Clinical Prompt For use AFTER the protocol is learned
Assessment – Functional Cognitive Behavior Assessment with a Community Assessment/Support Team
Engagement – gain the confidence of the child and get the sanction to proceed.
Psychoeducation – teach the concepts [self talk, automatic thoughts, habituation, etc., that are necessary for learning the skill. Explain the process.
Start the change process:
Awareness – Help the child become aware of his/her automatic thoughts
Attendance – devise strategies such as the use of journals and homework assignment to ensure that the child attends to his/her automatic thoughts
Analysis – teach the child a formal and public process for analyzing his/her automatic thoughts
Alternatives – teach the child way to find new and different meanings in an experience and to weigh the consequences of these new meaning and to select one that is balanced and rational
Adaptation – teach the child the methods of habituation
“Optimism, the conviction that you can change, is a necessary first step in the process of all change” [Seligman – 1994].
Human beings live in an interactive world. We do not exist as singular entities. Our whole way of thinking is shaped by the way people around us think. Our behaviors are products of the relationships we have. It is somewhat inappropriate to suggest that an individual is hostile, except as this occurs in a relationship. Our attitudes about even abstract concepts are shaped by the culture in which we live.
Gregory Bateson has suggested that our language leads us astray because it commonly stresses only one side of any interaction We commonly speak as though a single ‘thing’ could ‘have’ some characteristic. A stone is ‘hard’, ‘small’, ‘heavy’, and so on. ‘The stone is hard’ means a) that when poked it resisted penetration, and b) that certain continued interactions among the molecular parts of the stone in some way bond the parts together. ‘The stone is stationary’ comments on the location of the stone relative to the location of the speaker and other possible moving things.
Language continually asserts by the syntax of subject and predicate that ‘things’ somehow ‘have’ qualities and attributes. A more precise way of talking would insist that the ‘things’ are produced, are seen as separate from other ‘things’, and are made ‘real’ by their internal relations and by their behavior in relationship with other things and with the speaker.
“That song is lousy” would be more accurately stated as “I dislike that song”.
This leads us also to separate the child from the community of interest around that child. Community of interest being defined as the stakeholders in the child’s life. Yet one of the most important influences on the belief system of the child is the belief system of those around the child. While it is true that the child interprets such stimuli, it is also true that habituation to ideas can lead to long lasting beliefs.
Children have never been very good at listening to their elders, but they have never failed to imitate them. – James Baldwin
Children are natural mimics–they act like their parents in spite of every effort to teach them good manners. –Unknown
As the citations above show with humor, significant child managers have a powerful influence over the children in their care. Operant conditioning occurs regularly in the interaction between adults and children and its outcomes are very effective. The problem is that the operant condition occurs without the conscious involvement of the trainer. Therefore, the child is often given reinforcement for the wrong things or at the wrong time.
Further, child managers can not control all reinforcers and punishers, at all times. There are a number of environmental factors that are going to affect the child’s behavior that you have no control over, but which will still be a significant consequence for your child.
Some of these come from the child’s internal environment – their own reactions. Relief from stress, pain, or boredom are common reinforcers and some ‘self-reinforcing’ behaviors are actually maintained because of this. Examples are a dog barking because it relieves boredom, or a person chewing on his/her fingers or smoking a cigarette because it relieves stress. Drivers speed because it is fun. Guilt is an internal punisher that some people experience.
In addition, the significant adult ‘models’ behavior for their child. A parent might punish a child severely for the child’s punishment of another child, thus modeling that punishing is the way to go. Ambiguity of behavior and language is another problem. It is not always clear to the child that you are angry with his/her behavior and not him or her. The child appraises all of these factors as a part of identifying patterns of experience which will help create a theory of meaning.
Of all of the appraisals and judgments that we make about our experiences, the comparison of ourselves to others and others to others is the most powerful. What we believe [give credence as true and contain emotional +/- spin] about ourselves and others [and what we believe that others believe about us] are two of the three major core beliefs of human beings. Along with our beliefs about our future prospects, these core beliefs create our attitudes and personality. They are who we are. If we believe that we are okay and others are okay, this set of ideas often leads to some serenity in life. However, if we believe that we are not okay and that others know that we are not okay and are out to get us, this is likely to lead to substantial problems in living.
It is also important to understand how human beings operate. Once they learn something and become habituated to that learning, the central nervous system takes over and the actual thoughts about that learning become nonconscious.
There is no question that the operant conditioning of Central Nervous System activity occurs — in fact, it is so ubiquitous a phenomenon that there seems to be no form of CNS activity [single-unit, evoked potential, or EEG] or part of the brain that is immune to it. …One may say that the loss of consciousness of a predictable event ‘is’ the signal that the event has been learned completely. [Bernard Baar – 1988]
In fact, it is estimated that 95% of what we do, we do nonconsciously. This is not as bizarre as it sounds, when you think of going to the refrigerator and getting a glass of water. Very little of this rises to the level of consciousness. However, dissonance can cause consciousness. If you went to get water and spied the iced tea, you might consciously make a decision to change course. But then as you drink the tea, you don’t think about how you did that.
Since 95% of what people do is nonconscious, the reactions that they make to both habitual and novel experiences is often driven by their mental context. When they perceive something happening they feel a certain way about that perception. This perception may be mild or intense. The more intense the feeling is, the more distorted it is likely to be. The behavior that results from the feeling will likewise be mild or intense. It is doubtful that you will behave in an intense manner when you are only mildly aroused.
The fact is that when a stimulus occurs and BEFORE the response happens, there is a thought:emotion that occurs. The thought:emotion are connected to suggest that a) they happen almost simultaneously, b) they are related in character, and c) they are in fact, virtually the same thing. We can parse this out to two experiences, but they are connected at the hip. Emotion is biographical. What this means is that it is learned and is based on the memory of a history of experiences and patterns. Sensory representations [feelings] are purely biological – the stimulus itself causes some physical reaction, such as the hair standing up on the back of the neck.
When the sense alert us to a stimuli, the mind recognizes something in the experience and labels [names] it [partially or wholly] based on past experiences and the patterns of pleasure/pain that the individual has experienced from this category of ‘things’. The pleasure/pain mixture give the ‘thing’ a value of +/- /0, symbolically good, bad or indifferent and the complex mixtures that occur. Then, and only then, is the person able to respond.
