Cognitive Therapy

Cognitive therapy, like all therapies, has the potential for abuse when placebo relief substitutes for authentic relief

One of the techniques in cognitive therapy (and also talk therapy) is self-explanation. Self-explanation is a double-edged sword. The way it works is that by spelling out your issues or concerns, whether in text (or via talk), overly-distorted and overly-negative thoughts may seem apparently dysfunctional, and then have a way of magically disappearing.

The opposite may happen, though, which is where the potential for abuse is. Investigating an emotion or issue necessarily amplifies it, at the very least for that moment, as it's further brought into light. As a result, the epiphanies in cognitive therapy are usually forged after a temporary spike in anxiety. The relief that follows is at least half the result of the simple contrast of moving your attention away from your issues and going about your day-to-day activities.

The potential for therapeutic abuse comes when that automatic relief gets confused with the actual relief that comes from successfully disputing negative beliefs.

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Cognitive therapy isn't magic; It's just a methodical approach to building emotional intelligence

Cognitive therapy is ultimately about emotional intelligence. A lack of emotional intelligence, when applied to personal issues, is the real source of depression (outside of chemical-only causes). When an EQ-deficient person gets hit with an episode of dysphoria, they are liable to think their world is crumbling down. But after applying cognitive therapy, they will narrow down their ill-feeling to dissatisfaction with work, then to dissatisfaction with a specific co-worker, to finally dissatisfaction with a particular incident, which will lead to a clear and appropriate response. Without cognitive therapy, they would otherwise just live in a depressed haze for a week until the initial triggering incident somehow becomes a non-issue. With enough therapy sessions, this emotional winnowing process gets faster and more reflexive, and eventually, the patient has something that resembles the intuitive process of someone with a higher EQ.

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Daring to think of genuinely negative thoughts makes them easier to dispute than when they just sneak up on you

Oftentimes the solution in a cognitive therapy session turns out to be reverse psychology. For example, if you have a negative, distorted cognition such as, "I am a failure," cognitive therapy would urge you to present both evidence for and against it. Sometimes just the mere act of presenting evidence in favor of it is enough to provide relief. So if you sit down with yourself and say, "Okay, let's assume I'm a failure, what evidence would point to that?" then the cognition becomes something you control. You are effectively telling yourself you're a failure, with your fingers-crossed, because you know you're only saying so as a thought experiment to find facts that will be disputed anyways.

This implies that our negative distortions are oftentimes suppositions that we're too scared to confront. If you're too scared to think you might be a failure, then your mind has to double-down and present the negative thought with increased volume and repetition until you're jolted out of your complacency.

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Psychology's biggest wins remain in the experimental; Meanwhile, its conceptual wins remain clouded by myopic metaphors

The biggest bias in psychology is the pneumatic theory of the mind. It suggests that brains are like an interconnected series of reservoirs and pumps. For example, if at your first therapy session you explain how you're exhausted by work all of a sudden, the therapist could suggest, "Are you perhaps blocking out misgivings in other aspects of your life by throwing yourself into work." You might nod your head in agreement because somehow it makes sense. It makes sense that there is this pressure brewing, like a pot on the stove, and in order to avoid that pressure, you're drawing your attention away with escapism.

But our understanding of the mind is limited by a layman's understanding of engineering. We imagine issues in our lives like levers, with insight acting as fulcrums. We imagine bubbles of insecurity inflating and then popping. We immediately latch onto debunked pseudo-scientific theories from Freud, such as his notion of repression, which conceives of thoughts like steam pipes, that when shut for too long, burst.

While on a molecular level, the mind is a machine, at a high-level, the mind may not have any appropriate metaphor grounded in the basic sciences. The most accurate metaphor is that of society, which has been popularized by Daniel Dennett. This theory states that the mind is like a democracy with various factions competing for attention. Even if this is accurate, our scientific understanding of crowds is weak.

