Questions Regarding Cognitive Behavioral Therapy

[stargazer]

I just began CBT, and one of the things I'm to do is to "identify triggers," which I take to mean the thoughts/beliefs that trigger the feelings/emotions that may then trigger negative behavior patterns. This morning I made my first written attempt to do so, in a notebook I'll be taking to my therapy sessions. Rather than share that exact info right now, I find myself stumbling over basic questions regarding this type of therapy.

I'm on Wikipedia now reading these words:

"With thoughts stipulated as being the cause of emotions rather than the outcome or by-product, cognitive therapists reverse the causal order more generally used by psychotherapists. Therefore, the therapy is to identify those irrational or maladaptive thoughts that lead to negative emotion and identify what it is about them that is irrational or just not helpful; this is done in an effort to reject the distorted thoughts and replace them with more realistic alternative thoughts." (Italics mine.)

First of all, I am wondering about this reversal, why it has come about, and I guess why more psychotherapists "generally" use the reverse order; that is, that thoughts are the outcome of emotions, and not the other way around. I'm asking about this because I had difficulty in identifying thoughts that preceded negative emotions in an event that occurred a couple nights ago. (By the way, I do understand that cognitive therapy takes time, and this isn't an issue of my having an inordinately high expectation as to rate of progress. I'm only trying to gather information, so as not to be confused about the process as I proceed.)

It seems, in my experience at that moment of pain, that the emotion hits first, and that thoughts come next. So I guess I'm having a hard time believing in my ability to respond effectively to the therapy. I did, however, follow through with the assignment, and I was able to list seven thoughts that were at least *attached* to five negative emotions related to those thoughts. But I'm having a hard time reasoning that the thoughts in any way preceded the emotions. It all seems to be in reverse to me.

By the way, I didn't proceed into any negative behavior after this event, so maybe I'm making *some* progress. I might earlier have sent the guy an angry e-mail reply, but instead I let go of it and just went to bed.

 

[Into The Light]

hi sg, i think our thoughts are so lightning fast that they do occur before our emotions. if someone says something that angers us, when you stop to analyze why it made you angry it takes a bit more time to work things out. i find with these exercises that my thoughts do really create my emotions. once i work out what my thoughts actually are, and then create positive, realistic thoughts to counter the original thought, i find that my feelings improve. they may not go always away, but the negative feelings are lessened.

i find it interesting because we sometimes don't realize why certain things are upsetting to us until we stop to analyze. i have been surprised at some of the things that were actually going on in my head. maybe it's even sort of at a subconscious level, which is why you may think that the emotions come before the thoughts.

anyway this is my take on it, it certainly isn't a professional opinion but this is how i think it works.

 

[Into The Light]

another thing i wanted to mention it seems to be therapeutic too to write down all the thoughts that come with negative emotions i am having. it helps me process what i seem to be believing deep down about myself. it has saddened me or made me feel worse to write down the actual thoughts that i seem to believe, but once they're down and i work on countering those thoughts with more realistic ones that i truly believe, i do feel better.

 

[^^Phoenix^^]

I aggree

Also sg, I think that this level of thinking about the therapy might be helping you also. You've always struck me as a very introspective and insightful person anyway, and perhaps because of your personality, you need to dig through the therapy, root out what you don't aggree with/don't understand, and then discuss that with the psych, before you can proceed.

I set tasks for myself, using techniques like this one. When I'm down, or wanting to self harm, I sit down and write about how I'm feeling? then, what happened before that? then, how was I feeling before that happened? then what happened to make me feel like that, etc. Sometimes I reread what I wrote, and am totally shocked at the conclusions that I have come too. seeing the triggers right there infront of me, when I didn't think that they were triggers to begin with, and also finding out what aspects of the behaviour/actions are triggering, and why. Such triggers, I had previously thought were just mild fleeting thoughts. Fast ones, that I wouldn't have even caught had I not been looking for them. But by writing them down, I'm transferred back to those feelings, thoughts and emotions for a short period of time, to work through them and understand them.

