter moderately ill, get worse in the trial, and be declared ‘recovered’ at the end. Even the recent follow-up study conceded that, long-term, Graded Exercise and CBT are no better for ME than doing nothing. Investigative journalists and academics alike have dismissed the PACE trial as ‘clinical trial amateurism’. Like MS or epilepsy, which were also once wrongly believed to be psychiatric disorders, ME is a neurological disease, and the World Health Organisation lists it as such. I am too weak to walk more than a few metres, needing to lie in bed 21 hours a day. With the little energy I have, I am an ME patient activist.

But even drugged to the gills, I remained filled with dread about the impending book tour, so I went also to a young but highly regarded Stanford-trained psychologist who specialized in cognitive behavioral therapy, or CBT. “First thing we’ve got to do,” she said in one of my early sessions with her, “is to get you off these drugs.” A few sessions later, she offered to take my Xanax from me and lock it in a drawer in her desk. She opened the drawer to show me the bottles deposited there by some of her other patients, holding one up and shaking it for effect. The drugs, she said, were a crutch that prevented me from truly experiencing and thereby confronting my anxiety; if I didn’t expose myself to the raw experience of anxiety, I would never learn that I could cope with it on my own.

Thus, while it may be fairly easy to like yourself when feelings of love or happiness or serenity are present, deeper psychological health is seen only when you can maintain a posture of self-love and self-respect in the times of emotional hurt that accompany life’s inevitable contingencies of loss, loneliness, confusion, uncontrollable unfairness, and accidental mistake. The human feeling experience, much like the weather, is often unpredictably changeable. No “positive” feeling can be induced to persist as a permanent experience, no matter what Cognitive-Behavioral Therapy tells us. As disappointing as this may be, as much as we might like to deny it, as much as it causes each of us ongoing life frustration, and as much as we were raised and continue to be reinforced for trying to control and pick our feelings, they are still by definition of the human condition, largely outside the province of our wills.

This was the first study ever to show that cognitive-behavior therapy—or, indeed, any psychiatric treatment that did not rely on drugs—has the power to change faulty brain chemistry in a well-identified brain circuit. What’s more, the therapy had been self-directed, something that was and to a great extent remains anathema to psychology and psychiatry. The changes we detected on PET scans were the kind that neuropsychiatrists might see in patients being treated with powerful mind-altering drugs. We had demonstrated such changes in patients who had, not to put too fine a point on it, changed the way they thought about their thoughts. Self-directed therapy had dramatically and significantly altered brain function. There are now a wealth of brain imaging data supporting the notion that the sort of willful cognitive shift achieved during Refocusing through mindful awareness brings about important changes in brain circuitry as we will see in later chapters.

TANs could be crucial to the acquisition of new behavioral skills in cognitive-behavioral therapy. In neurological terms, we could say that cognitive-behavioral therapy teaches people purposefully to alter the response contingencies of their own TANs. This is a crucial point. Such therapy teaches people to alter, by force of will, the response habits wired into their brains through TANs.

The eighth-century Indian Buddhist scholar Shantideva said, “If you can solve your problem, then what is the need of worrying: If you can’t solve your problem, what is the use of worrying.

Here are some common dysfunctional core beliefs: I am incompetent. I am unlovable. I am a failure. I am worthless. I am trapped. I cannot cope with grief or loss. I will never be happy. Happiness requires perfection. Happiness requires success. The world is cruel. There’s no point to anything. Others cannot be trusted. The world is mostly bad.

For example, someone might have a set of assumptions that includes the statements “If I do well in school, my parents will love me” and “If I work out more, my peers will love me.” A possible core belief leading to both of these intermediate beliefs is “I am not loved” or “I am unlovable.” Also, you could discover that you hold a core belief along the lines of “People are mostly bad” if your automatic thoughts consistently reflect assumptions that people have bad intentions.

You can't fix a chemical imbalance with positive thinking. But the entire basis of cognitive behavioral therapy is that you can help the way your brain works. It's all about making new habits and patterns.

Christianity and Islam both teach that success in life on earth isn’t the ultimate goal—that life is more of a test and learning experience. Christians and Muslims, then, could incorporate that idea and try to see mistakes, problems, and hardships as natural and even good for their spiritual development and greater goals. Instead of thinking, “I made a mistake. I’m worthless,” they could think, “I made a mistake, just as I am meant to do in my time here. How can I learn from it?