Therefore, a black box approach still yields the only psychological truths. Even if the black box in question is a pneumatic theory, like cognitive therapy—which imagines negative thoughts like frothing vents—the therapy is only interesting if a meta-analysis validates it, which it does. In other words, the logic of cognitive therapy may be completely false, but at least we know that if we throw the therapy at a subject, we can predict the outcome. That's the best we can hope for in psychology.

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Since many negative distortions are inherited, it's possible that cognitive therapy could take multiple generations to work

It's possible that cognitive therapy may take multiple generations to work. Here we define cognitive therapy broadly as the process by which your worldview gets adjusted to more realistic/optimistic interpretations of the world. Without deliberate sessions with a therapist spread over six months, there are still natural forces designed to give you undistorted thinking.

Your grandparents, for example, might be well-adjusted human beings, but raised their children (your parents) in an environment much different than the one they grew up in, and therefore your parents might have distorted ways of thinking about the world. Your grandparents might have ways of thinking, that for them, weren't distorted, but when shared with their kids came out that way.

Your grandparents, for example, might have told your parents that, "If you veer from the Puritan work ethic, your soul will crumble." Your parents, growing up in the 1960s counter-culture, might have been split and even depressed while living in both worlds. When your parents then raise you, they might try to present a cohesive worldview that would've helped them go through the 1960s, one free from such dire statements. But their actions might contradict their commandments, and remnants of their parents' distortions might yet get passed onto you.

You might then fine-tune your parent's exhortations further until your children are well-adjusted and free from harmful fears of their "soul crumbling."

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The "wisdom to know the difference" between what to accept and what to change most easily comes from meditation

One of the common questions that comes up in meditation is in the following form: "If something bad is happening, let's say I see my children are fighting violently with each other, do I just meditate on it, and accept what's happening?" What you actually do is accept that this is the situation in front of you. You cannot avoid the reality as it exists in that moment. But meditation only goes that far, and therefore acceptance shouldn't be confused with approval. You accept that there is a fight in front of you, that it is not good, and you respond accordingly.

The difference between approval and acceptance may seem minor, but this subtle language difference is a common pattern in meditation. Oftentimes, meditation brings about a response that is perpendicular to the problem at hand. If problem and solution are arrows pointing in opposite directions, meditation often goes toward something that moves in neither direction. Coping is often in that gray area between problem and solution.

In cognitive therapy, one will also encounter that a fear of acknowledging the reality of the situation leads to distorted negative thoughts. And a common distorted negative thought is, "If I accept things the way they are, then it will make me okay with them." While it may be true that some element of non-acceptance feeds a stronger sense of disapproval, it comes at a price of sacrificing objectivity, and potentially harming yourself with exaggeratedly negative thoughts, likely making the problem worse.

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The 90-10 Rule

The 80-20 rule is a magic rule of business that states that 80% of your business comes from 20% of your customers. After the invention of this rule, it was discovered that it could be applied to all sorts of aspects of business. For example, 80% of the work done in a business gets done by 20% of the employees, or that 80% of procrastination can be eliminated by doing the initial 20% of a task.

In self-improvement, there is a similar rule that isn't as widespread, and it's the 90-10 rule. I first observed it in Sonja Lyubomirsky's The How of Happiness. The book, which is a comprehensive survey of studies on positive psychology, states that 90% of people's happiness is determined by internal factors, like temperament and intentional happiness activities, versus 10% which is based on external factors, like money, good looks, etc.

This makes intuitive sense. We see unhappy millionaires and happy paupers all around, to the point where the money, clothes, good looks, etc. all seem like noise.

I also noticed the 90-10 rule in my cognitive therapy sessions. 90% of the time, my cognitive therapy sessions led me to attitudinal adjustments. For example, I would have a session where I would be upset at my social skills, only to realize at the end of it, that I was harping too frequently on my supposed faux pas. Nine times out of ten, a cognitive therapy session would lead me to correct a distorted thought.

