Repost: The Philosophical Methods of CBT by Tim LeBon

This weekend, we are revisiting three of the posts on this blog over the last 18 months, which new readers to the blog (after Stoic Week 2013) might have missed. In this post, Tim LeBon looks at the philosophical side of CBT…. 

This week, Tim LeBon, philosophical counsellor and one of the Stoicism Today team, maps  seven typical errors of thinking, as recognised within CBT, with possible philosophical remedies for each error. The following piece is extracted from Tim’s book, Wise Therapy (2001), and is reproduced with kind permission of the author. The extract is prefaced by a short introduction, written by Tim for this blog, about the overall aims of the book.

In Wise Therapy (Sage,  2001) I aimed to examine some of the main practical topics in philosophy and explore their implications for psychotherapy and counselling.  The philosophy of well-being, right and wrong,  reason and the emotions and the meaning of life are all surveyed, what I hope to be acceptable conclusions reached, and then, in the final chapter, a counsellor’s philosophical toolbox is created.  Alongside a focus on philosophy,  I also examine the existing philosophically-inspired techniques from a variety of approaches, including logotherapy,  philosophical counselling, existential-phenomenological counselling, Rational Emotive Behavioral Therapy (REBT) and Cognitive Behavioural Therapy (CBT).

CBT and REBT often quote the Stoic Epictetus’s dictum that “Men are disturbed not by things, but the views which they take of them” (Epictetus, Enchiridion, 5). They have taken this idea and turned it into a technique, variously called thought records, mood logs or cognitive restructuring. The idea is that you notice when you are feeling upset (sad, angry, anxious etc) and try to determine the judgement or thought that lies behind the emotions. I usually recommend clients to imagine themselves in a cartoon with a speech bubble coming out of their head. The trick is to imagine what thoughts or images are in the speech bubble. Once you’ve worked out which thoughts are disturbing you, the next step is to untwist your thinking by looking typical thinking errors that cause emotional problems.  After that, you can come up with alternative (“rational”) responses to help you feel less upset.

In the following extract from Wise Therapy  I first describe some of the existing thinking errors described by leading CBT therapists, and then refine these to include philosophical insights.

The philosophical methods of CBT

Cognitive Behavioural Therapy (CBT) is in parta philosophical therapy aimed at identifying and correcting errors in thinking which lead to emotional disturbances. The CBT literature (e.g. Blackburn (1987) and Burns (1990)) includes lists of such errors and their remedies which are intended to be taught to clients. Clients are taught both these lists and ways to monitor their automatic thoughts, to which these should be applied . They are used in three key ways – to tackle automatic thoughts after and , if possible, during the emotional episode and also to tackle disruptive core beliefs which underlie the thoughts. There follow two lists – first a fairly standard list of ‘errors in thinking’ gleaned from CBT sources, and then a philosophically-enhanced list of ways to deal with these errors.

I) STANDARD CBT ERRORS IN THINKING

1. Overgeneralization

Overgeneralizing occurs whenever someone says that  something happens all the time when it only happens some of the time. e.g. “I never have any self-control”.

2. Personalising and blame

Personalising is taking too much blame; the converse is taking too little responsibility and blaming someone else. For example, if my car is vandalised, personalisation would mean saying “I’m such an idiot for leaving it outside” whereas the blaming response would be “Why didn’t you warn me of vandals in the area”?

3. Black and white thinking

Black and white thinking is “either/or” reasoning, not allowing for degrees, categorising everything at an extreme. e.g. “I’ve blown my diet completely”.

4. Jumping to conclusions

Jumping to conclusions happens when you reach a conclusion without sufficient evidence Cognitive therapists identify two categories: fortune-telling, when one is drawing conclusions about the future  on inadequate evidence (e.g. “I’m going to fail my exam”) and mind-reading, when one is inferring what other people think (e.g. “She’s going to think I’m an idiot).

5. Catastrophising and labelling

Catastrophising is magnifying how bad something is, getting it out of proportion e.g. “It will be a disaster if I lose my job”. Allied to catastrophising is the activity of labelling – either yourself or the event – in excessively negative terms e.g. “I’m an idiot”.

6.Disqualifying the positive and mental filter

This happens when people either don’t notice positive things (the mental filter) or else do notice them but play down their significance . For example, suppose you pay me a compliment that I have lost weight. Disqualifying the positive would mean either saying “you are only saying this to be nice” or, perhaps even twisting it into a negative “Oh dear, I must be fat if he’s commenting on my weight”. The mental filter might happen in the job situation; I ignore the fact that I was chosen for an interview and focus on the fact that I didn’t get the job.