I have never been directly involved in CBT, and I have to say, it does sound interesting!!

 

[stargazer]

i think our thoughts are so lightning fast that they do occur before our emotions.

Thanks for saying that, baseballcap--that was extremely helpful! That has got to be it...I had almost said in the previous post that they all seem to come at once, the thoughts as well as the emotions. But because emotions are felt so strongly, especially when thoughts are those of confusion, they are somehow "louder" than the thoughts that led to them.

i find it interesting because we sometimes don't realize why certain things are upsetting to us until we stop to analyze. i have been surprised at some of the things that were actually going on in my head. maybe it's even sort of at a subconscious level, which is why you may think that the emotions come before the thoughts.

I also find it interesting. In this case, though, well heck, I'll just go ahead and list the thoughts--it was kind of interesting, but since this is the first time I've done this, I'm not really grasping why this guy was bugging me so much with what he did. I mean, I generally like the guy...

Thoughts:

(1) Where on earth is he coming from?
(2) This is a downer. I was having fun until now.
(3) He's acting like there's a problem where there isn't one.
(4) Why is he suddenly giving me unsolicited advice?
(5) He does this all the time.
(6) Who does he think he is?
(7) He misunderstands me.

Emotions:

(1) depression
(2) disappointment
(3) futility
(4) frustration
(5) anger

Well, as you can see, I'm not very good at this. But anyway, that's what I was able to get down on paper about it.

Oh, by the way, the meditation instructor sent me his handout in a Word doc, I don't know how to get it to you though. You can probably e-mail him, I'm sure it would be cool.

 

[stargazer]

I think that this level of thinking about the therapy might be helping you also. You've always struck me as a very introspective and insightful person anyway, and perhaps because of your personality, you need to dig through the therapy, root out what you don't aggree with/don't understand, and then discuss that with the psych, before you can proceed.

Hi Phoenix, I just now saw your post after responding to baseballcap. LOL I don't know about "insightful" but "introspective" definitely! Thanks for the compliment, though. And I think you have a good point, in that my personality lends itself to the need to examine therapies a little more deeply, not so much because I am skeptical as to their usefulness, but because that examination is necessary for me to get to the place where I can more readily accept them.

Seeing the triggers right there in front of me, when I didn't think that they were triggers to begin with, and also finding out what aspects of the behaviour/actions are triggering, and why. Such triggers, I had previously thought were just mild fleeting thoughts. Fast ones, that I wouldn't have even caught had I not been looking for them. But by writing them down, I'm transferred back to those feelings, thoughts and emotions for a short period of time, to work through them and understand them.

Yes, that sounds so amazing, that these seemingly mild and fleeting thoughts should turn out to be triggers--and yet they do. I've begun to look more deeply into why my friend John's "sudden unsolicited advice" bothered me so much. We'd been in an e-mail exchange that I'd thought was perfectly fun and light-hearted and entertaining, and I wasn't even in the mode of thinking about my problems at all, I was just having fun. Then all of a sudden he's in counselor mode. Wouldn't that bug you too? Well, maybe not....I guess I still don't have an insight into it....oh well.......

 

[^^Phoenix^^]

SG - I think you are good at it, because youve identified your thoughts and then the emotions. If you've never done it before, being able to identify these is really good progress. Its not as easy to do as it sounds and you deserve to know that. The next step is probably working out why the emotions (on a personal level) occur after the triggers.

For example anger: Why do you feel anger? is it at being misunderstood? is it because you arn't feeling listened to? or is it a way of coping with with the depressive emotion? and if its that.. are you feeling angry at being depressed? at being made to feel depressed? or because that is a usual way of coping with being depressed?

 

[^^Phoenix^^]

I've begun to look more deeply into why my friend John's "sudden unsolicited advice" bothered me so much. We'd been in an e-mail exchange that I'd thought was perfectly fun and light-hearted and entertaining, and I wasn't even in the mode of thinking about my problems at all, I was just having fun. Then all of a sudden he's in counselor mode. Wouldn't that bug you too? Well, maybe not....I guess I still don't have an insight into it....oh well.......