We can put this into perspective for everyday life. The child sometime between the ages of four and seven years of age has created a complex, but workable understanding of self and others [A Theory of Meaning] and now begins to operate on that theory. A confirmation bias occurs which helps to maintain the theory, for contrary information is often ‘put aside’ until confirming information can be found. Almost none of this theory of meaning is conscious – it just is. If you were to ask someone to describe their theory of meaning about self, others and future prospects, they would find it very difficult to do. You can begin to infer their theory of meaning, however, by listening to what they say and observing what they do. If someone bumps into them – how they respond gives some indication of 1) what they perceived, 2) what they thought, 3) what value they put on what they thought, 4) and how they responded.
Of primary importance is the ‘leakage’ of automatic thoughts that occurs in self talk. Self talk is a very important part of human functioning. We constantly talk to ourselves about what is going on about us. We appraise, compare, judge, make predictions and have expectations. The content of this process is helpful in defining the beliefs that we have about self and others. Because we constantly talk to ourselves, we occasionally say these things out loud. It is particularly important to note what is said when startled or in a stressful situation. We will discuss this more later, but for now it is important that the formula is understood.
A stimulus is made up of sensory input. This sensory input has been identified by Bandler and Grinder as submodalities, these qualities such as light, color, movement, tone, beat, texture, etc., are stored in the memory along with the experience. These stimuli may or may not arouse consciousness. There are many things that happen around us which we simply ignore as unimportant. As Gregory Bateson has reported, it is the “difference that makes a difference” which creates information. If something happens that is different than the norm, the person is likely to become aroused.
Arousal causes comparison with the historical experience of individual learning and interpretation [memory] to try to identify a pattern. If the stimuli cannot be identified, parts of the experience may stir memories. Once some semblance of a pattern is evoked, an emotional spin is attached – this is good, this is bad, this is uninteresting – ignore it. As the emotional spin is added, a bent toward motion is begun. The very word emotion implies motion and the motion is likely to be as intense or passive as the emotion itself. Intense fear motivates us to run. Intense anger motivates us to aggress.
The actual behavior then, is the outcome of these mental activities and the mental activities themselves are based on a store of precedent interpretations of experience. Thus, the subjective experience of each person is idiosyncratic and based on the random experiences that have occurred to them and the patterns that they have identified from these experiences.
This idiosyncratic subjectivity is the ‘inner logic’ of the individual and is the basis for their behavior. While a behavior may seem inappropriate or even bizarre to an outside observer, it may make perfect sense based on the ‘inner logic’. Cognitive Process Correction is an attempt to help an individual identify his own ‘inner logic’ in areas where they feel distressed and to examine it consciously to determine whether it is as balanced and rational as it might be.
If we can change how we think about something, we can change the emotions we ascribe to it. And if our emotions change, we are predisposed to act differently.
When a child punches someone and is asked why – s/he may respond – “S/he made me do it!”; “S/he said, looked, acted …!”
The child interpreted the stimuli of the other person [e.g., through mind reading] in a way that caused him/her to become intensely angry – and then took the action that seemed appropriate to the feeling generated by the thought. The ‘INNER LOGIC’ allows the behavior to make sense. Often such a child will believe that the child manager ‘took sides’ with the other child unfairly when s/he was punished for the behavior.
However, if the child thought what the other child said, how s/he looked and/or acted was funny – s/he is unlikely to have punched him/her.
What drives all of this is the person’s Theory of Meaning and Core Beliefs.
We must remember that these cognitive structures or ‘major mental schema’ are nonconscious. People rarely think about what they think about the rules and values contained in the beliefs about themselves and others – let alone future prospects. While people constantly fantasize about the future and reminisce about the past, they seldom have long range goals. This is particularly true of people with problems in living, whose only goals often tend to be avoidance rather than attainment.
One of the major methods of opening up what the core beliefs are is to begin a process of psychoeducation on goal development. Psychoeducation is used here to specifically mean to open up to the individual new conceptions that will be used to effectively think differently.
The process of developing a vision for the future often will cause the individual to manifest ‘shoulds’ and ‘oughts’ indicative of their idiosyncratic belief system. Another process as we have indicated, is to listen for the ‘leakage’ of ‘self talk’.
Inner speech is one of the most important modes of experience. Most of us go around the world talking to ourselves, though we may be reluctant to do so out loud. We may be so accustomed to the inner voice that we are no longer aware of its existence ‘metacognitively’……the inner voice maintains a running commentary about our experiences, feelings and relationships with others; it comments on past events and helps to make plans for the future. [Klinger – 1971]
The most significant method of assessing the cognitive behavioral characteristics of a child are through a Functional Cognitive Behavior Assessment [See CBAT#01]. One part of this process is the Initial Inquiry, which when done with a group of people who are familiar with and have influence on the child, gives an opportunity to collect anecdotal information about self talk leakage and to begin to create hypotheses about the core beliefs and the ‘inner logic’ the child uses to make decisions about his/her behavior.
When done in a group using the Community Assessment/Support Team [See CBAT#05], there is also substantial opportunity to gather data about the thoughts, attitudes and beliefs of the child managers as well, allowing the clinician to begin to understand how they might initiate or maintain maladaptive thoughts in their children and their own irrational beliefs. Remember that the child is an interactive quality [a particle and a wave]. It is important, therefore, to understand fully the ‘forces’ that impinge upon his/her adaptation.
If nothing else, it is important that you become a sensitive listener. But what should you listen for? In both child management and in the helping professions, the critical listening is to identify distressing thoughts caused by patterns of cognitive errors. While there are different lists of cognitive errors, the following are fairly standard.
Filtering This pattern is characterized by a sort of tunnel vision – looking at only one element of a situation to the exclusion of everything else. A single detail is picked out and the whole event or situation is colored by this detail. For example, a computer draftsman who was uncomfortable with criticism was praised for the quality of his recent detail drawings and asked if he could get the next job out a little more quickly. He went home depressed, having decided that his employer thought he was dawdling. He filtered out the praise and focused only on the criticism.