7. ‘Should’ and ‘Ought’ statements

Cognitive therapists tell people to avoid “should” statements as in “I should have got the job” or “I should be earning a good wage by now”. 

ii) A philosophical cognitive therapists’ ways to correct errors in thinking

 Ways to correct the errors in thinking include asking the following questions about each negative thought. This list goes beyond the standard answers given by cognitive therapists, taking in philosophical insights from the rest of this book.

1. What error applies to this thought?

The first step is to analyse one’s thinking.  A good start is to look at it in terms of the seven errors in thinking mentioned above; one could broaden this using the fallacies mentioned in the Critical Thinking literature (see for example Warburton, 1997).

2. Examine the evidence

Look at actual evidence for and against belief and explanations. Turn each piece of evidence into a reason for or against whether the belief or explanation is true, and use the Charles Darwin Method (LeBon, 2001)to reassess it.[1]

3. Treat yourself as you would a sympathetic but honest friend

The CBT literature asks you to treat yourself as  a sympathetic friend would, as otherwise you may be applying a double standard. The philosophical cognitive therapist would add that you should be honest as well as sympathetic. Rationalisations and wishful thinking are no route to emotional wisdom.

 4. Avoid black and white, all or nothing thinking

Instead of thinking something is all good or all bad, try and see how it is somewhere in between. You can be helped to do this by thinking in terms of probabilities and percentages. For example, instead of saying “I’ve failed the exam” and “I’ve completely blown my diet” , say (for example) “There’s a 50% chance I’ve failed the exam” and “I’m 100 calories over my limit today”.

5. Avoid loaded emotional language

Redefine emotionally loaded language in more neutral, descriptive terms. Philosophers distinguish a words “emotive” from its “descriptive” meaning i.e. the facts it states and from the feelings expressed. Try to use words that stick to the facts. For example, instead of saying “I’m a disgrace” say “I am disappointed with myself”.

6. Examine the long-term consequences of emotions, attitudes and behaviour

What are the pros and cons for having particular attitudes, emotions and  behaviour? For example, does getting angry actually do you any good ? The long-term consequences should be evaluated in terms of one’s values (see RSVP (LeBon, 2001)) and ethical principles

7. Be careful about using ‘should’ and ‘ought’ statements

As was argued  earlier, it’s not true that you should avoid using these terms as some cognitive therapists have suggested. Instead, ask yourself these questions

i)               Is the action you are commending something that the person in question can actually do in this case (remember that ‘ought’ implies ‘can’)

ii)             Even if at first sight  they may have a duty to do something, is there another duty that overrides it in this case ?

iii)            Is the ‘ought’ a universal law of morality, or just a parental or societal prescription or a personal preference ?

In the final analysis, prudential ‘shoulds’ are best derived from an understanding of one’s values (not necessarily just happiness), which can be gained from RSVP.  Ethical ‘shoulds’ can only be evaluated in terms of acceptable ethical theories, or using a decision procedure such as Progress. (LeBon, 2001, LeBon and Arnaud, 2012)

8. Use the Serenity Prayer[2]

The philosophical version of the Serenity Prayer reads:

“Grant me the serenity to accept the things I cannot change;

Courage to change the things I should can (and should);

 and wisdom to know the difference.”

The Serenity Prayer tells us one path to emotional wisdom. In particular, it reminds us that even when things are not as we like, our attitude to this state of affairs makes all the difference. If we really are helpless, we should adopt serenity (what is the point of suffering ?), if we are not, we should use the emotions as information that something needs changing. To tell the difference, we need wisdom, which encompasses the RSVP type knowledge of our enlightened values, and Aristotelian practical wisdom about the nature of the situation we find ourselves in.

References

Blackburn I.  (1987), Coping with Depression, Chambers

Burns, D. (1990,) The Feeling Good Handbook, Penguin

Epictetus (2004),  Enchiridion,  Dover

LeBon, T (2001), Wise Therapy, Sage

LeBon, T. & Arnaud, D. (2012). ‘Existential Coach­ing and Major Life Decisions’, In E. Van Deurzen & M. Hanaway (Eds.)(2012). Existential Perspec­tives on Coaching (pp. 47-59). Basingtoke: Pal­grave Macmillan.

Robertson, D (2010), The Philosophy of CBT,  Karnac

Warburton, N. (1996), Thinking from A to Z, Routledge