II. How do Cognitive Therapy Exercises work to Lower Anxiety?

Cognitive Therapies intend to address two types of thinking processes that can become distorted:

• Cognitive distortions or automatic thoughts
• Faulty core beliefs about self, world and future

These distortions in thinking processes are based on the cognitive triad:

• Our collective thoughts about ourselves
• The world
• The future

Without realising it, we may have distorted views or automatic (active) thoughts that can lead to stress. For example, some people view themselves and other instinctive thoughts as:

• not being fit
• doing badly at maths
• worrying about their diet and exercise
• panicking when taking exams 
• fearful of walking anywhere alone at night as they view the world as a dangerous place
• worrying about whether they have saved enough for their future because of the volatile global economic changes

Sometimes these views are based on real experiences from the past:

• the person worried about diet and exercise may have been underweight or overweight as a child；
• the person who is scared to walk alone at night may have been mugged ten years ago；
• the person worried about saving enough money may be young, just out of college and in his first job.

These worries can still result in the same anxiety-based life disruptions. If the person who is worried about his weight stops eating, or the scared woman stops going out altogether (even for work), and the young college graduate stops buying for the house, their once reasonable concerns would then become full-blown anxieties. They will need help to reduce anxiety to deal with the reality of their concerns.

If we see our reasonable thoughts become an anxiety which can prevents us from feeling well physically and mentally, then cognitive therapies can help. There is a process and an underlying principle in most cognitive therapy to act, help and intervene.

Various cognitive therapy exercises often start by identifying unrealistic thoughts or exaggerations that can influence our behaviour and how we view ourselves. They are called cognitive distortions and these can become negative self-statements or self-talk.  Here are a few examples of cognitive distortions:

1. Catastrophic thinking:  believing that one event means the end of everything, or one small mishap will lead to disaster, always thinking the worst.
   
   “I missed the last train, the next one is not for another 15 minutes! I won’t make any of my connections! I’ll never get out of here!”
   “This plane is going to crash, I’m going to die, I’m going to die."
   “I can’t seem to get to work on time. I’m going to get fired and be poor for the rest of my life.”                                                                                                                                                            
2. Overgeneralization:  taking a few experiences and generalizing them for every experience.
   
   “After these 3 bad dates, I realise I’m just no good at anything.”
   “I didn’t get the jobs I applied for, so I'll probably not get into university either.”
   “My finances haven’t been looking very good of late, I’m just no good at living on my own.”                                                                                                                                                                           
3. All-or-nothing thinking:  You see your performance in black or white； everything is either perfect or a complete failure.
   
   “If I don’t get all high marks this term, I’m a terrible student.”
   “I mispronounced a word while speaking to my superior, he probably thinks I am incompetent now.”
   “They didn’t have the right food on the menu at that restaurant so our first date was a disaster.”                                                                                                                                                                                                                                  
4. Self-fulfilling prophecy:  Defeating your future actions and beliefs with negative ones now.
   
   “If I get on this bus now, I know I’ll have a panic attack.”
   “I can’t apply for that promotion, I’ll just get rejected.”
   “I just don’t think that it is possible to get high marks in school, I’m just too dumb.”                                                                                                                                                                                                                                                  
5. Mental filters:  Dwelling on one negative event until it changes your entire outlook.
   
   “It’s too bad that Joshua got laid off. They’ll probably cut staff in the whole department. I will be the next. If I lose my job, then I’ll lose my car. I won’t be able to pay my mortgage, I’ll be homeless. I should just stop caring about this job.”
   “I hope my supervisor is not upset about what I said earlier. If so I’ll never hear the end of it, and I’ll worry about it all night and then I’ll be tired and irritable tomorrow and I’ll just have to start all over again. I shouldn’t even talk to him.”
   “If I can’t keep this job I will lose my car. If I lose my car I won’t be able to feed the children. I will lose the house. I should just give it all up.”                                                                                                        
6. ‘Should’,‘must’, or ‘need to’:  Creating a rigid set of rules or beliefs that may never be completed.
   
   “I should only eat leafy greens all the time.”
   “I must exercise every day or it means I’m not dedicated enough.”
   “I need to keep working now or I’ll have to work twice as long tomorrow.”  
   “That audience will hate my speech； I just know it!”                                                                                                                                                                                                                                      
7. Discounting:  Rejecting positive experiences or not being able to accept positive feedback
   
   “I’m sure when she said I look nice today, she was just trying to boost my ego.”
   “The only reason I won this award is because nobody else wanted to apply for it.”
   “It was just a fluke that he was nice to me today, he must just be having a good day.’                                                                                                                                                                                        
8. Personalization:  Seeing yourself as the cause of a negative event when you actually had nothing to do with it.
   
