Self Care Strategy No 2 The Cognitive Restructuring Method

You are probably aware that mood states are affected by the things you tell yourself—by what we call "cognitions" or "self-statements." Many studies have shown that negative thinking is associated with depressed and anxious moods (for example, Clark et al., 1999; DeRubeis et al., 1998). People with depression often have negative "core beliefs" about themselves (for example, "I'm not a likable person"), about people in general (for example, "people are generally motivated by selfish concerns"), and about their future ("I'm never going to accomplish my goals/be loved/be healthy"). The assumption of cognitive-behavioral therapy (Beck et al., 1979) is that certain events provoke distorted "automatic negative thoughts" that reflect core beliefs about one's un-worthiness or unlovability. These automatic thoughts and core beliefs are important in causing and maintaining depressed mood and behaviors (for example, withdrawing from others). In cognitive restructuring, you hold your assumptions up to the light to see if they are logical and accurate or if there are other ways to make sense of your experiences. You may recall my discussion of cognitive therapy in Chapter 6; it is one of the most effective treatments for depressive and anxiety disorders (Clark et al., 1999).

The relationship between thoughts and mood states is probably not oneway: Depressed moods also generate distorted thoughts and increase a person's access to negative memories or images (Gotlib &r Krasnoperova, 1998). But learning to modify negative thoughts and replace them with more adaptive or balanced cognitions can go a long way toward alleviating your depression.

Cognitive restructuring involves a sequence of techniques. First, you identify the automatic thoughts or self-statements associated with certain disturbing situations or life events and link these thoughts with your mood states. You will probably find that certain thoughts or images are more powerful than others in provoking your emotional reactions ("hot cognitions"). Second, you evaluate the evidence for and against these automatic thoughts. Next, based on this for/against evaluation, you learn to replace your original thoughts with self-statements that provide a more balanced interpretation of your experiences. Last, you observe the effects of these new self-statements on your mood.

This method is not a matter of blithely replacing bad thoughts with good ones, which many people find superficial and unrealistic. Instead, it involves thinking up alternative or more balanced ways of understanding the things that have happened to you and looking at your situation from a number of different vantage points. A simple example: Some people automatically blame themselves when someone else treats them badly, without considering the possibility that this other person is having a bad day or often behaves in a similar manner with other people.

In this section, 1 describe the method of cognitive restructuring and outline exercises to help you learn it. Like the pleasurable activity scheduling, cognitive restructuring will probably have its greatest power once you have noticed the appearance of one or more depressive prodromal symptoms, be fore your depression gets really severe. If you want to explore this method further, 1 suggest consulting the book Mind Over Mood by Dennis Greenberger and Christine Padesky (1995) or books on the use of cognitive-behavioral therapy with people who have bipolar disorder (Basco &r Rush, 1996; Newman et al., 2001).

Step J: Identifying Negative Thoughts

Jacob, age 49, struggled with severe bipolar depressions that alternated with mixed episodes. When he was feeling well, he was a popular coach of a children's soccer team. But when he felt he'd had a bad day of coaching (for example, his concentration had been poor or the kids had not responded to his suggestions), his mood would sink. He became aware of a self-statement that went like this: "I'm just no good with kids. I have major character flaws that they can see in me." Sometimes, just the word character would pop into his mind, and he would feel his mood drop. Character became a hot cognition closely tied to his mood state of depression.

Jacob was actually quite good with children, and the kids and parents on his team frequently expressed their appreciation of him. Nonetheless, his thinking and resulting mood contributed to his increasing desire to quit coaching altogether. When asked to recount why he thought he had a bad character, he tended to focus on one or more mistakes he had made and magnify or overgeneralize these mistakes ('LI was impatient with one of my kids. I was too hard on him. I can't work well with people because I can't be patient with myself').

The first step in cognitive restructuring is to become aware of the thoughts, images, or memories that crop up when you have experiences that negatively affect your mood. Be particularly attuned to experiences involving your work, family, or close relationships. Take a look at the thought record exercise on page 232, which we'll be completing throughout this section. Pick out three negative experiences you've had in the past week and record them in the table (column 1). Rate the intensity of your mood (column 2) in reaction to these events on a scale of 0% (not depressed) to 100% (very depressed). (Alternatively, use the -3 - +3 scale we talked about in Chapter 8 if you're more comfortable with that rating format). List other moods you may also be feeling (for example, anxiety) and also rate their intensity. Try to distinguish how you felt during or immediately after the event, not how you felt that entire day.

Now see if you can recall any negative self-statements that came into your

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