Each person looks through his or her own particular tunnel.
Depressed people are hypersensitive to loss and blind to gain.
For anxious people, the slightest possibility of danger sticks out like a barb in a scene that might otherwise be safe and secure.
People who experience chronic anger look through a tunnel that highlights evidence of injustice and screens out fairness and equity.
Memory can also be very selective. A person may remember only certain kinds of events from their entire history and stock of experience. When you filter your memories, you often pass over positive experiences and dwell only on the memories that characteristically leave you angry, anxious, or depressed.
The filtering pattern “awfulizes” or “catastrophizes” thoughts by pulling negative events out of context and magnifying them, while ignoring all the good experiences. The fears, losses, and irritations become exaggerated in importance because they fill your awareness to the exclusion of everything else. Key words for the filtering pattern are terrible, awful, disgusting, scary, horrendous, and so on. A key phrase is “I can’t stand it.”
Polarized Thinking This is black-and-white thinking, with no shades of gray allowed. The person insists on ‘either/or’ choices, perceiving everything at the extremes with very little room for a middle ground. People and things are good or bad, wonderful or horrible, delightful or intolerable. Since the interpretations are extreme, the emotional reactions are extreme, fluctuating from despair to elation to rage to ecstasy to terror.
The greatest danger in polarized thinking is its impact on how the person judges him/herself and others. They could believe that if they or others aren’t perfect or brilliant, then they must be a failure or an imbecile. There’s no room for mistakes or mediocrity.
Overgeneralization In this pattern, the person makes a broad, general conclusion based on a single incident or piece of evidence. One dropped stitch leads to the conclusion: “I’ll never learn how to knit.” They interpret a rejection on the dance floor as: “Nobody would ever want to dance with me.”
This pattern can lead to an increasingly restricted life. Overgeneralizations are often couched in the form of absolute statements, as if there were some immutable law that governs and limits the chances for happiness. Some of the cue words that indicate a person may be overgeneralizing are all, every, none, never, always, everybody, and nobody.
Another hallmark of overgeneralization is the global label for persons, places, and things you don’t like, including yourself: Somebody who refused to give you a ride home is labeled a ‘total jerk’. A quiet guy on a date is a ‘dull clam’. New York City is ‘hell on earth’. Television is an ‘evil, corrupting influence’. You’re ‘stupid’ and ‘totally wasting your life’. ’I’m a total failure.’
Each of these labels may contain a grain of truth, but it generalizes and grossly exaggerates that grain into a global judgment. The overgeneralized label ignores all contrary evidence, making your view of the world stereotyped and one dimensional.
Mind Reading When you mind read, you make snap judgments about others. You assume you know how others are feeling, thinking and what motivates them: “He’s just acting that way because he’s jealous”, “She’s only interested in your money”, “He’s afraid to show he cares”.
If your brother visits a new female acquaintance three times in one week, you might conclude that he is (a) in love, (b) angry at his old girlfriend and hoping she’ll find out, (c) depressed and on the rebound, or (d) afraid of being alone again. Without asking, you have no way of knowing which is true. Mind reading makes one conclusion seem so obviously correct that you assume it’s true, act on it in some inappropriate way, and get into trouble.
As a mind reader, you also make assumptions about how people are reacting to you. You might assume what a friend is thinking and say to yourself, “This close s/he sees how unattractive I am.” If s/he is mind reading too, s/he may be saying to him/herself, “S/he thinks I’m really immature.” You may have a casual encounter with your teacher and come away thinking, “They’re getting ready to flunk me.” These assumptions are born of intuition, hunches, vague misgivings, or a couple of past experiences. They are untested and unprovable, but you believed them nonetheless.
Mind reading depends on a process called projection. You imagine that people feel the same way you do and react to things the same way you do. Therefore, you don’t watch or listen closely enough to notice that they are actually different. If you get angry when someone is late, you imagine everyone feels that way. If you feel excruciatingly sensitive to rejection, you expect that most people are the same. If you are very judgmental about particular habits and traits, you assume others share your beliefs.
Catastrophizing If you ‘catastrophize’, a small leak in the sailboat means it will surely sink. A contractor whose estimate gets underbid concludes he’ll never get another job. A headache suggests that brain cancer is looming. Catastrophic thoughts often start with the words ‘what if’, and lead to a conclusion that the outcome of the stated event will be overwhelming, rather than merely difficult or inconvenient.
“People, by and large, are astonishingly attracted to the catastrophic interpretation of things” [Seligman]
You read a newspaper article describing a tragedy or hear gossip about some disaster befalling an acquaintance, and you start wondering, “What if it happens to me? What if I break my leg skiing? What if they hijack my plane? What if I get sick and have to go on disability? What if my son starts taking drugs?” The list is endless. There are no limits to a really fertile catastrophic imagination.
Magnifying When you magnify, you emphasize things out of proportion to their actual importance. Small mistakes become tragic failures. Minor suggestions become scathing criticism. A slight backache becomes a ruptured disk. Minor setbacks become cause for despair. Slight obstacles become overwhelming barriers.
Words like huge, impossible, and overwhelming are magnifying terms. This pattern creates a tone of doom and hysterical pessimism.
The flip side of magnifying is minimizing: When you magnify, you view everything negative and difficult in your life through a telescope that enlarges your problems. But when you view your assets, such as your ability to cope and find solutions, you look through the wrong end of the telescope so that everything positive is minimized.
Personalization There are two kinds of personalization. The first kind involves directly comparing yourself with other people: “He plays piano so much better than I,” “I’m not smart enough to go with this crowd,” “She knows herself a lot better than I do,” “He feels things so deeply while I’m dead inside,” “I’m the slowest person in the office.” Sometimes the comparison is actually favorable to the person: “He’s dumb (and I’m smart),” “I’m better looking than she.” The opportunities for comparison never end. And, even when the comparison is favorable, the underlying assumption is that your worth is questionable. Consequently the person must continue to test their value, constantly measuring themselves against others. If they come out better, they have a moment’s relief. If they come up short, they feel diminished.
The second assumes that everything happens because of you.
A depressed mother blames herself when she sees any sadness in her children. A businessman thinks that every time his partner complains of being tired, he means he’s tired of him. A man whose wife complains of rising prices hears the complaints as attacks on his ability as a breadwinner.
