Depression and anxiety impact millions of people on a daily basis. For some, the symptoms are troubling but not so severe that they’re unable to function. For others, the symptoms can be debilitating, resulting in lost work time, damaged relationships, and even the ability to hold down a job.
Numerous different prescription medications are available to help reduce symptoms of anxiety and depression. However, even though a pill may be easier, less expensive, and more convenient to take, most experts agree that therapy should be the predominant form of treatment for both depression and anxiety. One of the most effective – and widely researched – types of therapy is Cognitive Behavioral Therapy. This is because negative thoughts and beliefs always play a powerful role in depression and anxiety.
The Basis of CBT
Often referred to as simply “CBT”, this type of therapy was developed nearly half a century ago by Dr. Aaron Beck. Dr. Beck was a psychiatrist who recognized that his depressed patients’ thoughts and feelings were strongly connected. They all held negatively distorted “core beliefs” that significantly impacted the way they viewed themselves, their experiences (and the world in general), and their future. These underlying beliefs triggered faulty assumptions and irrational or unrealistic thoughts that Beck referred to as “thinking errors”.
Examples of thinking errors include:
- All or nothing thinking (e.g. statements that involve “always” or “never”)
- Discounting the positive while focusing on the negative
- Jumping to conclusions
- “Should” statements (“I shouldn’t have said anything!”)
- Catastrophizing (e.g. viewing a situation or event as much worse than it really is or will likely be)
- Making something personal when it isn’t (e.g. your boyfriend breaks up with you because you’ll be attending colleges on opposite sides of the country, but you insist it’s because he doesn’t care about you any more)
- Emotional reasoning (e.g. making a decision based on feelings rather than facts)
- Overgeneralizing (e.g. making a sweeping generalization based on one incident or limited information)
- Labeling (e.g. you make a mistake on a report and call yourself an idiot)
As humans, we’re all prone to thinking errors from time to time. However, for those struggling with depression or any type of anxiety disorder, these irrational and negative thoughts occur on a very regular basis – if not constantly. That underlying pattern fuels depression or anxiety (or both, as they often occur together). And of course, maladaptive behaviors (e.g. using alcohol to cope, or avoiding situations that make you feel anxious) occur in reaction to the negative thoughts and feelings. It doesn’t take long for it to become a vicious circle that continues to reinforce itself.
An Example of Negative Thought Patterns and Depression
Justin, 32, has a degree in accounting. He has been struggling with depression since high school. One of his core beliefs is that he’s a loser. Recently, a close friend didn’t return his call and he didn’t get hired for a job he’d been pursuing for some time. He was quick to attribute these incidents to his “loser” status in life, saying to himself, “Of course Dan didn’t return my call; he’s got much better things to do than bother with a loser like me” and, “What an idiot I was to even bother interviewing! No worthwhile company wants to hire losers!”
Did you notice Justin’s “thinking errors”? You see, he’s jumping to conclusions rather than considering alternative possibilities. In reality, Dan hasn’t had time to return any social calls because his demanding boss gave him an extra project with a tight deadline. The job fell through because, even though Justin had all the qualifications, the company president’s nephew had also applied for it.
Now, you’d think that if Justin knew these two facts, he’d feel a lot better about both situations and realize they had nothing to do with him personally. Right? Not necessarily. Even if he felt better temporarily, the negative patterns that dominate his thinking will quickly twist “reality” in another irrational direction. His defeatist mentality triggers more negative thoughts and depressed feelings. He tells himself, “Nephew or not, nothing ever works out for a loser like me” or “Why bother? There will also be a work project or favorite nephew that takes priority – that’s how things work in my crappy world!”
An Example of Negative Thought Patterns and Anxiety
While Justin is a perfect example of how negative core beliefs and thought patterns fuel depression, Sarah’s story illustrates how they can also play a significant role in anxiety.
Sarah has been suffering from social anxiety disorder for as long as she can remember. Extremely timid as a child, she still struggles to keep her nerves calm in the vast majority of social situations. Bullied for being chubby during grade school, Sarah – now a tall, slender, attractive young woman – is convinced that people are quick to notice her physical flaws and social ineptness. As a result, she avoids most social situations and works at an animal shelter; one of the few places where she feels at ease.
Recently, Sarah was required to attend a work-related social event. Held up in traffic, she was several minutes late. Moments after she arrived, she noticed several individuals huddled near the refreshments, laughing and whispering to each other. She felt her face flush and her heart begin to pound as she thought to herself in horror, “They’re making fun of me because I was late and looked like an idiot when I came in!” Sarah found the host, told her she wasn’t feeling well, and hastily left the event. As she drove home, she played the humiliating incident over and over in her mind.
What Sarah didn’t know was that none of those individuals had even noticed her. They were laughing and whispering in response to a very funny story that one of them had been telling when Sarah got there. Sarah spent the rest of the evening and the entire next day reliving her embarrassment. Of course, this reinforced her anxiety about all social situations.