One out of ten times, though, my initial reason for having a cognitive therapy session would bear some truth. I may start a session filled with social anxiety, replaying events from a party the night before. At the end of the session, I may then realize there are specific social skills I should work on, like not prying too much into other people's lives.

Perhaps a recognition of the 90-10 rule, in of itself, is essential to happiness. Some happy people, when quizzed about their philosophy of life, may say, "Happiness is a state of mind." Whereas some unhappy people, when quizzed, might talk about external factors. A common philosophy of happiness states that it's important to have "Something to do, something to hope for, and someone to love."

Believing that your happiness is tied to external factors may lead to a hedonic treadmill, though, where you falsely believe certain goals are supposed to make you happy. You then seek them, possibly achieve them, but then find out that the goal post has now moved further back. And then the cycle repeats itself.

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Tunnel vision is the common element between cognitive therapy and Asperger: One relieves it, the other is fenced in by it

Since cognitive therapy is such a powerful and reliable tool for alleviating depression, its techniques provide insight into the nature of depression.

The basic premise of cognitive therapy is that by iterating through a list of negative biases, one can cultivate a more calm and quieter self-understanding. For example, a common disputation technique is to address whether your thoughts are too black-and-white. For example, if you believe, with 100% certainty that you will get fired, probably the situation is more nuanced and gray.

There's a little over ten common disputation techniques, and they all have a similar pattern: they address the mindset of someone with an Aspergers-like tunnel vision. Aspies often lock onto an idea and rigidly shut out all contrary thoughts. The black-and-white disputation would apply to this, and so would the disputations on over-generalizing ("I'm unemployable"), filtering (ignoring some side jobs you heard about recently), disqualifying the positive (ignoring the compliments you've received at work), jumping to conclusions ("that criticism from my boss means I'm definitely fired"), and magnification (this is all you can think about).

Is depression, then really just about having a narrow, and inflexible mind? Is that perhaps why meditation is so effective at alleviating depression as well because it loosens up the mental muscles that clench onto single, negative thoughts?

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When you realize that 90% of cognitive therapy sessions lead to attitude changes, all introspection starts to seem suspect

Cognitive therapy indirectly teaches that introspection itself is the cause of depression. Much of cognitive therapy involves renaming and rewording negative cognitions to something more balanced. For example, if you make a mistake at work, it is easier to say to yourself, "You're a failure." Cognitive therapy would urge you to spell out a more accurate reflection: "I made a mistake filling out paperwork yesterday, and that's the second mistake this week. Although it doesn't appear to be part of a larger pattern, it happened twice, and people might say something. I won't get fired unless I really mess up, but I should stay alert, especially in this economy."

Since this rewording calms patients down, it begs the question, "Why don't naturally we have these longer, healthier self-descriptions in the first place?" But perhaps that's not the point of introspection. Introspection might have evolved as a warning system, coded with exaggerations and distortions to shock us out of complacency. When this system is abused, the alarm bells linger past the non-existent fight-or-flight scenarios they were designed to anticipate.

If every cognitive therapy session involves realizing that your initial negative thoughts are inaccurate, at some point, you stop worrying about what your inner voice says and instead carry a skepticism toward all introspections in general.

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You could abuse cognitive therapy if you mistake a distorted negative belief for a fixed inclination, like trying to dispute one's sexual orientation

What is the basis of one's stance toward something? Is it taste or belief? Some stances we take because of taste. You can't, for example, use cognitive therapy, to make yourself enjoy heavy metal or hip-hop music. That is unless your negativity toward those genres is based partly on a distorted negative belief toward those underlying subcultures. By extension, is it possible that some negative attitudes toward ourselves are not based on distorted beliefs, but a natural distaste or revulsion?

Most likely it's a spectrum, of taste and belief, and at the very least, cognitive therapy should be used to rule out the belief component. But beyond that, a different tool has to be used.