Shoulds In this pattern, the person operates from a list of inflexible rules about how they and other people should, must, have to act. The rules are right and indisputable. Any deviation from the particular values or standards is bad. As a result, they are often judging others and finding fault. People irritate them. They don’t act correctly and they don’t think correctly. They have unacceptable traits, habits, and opinions that make them hard to tolerate. They should know the rules, and they should follow them.
One woman believed that her husband should want to take her on Sunday drives. She decided that a man who loves his wife ought to take her to the country and then out to eat in a nice place. The fact that he didn’t want to meant that he “only thought about himself”. Cue words indicating the presence of this pattern are should, ought, or must.
Personal shoulds are just as hard on the person as they are on other people. They feel compelled to be or act a certain way, but they fail to ask objectively if it really makes sense. Psychiatrist Karen Horney (1939) called this the “tyranny of shoulds”. It also should be noted that ‘shoulds’ make somebody wrong.
Externalizing The person explains the cause of success and/or failure as external forces such as task difficulty or luck over which s/he has no control, instead of to his/her own effort. “It’s his fault!” “She doesn’t like me!”
When a person externalizes, they tend to think of themselves as an object, rather than a subject. More than likely, they become a ‘victim’ of the circumstances. They rarely take responsibility for their success or failure. Externalizing is connected with expectancy theory.
Prophesizing The person has negative and relatively stable expectancy or generalized beliefs about a lack of self competence in achievement situations. “I’m going to fail this test. Nobody is going to talk to me.” Prophesies of negative outcomes tend to lead to negative outcomes.
Prophecy is also connected to expectancy theory. When we make a prophecy, we tend to behave in ways to make it come true. When a child manager believes a child can’t learn – s/he nonconsciously will behave in ways that keep the child from learning.
When you say you can or you say you can’t, you are right. [Henry Ford]
One other cognitive error is often listed: Canceling the positive [usually occurs when someone gives a compliment]: I should have done better. This wasn’t my best work.
So now that we know what to listen for, what do we do when one of these thoughts show up? First, we need to understand that all of us use these cognitive processes occasionally. So what we want to do is to find out if these thoughts are distressing. We will have to follow at least the first step of the Cognitive Process Correction intervention if we want to find out.
A FIVE STEP PROCESS
Remember that 95% of what we do is nonconscious. Much of what the person is saying to him/herself and what it means is nonconscious. They have said these types of things so long that they have not examined the fundamental basis for these thoughts. Some people even deny what they have just said, because it is so automatic.
Once the person becomes aware of these thoughts it may hard to hold onto them. We can hold very few things in consciousness for very short periods of time.
The Nature of Automatic Thoughts
1. They often appear in shorthand, composed of just a few essential words phrased in telegraphic style: “lonely . . . getting sick . . . can’t stand it . . . cancer . . . no good.” One word or a short phrase functions as a label for a group of painful memories, fears, or self-reproaches.
An automatic thought needn’t be expressed in words at all. It can be a brief visual image, an imagined sound or smell, or any physical sensation. A woman who was afraid of heights had a half-second image of the floor tilting and felt herself sliding down toward the window. This momentary fantasy triggered acute anxiety whenever she ascended above the third floor.
Sometimes the automatic thought is a brief reconstruction of some event in the past. A depressed woman kept seeing the stairway in Macy’s where her husband had first announced his plan to leave her. The image of the stairway was enough to unleash all the feelings associated with that loss.
Occasionally an automatic thought can take the form of intuitive knowledge, without words, images, or sense impressions. For example, a chef who was plagued with self-doubt “just knew” that it was useless to try to get promoted to head chef.
2. Automatic thoughts are almost always believed, no matter how illogical they appear upon subsequent analysis.
For example, a man who reacted with rage to the death of his best friend actually believed for a time that his friend deliberately died to punish him.
Automatic thoughts have the same believable quality as direct sense impressions. You attach the same truth value to automatic thoughts as you do to sights and sounds in the real world. If you see a man getting into a Porsche and have the thought, “He’s rich; he doesn’t care for anyone but himself,” the judgement is as real to you as the color of the car.
3. Automatic thoughts are experienced as spontaneous. You believe automatic thoughts because they are automatic. They seem to arise spontaneously out of ongoing events. They just pop into your mind and you hardly notice them, let alone subject them to logical analysis.
4. Automatic thoughts are often couched in terms of rules: should, ought, or must. A woman whose husband had recently died thought, “You ought to go it alone. You shouldn’t burden your friends.” Each time the thought popped into her mind, she felt a wave of hopelessness. People torture themselves with “shoulds” such as “I should be happy. I should be more energetic, creative, responsible, loving, generous….” Each ironclad “should” precipitates a sense of guilt or a loss of self-esteem.
“Shoulds” are hard to eradicate, since their origin and function is actually adaptive. They are simple rules to live by that may have worked in the past or were learned from one’s parents. They are templates for survival that you can access quickly in times of stress. The problem is that they become so automatic that you don’t have time to analyze them, and so rigid that you can’t modify them to fit changing situations. Of greatest significance, however, is when these ‘rules’ lead to exaggerated negative emotions and counterproductive behavior.
5. Negative automatic thoughts tend to “awfulize”. These thoughts predict catastrophe, see danger in everything, and always expect the worst. A stomachache is a symptom of cancer, the look of distraction in a lover’s face is the first sign of withdrawal. “Awfulizers” are the major source of anxiety.
Awfulizers are also hard to eradicate because of their adaptive function. They help you predict the future and ‘prepare’ for the worst-case scenario. Unfortunately, they create feelings of anxiety in the present regardless of whether or not the worse case scenario develops in the future.
6. Automatic thoughts are relatively idiosyncratic. In a crowded theater a woman suddenly stood up, slapped the face of the man next to her, and hurried up the aisle and out the exit. The witnesses to this event reacted in different ways.