Unlike Justin, if Sarah had known the real cause for the whispering and laughter, she probably would have felt better and stayed at least a little longer. However, her painful assumption that it was about her reinforced her determination to avoid social events; the anxiety she feels in such situations simply isn’t worth it.
Perhaps you know someone like Justin or Sarah. Getting him or her to look at anything in a more positive light is like trying to hold running water in your hand. Or, maybe you can relate to one or both of them because you also tend to assume the worst and feel awful as a result, rather than doing a “reality check” first.
CBT helps you learn to identify, challenge, and change distorted beliefs and negative, irrational thoughts to ones that are more empowering, realistic, and positive. It also teaches you healthy coping skills and behaviors. When you change the way you think about yourself, it changes the way you react to and perceive the world around you. As a result, depression and anxiety no longer rule your life.
Putting a Stop to Automatic Thoughts
With both depression and anxiety, automatic thoughts fuel the fire. Justin was quick to attribute negative situations to his belief that he’s a loser, while Sarah assumes any laughter or whispering is about her. These automatic thoughts feed their negative emotions.
In CBT, these automatic thoughts are addressed. Most people don’t even realize that these thoughts occur countless times throughout each day – until it’s brought to their attention. Once in awareness, you can begin to stop them in their tracks when they pop into your head.
Challenging and Changing Core Beliefs
Automatic thoughts are tied to your core beliefs. Core beliefs that often occur with depression include:
- I’m a failure
- I’m worthless
- I don’t get to be happy
- Nothing good ever happens in my life
- My life is cursed
- I’m unlovable
- I’m powerless to improve my situation
The core beliefs associated with anxiety are often tied to a profound sense of helplessness. For example, the sense that everything is beyond your control or the belief you won’t be able to handle “it”. “It” can represent a vast array of things, such as a 3-hour flight, a performance, an unwanted impulse, a negative outcome, and so on. “It” often becomes the metaphorical mountain your mind makes out of the molehill before you.
In many cases, these beliefs begin in childhood. For example, a child who was frequently abused by one or both parents will often mistakenly come to believe that she deserved it because she’s unlovable or worthless. To further ingrain that belief, her parents may have even said that to her on multiple occasions. Children don’t have the ability to look at the bigger picture or challenge the validity of hurtful things they are told. They take it at face value and assume it’s the truth.
Other beliefs develop more subtly. For example, a string of bad luck can make a young man vulnerable to depression start to expect more of the same. Rather than recognize that many factors were beyond his control, he adopts the belief that his life is truly cursed – that no matter how hard he tries, nothing will ever work out.
One of the primary goals of CBT is to challenge these core beliefs. A skilled therapist will help you “examine the evidence”. For example, in order for Justin to challenge his belief that he’s a loser, he needs to look at all the things in his life that don’t support that idea. His list might include the following:
- He has several close friends who care about him and value his friendship
- He was a straight “A” student who earned a full scholarship to a prestigious college
- He graduated from college with honors
- His current employer offered him a raise when he got wind that Justin was looking for a new job
- He has helped a lot of people through his volunteer work over the years
Does that sound like a “loser”?
Of course, Justin will also have a long mental list of things that, in his mind, fully support his core belief. For example, the two girlfriends who dumped him in college, the two high-paying jobs he didn’t get, and the various hurtful things people have said or done to him over the years. However, a skilled therapist will help him see how he looks at – and misinterprets – these types of negative events through his “I’m a loser” filter. In time, Justin will be able to catch himself when he jumps to erroneous, painful conclusions and starts to get stuck in negative thought patterns.
Sarah, on the other hand, might challenge the evidence another way. For example, her therapist may encourage her to try something: The next time she’s in any type of social setting and notices two or three people laughing about something, she could casually ask one of them if they’d care to share. Most likely, the other person will say something like, “Oh, Josh was just telling us the funniest story about his cute new puppy…” Sarah can take this as evidence that her fears are rarely – if ever – warranted.
Her therapist can also help her to identify and change the negative “self-talk” – both before and during social interactions – that feeds her anxiety. By learning new coping skills, changing her thinking, and trying out new behaviors in various settings and situations, Sarah can begin to enjoy socializing without so much anxiety.
Learning to Not React
It’s often said it’s not what happens to you, but how you react to it that matters in life. You see, your reactions are a result of your thoughts and feelings – the meaning you give to a particular event or situation. And with depression and anxiety, those meanings are negative, painful, or scary. Cognitive behavioral therapy can help you learn to look at things from a new perspective – changing the meaning and becoming less reactive as a result.
Prior to CBT, Justin’s typical reactions would be stop exploring new job opportunities (and stay stuck in an unfulfilling job) and get angry at his friend. Sarah’s were to avoid or quickly leave anxiety-provoking social situations. After therapy, however, they’ve both learned to look at things in a more positive light and react more appropriately.
Cognitive behavioral therapy is, of course, more involved than this article can possible convey. However, hopefully this will give you some idea of how this type of therapy can help you defeat the negative, distorted thoughts and beliefs fueling your anxiety or depression. Your thoughts are powerful, but CBT can teach you how to change them in a way that enables you to live the happy, fulfilling life you deserve.