Lol Sg, I also saw your post after posting!!

what you've quoted above, used to bother the snot out of me!! especially - the unsolicited part. It was definatly a trigger for me, as it is for you. I think that probably the 'training your thoughts' part of CBT will help you, not be triggered when coming accross this type of info (this isn't a critisim in anyway) for instance, when you recognise the trigger, you may automatically begin to think in terms of, "why is he saying that" rather than, "how dare he say that" lol - (extreem example, I know - but you get the jist?)

 

[stargazer]

For example anger: Why do you feel anger? is it at being misunderstood? is it because you arn't feeling listened to? or is it a way of coping with with the depressive emotion? and if its that.. are you feeling angry at being depressed? at being made to feel depressed? or because that is a usual way of coping with being depressed?

This is all very valuable. I think the anger results from an idea I have, not so much that I need to be understood (although that figures into it) but that I need to be *recognized* for who I am, and not mistaken for somebody else. When I feel *unrecognized,* I then feel "disrespected" -- and that's one of the worst feelings. So the idea is that I am worthy of recognition and respect. When I am not offered those, I feel violated and I become angry.

As you say, "not being listened to" is part of it as well. That's all part of being/feeling "disrespected." As far as anger being a way of coping with depression, I'm not sure. I think it's more like, I get angry at the fact that I was somehow made to feel depressed, when all I really ever wanted was to have fun to begin with.

As I say that, I sound so childish. But that's really my thought process. I just don't know that I've ever stopped to take a look at it before.

When you recognise the trigger, you may automatically begin to think in terms of, "why is he saying that" rather than, "how dare he say that" lol - (extreme example, I know - but you get the jist?)

Got it. It goes back to the prayer I quoted at the end of my thread--it is somehow a "higher" thing to try and understand than to try and be understood. Instead of feeling insulted at John's audacity, I might ask: "Why does John jump suddenly into counselor mode and give unsolicited advice? And does he have the faintest clue that his advice is very often wrong???" (That part might be irrelevant, but I just had to throw it in, he he.)

 

[^^Phoenix^^]

As I say that, I sound so childish. But that's really my thought process. I just don't know that I've ever stopped to take a look at it before.

The amount of times I've called myself 'childish' is unmeasurable!!! But thats the nature of most triggers. They arn't always rational. When I deal with triggers, I find alot of them begin to route themselves to my mother, hehehe (unresolved issues there that I'm still trying to work on) but the response to triggers like that - tantrums, sulking, things that you'd expect from a child. I think it is because that is when the triggers were er... 'put in place' (for want of a different phrase).

 

[stargazer]

I think that the whole idea of being childish, of not quite accepting that reality is full of hard knocks and that things can't always go our way, is so attached in our culture to a sense of moral inferiority, that it's a hard feeling even to cop to in many cases. A childish person is somehow "not holding up their end of the load" and they find themselves bucking against our various ethics, our work ethics, and all that. At least, that's been my experience.

On the other hand, sometimes when I observe someone sulking or pouting or throwing a tantrum, my heart goes out to them at that moment, because I can so identify with the pain that they must be feeling.

On another note, I just now had another trigger--something having to do with m studio session in this Saturday--and I better do some more writing, while it's fresh. This one happens ALL the time, and it's a bad one, too.

It's been nice talking with you this morning.

 

[^^Phoenix^^]

And you SG - I am really proud, seeing you working through these things this morning. Good luck with your writing this morning! ttyl

 

[stargazer]

Well, I just did the writing, this time identifying five thoughts triggering three emotions and an absolutely crazy scheme I'd have to be completely deranged to decide to enact! But now I've developed two new questions.

Do these thoughts need to be triggered by external events, or can they simply be triggered by habitual thought patterns intrinsic to our personalities? (I confess I've not yet read the entire hand-out Dr. Baxter just sent me, so perhaps the answer is there.)