One woman was frightened because she thought, “She’s really going to get it when they get home.” She imagined the details of a brutal beating and recalled times when she had been physically abused. A teenager was angry because he thought, “That poor guy. He probably just wanted a kiss and she humiliated him. What a bitch.” A middle-aged man became depressed when he told himself, “Now he’s lost her and he’ll never get her back.” He could see his ex-wife’s face set in angry lines. A social worker felt a pleasurable excitement as she thought, “Serves him right. I wish some timid women I know had seen that.”
Each response was based on a unique way of viewing the stimulus event and resulted in a different strong emotion.
7. Automatic thoughts are persistent and self-perpetuating. They are hard to turn off or change because they are reflexive and plausible. They weave unnoticed through the fabric of your internal dialogue and seem to come and go with a will of their own. One automatic thought tends to act as a cue for another and another and another. You may have experienced this chaining effect as one depressing thought triggers a long chain of associated depressing thoughts.
8. Automatic thoughts often differ from your public statements. Most people talk to others very differently from the way they talk to themselves. To others they usually describe events in their lives as logical sequences of cause and effect. But to themselves they may describe the same events with self-deprecating venom or dire predictions.
One executive calmly explained aloud, “Since I got laid off, I’ve been a little depressed.” This matter-of-fact statement differed sharply from the actual thoughts that unemployment triggered in him: “I’m a failure . . . I’ll never work again . . . My family will starve … I can’t make it in this world.” He had an image of himself spiraling down into a bottomless black pit.
9. Automatic thoughts repeat habitual themes. Chronic anger, anxiety, or depression results from a focus on one particular group of automatic thoughts to the exclusion of all contrary thoughts. The theme of anxious people is danger. They are preoccupied with the anticipation of dangerous situations, forever scanning the horizon for future pain. Depressed individuals often focus on the past and obsess about the theme of loss. They also focus on their own failings and flaws. Chronically angry people repeat automatic thoughts about the hurtful and deliberate behavior of others.
Preoccupation with these habitual themes creates a kind of tunnel vision in which you think only one kind of thought and notice only one aspect of your environment. The result is one predominant and usually quite painful emotion. Beck has used the term selective abstraction to describe this tunnel vision.
Selective abstraction means looking at one set of cues in your environment to the exclusion of all others.
10. Automatic thoughts are learned. Since childhood people have been telling you what to think. You have been conditioned by family, friends, and the media to interpret events a certain way. Over the years you have learned and practiced habitual patterns of automatic thoughts that are difficult to detect, let alone change. That’s the bad news. The good news is that what has been learned can be unlearned and changed.
How are you going to teach these ten principles to your client? Methods will vary based upon the age and other characteristics of the child. But it is important that there be a repetitive dialogue about these factors. Do not expect to tell the child once, and have them absorb these concepts. Further, you will need to feed these principles one at a time. The concept of a formal dialogue is to ensure that you develop a script every day which reminds you to discuss concepts and language with the child. You know that these ten concepts will need to be mentioned in some form with every early contact, until you are sure that the child is able to understand and use these concepts on their own. Further, you will want to use the Basic Thought Journal CBT#01-001 as a means of reinforcement.
Listening for Automatic Thoughts
Helping the client hear his/her automatic thoughts is the first step in helping to gain control of unpleasant emotions. Most of a person’s internal dialogue or self talk is harmless. The automatic thoughts that are distressing can be identified because they almost always precede a continuing painful feeling.
To identify the automatic thoughts that are causing a continued painful feeling, the client should be helped to try to recall the thoughts s/he had just prior to the start of the emotional distress and those that go along with the sustained emotion. Help them think of it as listening in on an intercom. The intercom is always on, even while they are conversing with others and going about life. They are functioning in the world and they are also talking to themselves at the same time. Tell them to listen in on the intercom of their internal dialogue, and hear what they are telling themselves. These automatic thoughts are assigning private, idiosyncratic meanings to many external events and internal sensations. They are making judgments and interpretations about the client’s experience’
Automatic thoughts are often lightning fast and very difficult to catch. The child needs somehow to find a way in essence to “catch themselves blinking”. The thoughts flash on as a brief mental image, or are telegraphed in a single word. You can provide two methods for coping with the swiftness of these thoughts:
1. Have the child reconstruct a problem situation, going over it again and again in their imagination until the painful emotion begins to emerge. Ask “What are you thinking as the emotion comes up?” The child should regard these thoughts as a slow- motion film. Look at the internal dialogue, frame by frame. Notice the millisecond it takes to say, “I can’t stand it,” or the half-second image of a terrifying event. Help the child to notice how s/he is internally describing and interpreting the actions of others: “She’s bored…. He’s putting me down.”
By reconstructing the problem situation, the child is able to slow down the emotional reactions and back up to the thoughts.
2. Have the child stretch out the shorthand statement into the original statement from which it was extracted. “Feeling sick” is really “I’m feeling sick and I know I’m going to get worse. . . . I can’t stand it.” “Crazy” means “I feel like I’m losing control, and that must mean I’m going crazy…. My friends will reject me.”
By spelling out the entire chains or sequences of thought, the child is lengthening the thoughts and the time that they are available. Hearing the shorthand isn’t enough. It is necessary to listen to the entire interior argument in order to understand the distorted logic from which many painful emotions bloom. By lengthening the thoughts and putting them into longhand, the child is keeping the thoughts in the conscious arena, where they can be analyzed and reviewed.
It is critical to recognize that these irrational or distorted thoughts generally are linked together. It will be necessary to continue coaxing the child [‘What else?”] to elicit a full range of thoughts that add up to or convey the extremely negative emotional reaction. Left to themselves, a child may only identify a small section of the ‘chain’. They will need help and practice to uncover all of the reflex thoughts in any given situation.
Impartial spectator: trying to observe your own behavior as if you were observing the behavior of another.
…the Impartial Spectator is a concept that Adam Smith used as the central feature of his book, The Theory of Moral Sentiments. He defined the Impartial spectator as the capacity to stand outside yourself and watch yourself in action, which is essentially the same mental action as the ancient Buddhist concept of mindful awareness.
Adam Smith understood that keeping the perspective of the Impartial Spectator under painful circumstances is hard work, requiring, in his words, the ‘utmost and most fatiguing exertions’.
As reported by Schwartz in Brain Lock, 1996
One of the things that a changeworker will need to do is provide some mechanisms to help the person pay attention to these thoughts.