   “Maybe if I had driven faster when John woke up late, he would not be late for work now.”
   “If I hadn’t tossed my cigarette out the window, that car accident might not have happened.”
   “She had that house fire because I didn’t buy her a safer hairdryer.”                                                                                                                                                                                      
9. Blame shifting:  Shifting responsibility on your behaviours to the people around you.
   
   “If my friends didn’t drink so much, maybe I wouldn’t either.”                                                                                                                                                                                                   
10. Mind reading:  Assuming you know what people are thinking and then think the worst about yourself.
    
    “I know they all think I am an idiot, that I can’t get anything right.”                                                                                                                                                                                          

You may find that these all sound rather familiar but that you never realised you were doing it before. They may come without any active thought on your part - these are called automatic thoughts. Or, they may be something you tell yourself constantly in a specific situation - this is negative self-talk.

These distortions can be identified by thought tracking. In thought tracking, you may keep a journal of these thoughts as they occur, so you understand what they are and how they are triggered.  You can then use different exercises to change your negative thinking to something more positive that can help your wellbeing.

Changing from a negative to a positive thought is useful and beneficial to the mind. It is a matter of having the “glass is half empty” perspective to a “glass is half full” perspective. It is the same glass, with the same amount of liquid but how you look at it makes all the difference. This will help to visualise your thoughts in a positive light.

Here are the scenarios to illustrate the two types of perspective:

• You are driving down the road to work. It is early morning, you have not slept well, and before you left the house you and a loved one had an argument about who is to do the grocery shopping after work.
• As you get into your car, you tell yourself, “I hate it when my car door sticks.”
• You slam the door and put your foot on the accelerator, “If that horrible person didn’t live with me I would be able to afford a different car.”
• When you arrive at work, a colleague waves to you and you think to yourself, “what an idiot, they are just rubbing it in that they are having a good day.”
• You then go to work and spend most of your day stressed and out of sorts.

2) Scenario with a ‘glass of half full’ approach:

• As you get into your car, you tell yourself, “this sticky car door probably needs to be fixed, but it gives this old car character.”
• You slam the door and put your foot on the accelerator, “He is a good person, he just doesn’t understand that I don’t have time for these things.”
• When you arrive at work, a colleague waves to you and you think to yourself, “at least somebody is having a good morning, maybe I can make the best of my day.”
• You then go to work with much more of a fighting chance to avoid becoming stressed out or out of sorts.

After identifying stress-producing thoughts and negative self-talk through thought tracking, you can use a number of cognitive strategies to replace negative self-talk or thoughts to achieve any goal. Some of these goals can include:

• lowering fears
• removing beliefs about situations that used to lead to panic
• becoming more physically healthy
• generally feeling better about yourself
• counter anxiety and low self-esteem
• increase overall wellbeing: better breathing and cardiovascular health
• increase greater immunity
• lower stress
• prevent burnout

The cognitive strategies are often practiced daily and at home. If you are working with a therapist or a partner, you can review your practice and see how much closer you are to your goals. Remember to try and look at the glass half full, by changing your thoughts and self-talk.

Cognitive Therapy techniques can be combined with Behavioural therapy to address the behaviour that results from faulty cognitive processes, and is known as Cognitive Behavioural Therapy (CBT). Identification, goal setting, and strategy practice or daily practice are also part of Behavioural Therapy.

Much like Behavioural Therapy and CBT, Cognitive Therapies require your initiative and hard work. If you do not believe that you can maintain your motivation at this point in your stress treatment, you may want to use cognitive therapy. Although you can do many of these strategies on your own, Cognitive Therapy is often more successful when done with a therapist or partner. If you are looking for support while practicing and using these techniques, you can look at the lesson on Social Support for information on ways to include therapists and supportive people in your anxiety treatment strategies. Some forms of Cognitive Therapy are designed to be done with a therapist only.

Although Cognitive Therapies and CBT address core beliefs that may have originated from past experience, the strategies are designed to deal with current issues and problems. If you have experienced traumatic events early in life, you may wish to use other therapeutic approaches like Psychodynamic Therapy which deals with the emotion and motivation.