The reason I ask is that I have noticed certain very irrational thought processes related to the production of my musical. In fact, it's possible that these processes are inhibiting its actual production, since after all, it has not yet been produced. And I find no prompting for these thought processes in external reality, only within my own realm of inner intellectual delusion.

The second question regards the types of emotions that arise from these types of thoughts/beliefs. I'm not sure they're "emotions" because they seem., from my religious background, to be more akin to the seven deadly sins, or something like that. In other words, are things like "greed," "pride," and "lust" emotions? Or feelings? Or are they on some other plane?

Because of these two new questions, I'm questioning the legitimacy of the exercise I just undertook.

 

[stargazer]

In fact, I ripped up the second exercise. The thoughts were just too horrible to even see on paper. Maybe I'm going at all of this too quickly...the feelings themselves were certainly universal enough, and at least understandable. But the thoughts were just awful. I really need to get a grip.

I'll read the hand-out right now.

 

[stargazer]

I feel kind of dumb--the answer's right here. David Burns writes: "If you want to feel better, you must realize that your thoughts and attitudes – not external events – create your feelings."

Anyway, I'll read the rest of the hand-out now.

 

[stargazer]

Having awakened unusually early in the morning (2:45am) I found myself nodding out shortly after my last brief post. On re-awakening, I finished reading the hand-out. David, thanks so much for sending that. I love the "ten forms of twisted thinking" -- I'd read those here on PsychLinks earlier. I also gained a lot from the table entitled "Your Thoughts and Your Feelings," in which an emotion is identified, and examples of thoughts leading up to those emotions are given.

I'm still unclear as to where the feelings I associated earlier with the cardinal sins in Catholicism; i.e., not actual sins, but attitudes or emotions that could conceivably lead to "sin" (or simply to destructive or negative behavior) Fit into the picture, but I definitely got the distinct impression that a certain destructive thought pattern of mine is something that Coginitive Behavioral Therapy can address. I'll re-create the list I discarded earlier.

 

[David Baxter PhD]

I'm glad you found it useful, SG.

Did you ever read James Joyce's Portrait of the Artist as a Young Man? I always thought that was an excellent indictment of the destructive impact of the Catholic emphasis on "sin".

 

[stargazer]

Haven't read it, David, but would like to. I'm not a very good reader, unfortunately, and I rarely make it all the way through a novel. I enjoy reading articles and synopses on the Internet, so perhaps I can read an overview of it, and learn more of what you're talking about.

On a side note, a lawyer friend of mine starts every morning by reading portions of Joyce's Ulysses on the toilet seat, because he claims it gets his brain going.

 

[ThatLady]

A couple of things that might help, stargazer:

It's difficult for people to recognize us for who we are when, because of our illness, we're not even sure who we are yet. It helped me to give those people the benefit of the doubt, and to realize that I hadn't (and, maybe, wasn't) presenting myself in a way that was easily recognized.

The second thing that strikes me is the phrase "made to feel depressed". Another person cannot "make" us do anything. What we feel is our responsibilty alone. Therapy helps us work on this issue, and learn to filter incoming information for value a bit better than we may have been doing. Everything someone else says is not going to be of value to us; yet, they're just people and they make mistakes, or have difficulties of their own that manifest in "preachiness" or intrusiveness. They don't mean harm. They're trying to help, but their way of doing so doesn't work well for us. These are the people we can value as friends, but take their "advice" with a grain of salt. It doesn't need to make us angry unless WE allow it to do so.

 

[Into The Light]

stargazer, i think you did an excellent job identifying your thoughts and your moods. that is the first step. the next step will be to come up with realistic, more positive thoughts to reduce the negative feelings that come with the original thoughts. i am not sure if you are already having to do that, i suspect that probably you'll be working on that with your therapist next time. initially it's a bit tricky to do but you'll get the idea once you've done a few with her.