This is usually accomplished with the use of journals and homework. The nature of this material can be found in CBT#01 – Perceiving Reflex Thoughts, CBT#02 – Altering Limited Thinking Patterns, and CBT#03 – Changing Distressing Thoughts. It is through a process of catching and recording these thoughts that the person can a) decide whether they are helpful or distressing, and b) decide whether they want to change them. In addition, once they are attending, they can use the Journals and homework to do the next steps in the process.
However, the purpose of attending does not end with the journals or homework. The concept of mindfulness is one which needs to be exploited. Mindfulness is a term which implies an ability to separate oneself in ones mind and to observe oneself in thought, word and deed.
Trying to observe your own thoughts, feelings and behavior as if you were observing the experiences of another person implies a degree of dissociation to a second person level. As in the use of metaperception, this ‘step back’ allows for a diminishment of emotional involvement. The person is then able to observe him/herself in highly emotional situations without becoming infected by the emotions. The idea is neither to suppress emotions nor to act upon them, but simply to be aware and acknowledge them. A mindful person focuses on the process of awareness without getting caught up in the content of awareness.
Bennett-Goleman suggests that there are two dimensions to mindfulness: the calming aspect and the investigatory aspect. The calming approach would be to say to yourself the moment you have the distressing thought: I know what this is and how I respond to it. The investigative approach allows you to notice how you emotionally judge and compare while you are doing it. With an observing awareness, you notice how you are being affected – while not getting pulled deeper into the reaction or its story line. You see the process as a learning opportunity. Bennett-Golman reports that Nyanaponika Thera in The Power of Mindfulness offers a rule of thumb for being mindful of varying intensities of our inner turbulence: put the least effort into dealing with a disturbing feeling that will do the job. A brief act of noticing the distressing thoughts and feelings, just an acknowledgement, like an inner nod – can sometimes suffice.
However, even when a subject does bring these thoughts into consciousness – they are biased not to change – even if the thoughts are distressing. It is the coherence of these thoughts that makes up the personality. Our ability to make judgements and predictions is based upon this coherence. The very principle that permits us to make judgments with apparent ease and considerable success can also be responsible for some of our systematic errors.
No feature of human judgment and reasoning illustrates the trade-off of advantage and disadvantage better than the tendency for our expectations, preconceptions and prior beliefs to influence our interpretation of new information If a belief has received a lifetime of support, it is perfectly justified to be skeptical of an observation or report that calls the belief into question, but to readily accept evidence that supports its validity. Obviously, this stress for maintenance is less powerful with a child than an adult, since the child is still creating pathways.
We are justified in allowing our beliefs and theories to influence our assessment of new information in direct proportion to how plausible and well-substantiated they are in the first place. Well supported beliefs and theories have earned a bit of inertia and should not be easily modified or abandoned because of isolated antagonistic ‘facts’. Not all bias is a bad thing; indeed, a certain amount is absolutely essential. The power and flexibility with which we reason depends upon our ability to use context, generic knowledge, and pre-existing information to disambiguate and extract meaning from new information – and to some degree, to bias our interpretation of evidence. Our pre-existing knowledge of what is and is not plausible allows us to quickly and effortlessly draw the correct conclusion. Without this ability to use context and expectations to ‘go beyond the information given’, we would be unintelligent in the same way that computers with superior computational capacity are unintelligent.
In evaluating clear-cut information, our perceptions are rarely so distorted that information that completely contradicts our expectation is seen as supportive. Nor do we simply ignore contradictory information and pay attention only to that which supports our preconceptions. Rather, our expectations have their effect through the way we subject inconsistent information to more critical scrutiny: through the way we seek out additional information only when the initial outcomes are inconsistent with our expectations; and – more generally – through the way we assign meaning to new information.
This confirmation bias operates a little bit like a situation where you find your lost keys. You look here, you look there, you look everywhere; but you stop looking when you find your keys. In the same fashion, we find disproof here, we find disproof there, and when we find support for our beliefs, we stop looking – ‘See, I knew I was right!”.
Scientists utilize a set of formal procedures to guard against the source of bias and error discussed – a set of procedures of which the average person is insufficiently aware, and has not adequately adopted in daily life.
Perhaps the most fundamental safeguard is the requirement that the meaning of various outcomes be precisely specified [in advance if possible] and objectively determined.
These formal procedures of scientific investigation must be used to help the person weigh evidence of their own thoughts. This kind of precise specification of what constitutes ‘success’ and ‘failure’ is something we rarely do in everyday life, and consequently our preconceptions often lead us to interpret the meaning of various outcomes in ways that favor our initial expectations.
The methods of science protect an investigator from juggling the meaning of different results by deliberately making the investigation rigid and ‘unintelligent’ in the same way that computers are rigid and unintelligent.
Humans seem to be extremely good at generating ideas, theories, and explanations that have the ring of plausibility. We may be relatively deficient in evaluating and testing out ideas once they are formed.
One of the biggest impediments to evaluating and testing is our failure to realize that when we do not precisely specify the kind of evidence that will count to support our position, we can end up ‘detecting’ too much evidence for our preconceptions.
Our expectations can often be confirmed by any of a set of ‘multiple endpoints’ after the fact, some of which we would not be willing to accept as criteria for success beforehand. The problem of multiple endpoints is most severe when the subject under investigation is inherently fuzzy and hard to define.
An interesting analogue to the problem of multiple endpoints is what could be called the problem of ‘variable windows’. The essence of a number of beliefs is that certain events tend to happen within some (unspecified) period of time. By allowing the window of opportunity to be sufficiently flexible, such beliefs can only be confirmed.
People are also prone to self-serving assessment when it comes to apportioning responsibility for their successes and failures. People have been found to attribute their successes to themselves, and their failures to external circumstances. We are inclined to adopt self-serving beliefs about ourselves, and comforting beliefs about the world.
Finally, scientist have a public peer review and publication process which causes controversial beliefs to be challenged. In a similar manner, in Cognitive Process Correction, the involvement of a changeworker, coach or trainer causes the beliefs to be challengeable by another person which helps to keep us on the right track.
Developing alternative requires creative thinking – there are three basic attributions of creative thinking.