What else can cause or activate a depression? Many tomes have been written on this subject, and I shall only mention the two theories backed, in my judgment, by the most scientific evidence. The first is Aaron Beck’s cognitive theory of depression, which forms the basis for the most commonly used psychotherapy for this illness, cognitive-behavioral therapy. Beck is a psychiatrist who argues that some people have dysfunctional attitudes that make them vulnerable to becoming depressed in the face of a negative event. These maladaptive attitudes often involve the notion that our happiness and self-worth depend on our being perfect or hinge on other people’s approval. For example, we might think, “My teacher’s critical comment means that I’m a total failure” or “If my girlfriend doesn’t love me, then I am nothing.” If we share these beliefs, then when something truly bad happens, we tend to have automatic negative thoughts about (1) ourselves (e.g., “I’m not lovable”), (2) our present experiences (e.g., “My boss always prefers my coworkers”), and (3) our futures (e.g., “I’ll never outgrow my shyness”). Beck calls these types of thought a negative cognitive triad.

chapter with a quotation from the Greek Stoic philosopher Epictetus, but we could just as easily have quoted Buddha (“Our life is the creation of our mind”)2 or Shakespeare (“There is nothing either good or bad, but thinking makes it so”)3 or Milton (“The mind is its own place, and in itself can make a heaven of hell, a hell of heaven”).4 Or we could have told you the story of Boethius, awaiting execution in the year 524. Boethius reached the pinnacle of success in the late Roman world—he had been a senator and scholar who held many high offices—but he crossed the Ostrogoth king, Theodoric. In The Consolation of Philosophy, written in his jail cell, he describes his (imaginary) encounter with “Lady Philosophy,” who visits him one night and conducts what is essentially a session of cognitive behavioral therapy (CBT). She chides him gently for his moping, fearfulness, and bitterness at his reversal of fortune, and then she helps him to reframe his thinking and shut off his negative emotions. She helps him see that fortune is fickle and he should be grateful that he enjoyed it for so long. She guides him to reflect on the fact that his wife, children, and father are all still alive and well, and each one is dearer to him than his own life. Each exercise helps him see his situation in a new light; each one weakens the grip of his emotions and prepares him to accept Lady Philosophy’s ultimate lesson: “Nothing is miserable unless you think it so; and on the other hand, nothing brings happiness unless you are content with it.”5

At the same time, in my reading, I discovered some evidence that traditional talk therapy might not actually be particularly effective for C-PTSD. In The Body Keeps the Score, Bessel van der Kolk writes about how talk therapy can be useless for those for whom “traumatic events are almost impossible to put into words.” Some people are too dissociated and distanced from these traumatic experiences for talk therapy to work well. They might not be able to access their feelings, let alone convey them. For others, they’re in such an activated state that they have a hard time reaching into difficult memories, and the very act of recalling them could be retraumatizing. One study showed that about 10 percent of people might experience worsening symptoms after being forced to talk about their trauma. Between 40 percent and 60 percent of people drop out of therapy at some point. Most drop out within the first two sessions. And plenty of statistics show that even pointed, skills-based talk therapy is ineffective for PTSD. Cognitive behavioral therapy (CBT), a form of talk therapy where patients unlearn negative patterns of behavior and try to practice strategically positive patterns, is widely accepted as a treatment for PTSD. But it has abysmal statistics. In one study of seventy-four patients, eight got better with CBT, compared with four who received no therapy at all.

CSJ is fundamentally incompatible with the enlightenment values and scientific worldview of Cognitive Behavioral Therapy (CBT).

In The Coddling of the American Mind, attorney Greg Lukianoff and social psychologist Jonathan Haidt describe this process as a kind of reverse cognitive behavioral therapy (CBT), which makes its participants less mentally and emotionally healthy than before.60 The main purpose of CBT is to train oneself not to catastrophize and interpret every situation in the most negative light, and the goal is to develop a more positive and resilient attitude towards the world, so that one can engage with it as fully as possible. If we train young people to read insult, hostility, and prejudice into every interaction, they may increasingly see the world as hostile to them and fail to thrive in it.