Humans are conscious beings. We share a common experience of a sense of self – a trait some believe is uniquely human. Yet, we can only be conscious of one densely coherent stream of events and a conscious event may decay in a few milliseconds. Every conscious event is shaped by a number of enduring unconscious systems, specialized processors which operate on habitual, automated tasks without our awareness. The role of attention seems to be to select and simplify the multiplicity of messages coming through the senses. While we think of ourselves as conscious beings, we are in fact, unconscious of most of what goes on mentally within our system, and the more habitual the thought or behavior, the more it operates without conscious thought. To be creative requires, that the habitual be made conscious. We must focus our attention on something; typically something we have not focused much attention on before. All methods of creative thinking require that we prepare our minds to focus through some technique which separates out the fundamental essence of the issue.
Attitudes are predisposed mental disposition with regard to something. Such attitudes develop over time based on our interpretation of our experiences and range from a dislike of certain foods to spiritual beliefs. To have an attitude is to have a predisposed way of interpreting new information. We tend to formulate our point of view to protect our preconceived attitudes. It makes us distort, rationalize or forget things. In order to be creative, we must become aware of and then abandon or at least constrain our attitudes.
One way to do this is to deliberately look at the issue from different perspectives. Creative thinking gurus suggest certain basics which can be extrapolated.
We can look at the process – which deals with change in time and space [growth, transformation, development, evolution, sequence, stage and cycle]. By concentrating on the details of order we ask about phases and steps, expansion/diminishment, etc.
Or we can look at differences [contrasts, distinctions] or similarities [connections, affiliations]. These help us to define allegories – “This is like that” – or metaphors – “this is that”. In learning we change contexts by transforming the strange into the familiar, as when we describe gravity as an attraction. In innovating, we need to change contexts transforming the familiar into the strange.
We can also change our attitude by viewing the problem on a different order or level.
What does society look like from a molecular level or an astrophysical level. Social problems of individuals look different from higher or lower orders. All of these changes of perspectives are important, but perspective is not limited to these constructs.
We can change our perspective by becoming someone or something else. “Walk a mile in my shoes”, even imaginatively, is a method of changing perspective. Thus, the methods of delimiting attitudes, many of which are unconscious, are infinite; but unless one becomes consciously aware and makes a specific effort to develop a beginner’s mind, a mind which is open to considering new options all such perspectives are limited by our attitudes.
One effective method is to prohibit your present thinking. If they passed a law prohibiting what you think should be done; what would you do?
The natural mental process of judgement tends to reject new thoughts as not productive and inhibit the ability to get to more creative thoughts.
The human mind has a hierarchy of ideas built into its attitudes, and the first ideas that appear to solve a problem are usually those that have worked in the past. While this is quite effective for solving the day to day problems, it interferes with creativity. Taking action then means developing an energy, an elan for ideas themselves; no matter how bizarre they may at first appear. The creative thinking processes of brainstorming, nominal group technique lateral thinking and the like are simply ways of keeping the action going for a while before any conclusions are drawn.
While groups can be helpful in breaking down judgments, since most groups will contain at least one person who has a differing set of attitudes; it is not necessary. It is like trying to find the largest number of words out of the letters contained in a single word. When you decide that you have found all you can, you quit trying. However, if you walk away for some period of time and then come back, you may find more. How long are you willing to keep the action going so that more solutions can be found? And this is just a change in perspective occurring because of time. If the process of seeking alternative solutions is enhanced by a specific process of changing attitudes, the imagination is stimulated to find more alternative solutions.
Creative thinking is merely ‘dreaming’, however, unless there is a productive aspect to the process. Unlike our word finding, we do need at some point to make judgements and decide upon a preferred solution to solve a problem or create an innovation or invention. Further, we must act upon the solution. Having thought of personal computers first, is not nearly as effective as having created the Apple Computer.
There is good evidence that we can gain a degree of conscious control over virtually any population of neurons, provided that we receive immediate conscious feedback from the neural activity. This has been demonstrated in research with biofeedback and meditation. If this is so, we can control our thinking process in a similar manner. While meditation is a process of mental adaptation, it is not usually structured to adapt to a specific thought or set of thoughts, but rather to non-thought.
However, the meditative process does use a mantra to remind the individual to not think. A habit mantra of the new thought can help to habituate the individual to the new thought. How exactly does this habituation work?
The answer proposed by neurobiologist Gerald Edleman, is that an evolutionary process takes place – not one that selects organisms and takes millions of years, but one that occurs within each particular organism, and within its lifetime, by competition among cells, or selection of cells or rather groups of cells in the brain.
Edelman discusses two kinds of selection in the evolution of the nervous system; ‘developmental’ and ‘experiential’. The first takes place largely before birth and is not of great concern to us here except as background. The genetic instructions in each organism provide general constraints for neural development, but they cannot specify the exact destination of each developing nerve cell, for these grow and die, migrate in great numbers and in entirely unpredictable ways; all of them are ‘gypsies’, as Edelman calls them. Thus, the vicissitudes of fetal development themselves produce in every brain unique patterns of neurons and neuronal groups [‘developmental selection’]. Even identical twins with identical genes will not have identical brains at birth; the fine details of cortical circuitry will be quite different. Such variability, Edelman points out, would be a catastrophe in virtually any mechanical or computational system, where exactness and reproducibility are of the essence, But in a system in which selection is central, the consequences are different, here variation and diversity are themselves of the essence.
As we had indicated earlier, it is up to the infant animal to create its own categories and to use them to make sense of, to construct a world – and its not just a world that the infant constructs, but its own world, a world constituted from the first by personal meaning and reference. A unique neuronal pattern of connections is created and then, experience acts upon this pattern, modifying it by selectively strengthening or weakening connections between neuronal groups, or creating entirely new connections. Thus, experience itself is not passive, a matter of ‘impressions’ or ‘sense-data’, but active, and constructed by the organism from the start.
When we create a mantra of a balanced and rational thought ,we create a new neuronal pattern of connections and make this thought available. It does not destroy the other path of negative, distressful thought. However, when the situation demands, two thoughts now become available. Since we tend to accept the most satisfying and gratifying thought, that is the new one. Over time, the old pathway begins to deteriorate and our new balanced and rational thought become a part of our memory system.
People with problems in living must learn what to say when they talk to themselves and what never to say, even as a joke.
By hearing enough examples of good self instruction, a person can literally condition him/herself to catch those words – spoken by him/herself or others – which contain negative and untrue beliefs. After listening to enough balanced and rational affirmations and/or self instruction, not only will s/he stop using negative self talk, but s/he will automatically begin to erase and replace the old negative programs with new, powerful and effective positive programs.
The process is very simple. The client will become accustomed to how the sentences are structured and the types of beliefs that they are designed to convey. After as little as three weeks, the person should begin to internalize these speech patterns just as s/he might begin to pick up figures of speech from hanging around a new group of people.
The best part of all is that repeatedly listening to, speaking, and thinking positive self instruction causes the language to embed itself into the person’s system of beliefs. For this reason, self instruction has been used to train and build confidence in such performance-demanding arenas as commercial airline pilot training and professional sports. Managers and salespeople were quick to recognize the benefits of using self instruction, and it is simple enough that it can be used by parents and teachers to build self esteem and self management in small children.
There is a caution, however. Simply saying positive things about yourself is not sufficient to change anything. If you say, ”I am good at math”, and you really aren’t, that fact will out, and you may feel more miserable and depressed than you started out. The idea is to say rational things to yourself. “I am not good at math, but I can learn” is a much more rational and supportive statement. To be rational, a statement must be realistically positive, not ‘pie in the sky’.
Helping other people change their cognitive processes is a simple, although not easy process. As with all interactive processes, it starts with a trusting relationship. To state that all of this cannot happen without the helper being significant to the client in terms of trust, respect and affection is to miss the point. Rigorous analyses of your own activities is a tiring and frustrating job. It would be so much easier just to blame someone else and just “grin and bear it”. The helper must be sanctioned to help.
This trust is based not upon a personal commitment, but upon the professional commitment of the total organization that it will respond on behalf of the client. In order to accept this, we must also recognize our responsibility to the greater society and articulate to the client exactly when and how we would invoke this potentially contrary commitment and how, in doing so, we are responsible to his/her needs. There can be no conflict between our responsibility to society and to the individual. This is an ethical dilemma which demands ethical response.
In the introduction to Buber’s I/Thou, the translator, Walter Kauffman, says something important regarding this concept:
“The basic “I/Thou concept establishes the world of relations. As a thou, I have no right to use the I before me as an object with which I may take liberties.” “It is not for me to play with or manipulate. I am not to use it as a point of departure, or anything else. It is a voice of a person that needs me. I am there to help HIM speak.”
Service delivery designs, which assume the strengths of the client, orient themselves toward a change experience which is a prototype role-learning situation; thus, the helper’s role is, in many ways, a teaching one. Since the client directs the process, the helper must try to influence, not control. Coercive interventions have no effect other than resistance. The authority to provide services must be sanctioned by the client and it is this sanction which is at the root of the success. And individuals who sanction dominance, must be helped to seek independence.
The predominant issue that precedes all else in the practitioner attempts to engage the involuntary, ‘resistant’, ‘unmotivated’ or ‘hard to reach’ clients is that nothing can be achieved until authority has been granted and influence attained [Goldstein – 1973]. This sanction of the authority of the helper to elicit change is the essence of the trusting, significant relationship.
The extent to which the person with problems in living is open to change corresponds to the extent to which the presence of the helper is recognized, experienced and authorized by the person in need. The helper’s “value and effectiveness is contingent on the extent to which the right to be influential is granted” [Goldstein – 1973].
SUMMARY AND CONCLUSIONS
Cognitive Process Correction is built on the initial endeavors of Albert Ellis and Aaron Beck. In 1959, Ellis created what he called Rational Emotive Behavior Therapy on the following principles.
• Rational emotive behavior therapy (REBT) employs cognitive reformation to change irrational thoughts.
• Ellis’ rational emotive theory holds that it is beliefs about events in our lives, rather than the events themselves, that maintain psychological problems.
• Maladaptive thoughts are illogical because they result from logical errors in thinking and absolute thinking, overgeneralizing, and categorizing.
• Two themes are common in irrational ideas that lead to psychological problems:
• personal worthlessness and a sense of duty.
In a separate development, in 1963, Beck followed with what he referred to as Cognitive Therapy and is similar to REBT. Both assume that psychological disorders are maintained by distorted cognitions, and both use cognitive change as a major technique.
The major difference between the two is that Cognitive Therapy emphasizes empirical hypothesis testing and evidence collecting as a means of changing existing beliefs-rather than disputation and persuasion as promoted by Ellis.
Neither was able to formulate much theoretical data about why their processes worked and both named their styles according to the medical model they were familiar with despite the fact that this breakthrough was of an entirely different order since it was based on social learning theory rather than biological or psychodynamic theory. The process itself is one of training, and while therapeutic, we reject the connection to the medical model as a tenet of the need to send appropriate messages to our clients and not messages that are ambiguous.
Neither innovator gave sufficient credit to the behavioral roots of their cognitive approaches, but rather operated on instinct and with a pioneer spirit to lead them to their approaches. They also did not deal with the right brain or symbolic aspects of cognition. Both the behavioral and the symbolic have been added by practitioners who have taken the basic training further to address specific issues.
Most of the available protocols embody the five step process [which really is six steps if you consider the psychoeducation that occurs before the process can begin] although some of the symbolic interventions allow the subject to discover through direction more than direct the discovery. Metaphor Counseling through Clean Language [See CBT#37], for example, has taken away the dispute, persuasion or evidence gathering, to allow the individual to sense their way through the process and to make purely emotional affirmation of the outcome.
The Cognitive Process Correction Protocol clearly overlaps the Cognitive Restructuring Protocol and other individual protocols such as CBP#04 Obsessional Compulsive Disorder lie somewhere in the middle.
Whatever cognitive behavior process is used, the process is a self-help process which is facilitated by a trainer who a) has the capacity to engage in a trust relationship with the client, b) has the capacity to send consistently balanced and rational messages to the client, and c) has sufficient knowledge of the process to coach the client through it effectively.