How to Handle Mistakes–CBT Techniques for Gracefully Coping With Mistakes and Setbacks

Sometimes clients really integrate the learning about Cognitive Behavioral Therapy, and share it with family members. I was very moved when a client recently shared with me an email she wrote to her two teenage children. She gave me permission to publish it here, with a few identifying details deleted. Here it is:

To my dear children, please read this email because it will help you live life more peacefully.

I have lived my whole life worrying and I’m sick of it so I’ve spent the past months studying how to combat it. Here are some tips I’ve learned that should help you too.

As Dr. Gottlieb shared with me, here are key questions to ask yourself after making a mistake or facing something you think is devastating, in order to put the mistake into perspective

  • Did anyone die or get hurt? Remember, what doesn’t kill you makes you stronger.
  • Will I remember it in 1 or 5 years?
  • Did I lose a lot of money? (Defined as an amount that would truly change your way of life. ($100, $1000, or $10,000)
  • Is the mistake easily fixable with time or money or words?
  • What can I learn?
  • Does it really matter in the grand scheme of things?

OK, so the last point is the hardest.  Of course it always seems to totally matter and be catastrophic.  However, this brings me to the next step of Cognitive Behavior Therapy (CBT).

Sit with your thoughts. Then ask yourself what are your negative thoughts causing you to feel this way.  For instance, “I’m going to get into a horrible college, have a lousy job, be poor, get fired, be miserable, etc.”

THEN recognize these thoughts.  Are they all-or-nothing thinking?  Am I mind reading, assuming that others feel this way?  Am I being catastrophic, blowing this out of proportion?

Once you determine that this is really a distorted thought, then examine the thought in a healthier way.  You can step back and ask yourself on a scale of 0-100, how bad is this current event really?  Think of something tragic that would be a 100 (ie: parent dying, you getting cancer, etc.). Ugh.  Then compare the current event with the true 100 catastrophic event.

To help you determine the true number, ask yourself a series of ”what if” statements for healthier thinking.  For instance:  “What if I don’t get an A…. I won’t get into a good college… if this is true then what if you don’t get into a good college…. I won’t get a good job…. if this is true what if you don’t get a good job…. I’ll be unemployed forever, be poor and miserable”…. Is this really true?  No.  You can think of people who didn’t attend college and are successful. You can even think of the opposite of people who DID attend a prestigious school and never worked outside of the home. You can think that there are ALL types of jobs that require all types of skills.

Then re-number your worry.  It’s probably much lower.  If not, review Dr. Gottlieb’s key points above and go through this exercise again. Most of the time the worry/event isn’t as bad as we think.

Finally, turn unproductive worry into product worry.  Unproductive worry is just thinking OMG, OMG, OMG!  That doesn’t help.  However, productive worry is problem solving.  You switch the energy into something productive and try to solve the problem.

And one last thing, remember that if you’re mind reading (believing that others will think negatively of you), no one really cares.  True, your parents and close ones do care about the important stuff, but truly no one looks at you.  Everyone is a self-centered, too busy focused on them to be concerned about you.  And if you assume that people are thinking something negatively about you, do the above steps, asking yourself to replace this with a more realistic/healthier thought and the what if exercise.  Remember, just because you may have judgmental thoughts, doesn’t mean everyone else is.  The first step is to stop judging others and be more compassionate.  Once you stop being so judgmental of others, you’ll start treating yourself nicer and have better self esteem.

I hope that you read and implement these tips so you can lead happier, more peaceful lives.  And just think, I’ve saved you hours and hours of reading, studying and discussing this stuff…  You get the Spark Notes version.  :)

I love you both dearly.

Mom

Thanks Mom for sharing this with me, and with all of my readers….

Copyright © 2010, 2011 Andrew Gottlieb, Ph.D. /The Psychology Lounge/TPL Productions


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Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, and other difficulties using evidence-based cognitive behavioral therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.

Changing Thoughts May Be Better Than Changing Behavior in the Early Stage of Psychotherapy for Severe Depression

A recent study took a close look at what predicts improvement in depression in the first five sessions of cognitive behavioral therapy. They looked at the degree to which the therapists used either cognitive therapy methods, practiced structuring the sessions clearly, and how much they used behavioral methods/homework. They also examined whether the patients cooperated with these parts of cognitive behavioral therapy. They also measured the strength of the therapeutic alliance.

Sixty patients with major depression participated in the study. Their sessions were videotaped and trained raters rated how much the therapists used cognitive versus behavioral methods.

What they found was only two aspects of therapist behavior predicted improvement between sessions. Depression was measured after every session, and these measurements showed that patients felt better when therapists used cognitive techniques, but didn’t improve when the therapists focused on behavioral techniques.

Patients also showed greater improvement when they adhered to suggestions made by the therapist, which is not surprising.

The behavioral methods used were techniques such as having patients schedule their activities to become more active, and tracking how they actually spent their time. This is called behavioral activation, and previous studies have suggested it is an effective approach to treating depression. The behavioral activation model is that depressed patients tend to do very little, and this leads to further depression. Patients are encouraged to schedule activities that are fun, or activities that provide a sense of mastery or success. This leads to a lessening of depressive feelings.

The cognitive methods were techniques such as writing down what your thoughts are, and using cognitive therapy to challenge or modify distorted thinking.

So how to interpret the results of this study?

It’s only one small study and I would be cautious about taking too much from it. It does suggest that at least in the early sessions of therapy, cognitive methods may be superior to behavioral methods. This makes sense to me because early in therapy depressed patients feel a lot of pain and lethargy, and getting them to suddenly increase their activity can be very challenging and perhaps too difficult. This may lead to a sense of failure which increases depression rather than reducing it. On the other hand, using cognitive methods may lead to more immediate sense of control and relief, which would tend to reduce depression levels.

My sense is that later in therapy behavioral activation techniques are very useful. But typically in order to get patients to cooperate with these techniques there needs to be a strong alliance with the therapist. This takes some time to build.

It would have been interesting if they had continued the study beyond the first five sessions, and looked at whether over time the relative importance of the cognitive versus behavioral techniques would have shifted.

The study shows that therapist behavior in sessions does matter. This is one of my pet peeves. Many psychotherapists claim to use cognitive behavioral therapy, yet fail to actually use any cognitive behavioral techniques on a regular basis in sessions. This study shows that therapist adherence to structuring sessions and using cognitive techniques matters.

So from a consumer point of view there are a few take-home lessons.

1. If you are seeking cognitive behavioral therapy, make sure your therapist actually does cognitive behavioral therapy during sessions. This means they should structure the sessions clearly, as opposed to simply letting you talk about whatever is on your mind. It also means they should be asking you to track your self talk in written form, during sessions go over those thoughts, helping you learn to identify and correct distortions in the thoughts. If they don’t do these behaviors, and therapy feels free-form, then you’re probably not getting cognitive behavioral therapy, and you might want to look elsewhere. If you don’t regularly get homework to do between tasks, you aren’t receiving cognitive behavioral therapy.

2. At least in the early part of therapy pure cognitive therapy techniques may be more effective than behavioral techniques. You may want to focus your own homework more on identifying and changing your inner thoughts, rather than trying to increase positive behaviors. This probably will yield more relief of depression.

3. The study also confirmed that when clients cooperate and are more involved using cognitive therapy techniques, they improve faster. So even if you’re feeling skeptical, try to fully participate during sessions and in between sessions, as that provides you the best chance of more rapid relief.

Your off to analyze his thoughts psychologist,

Andrew Gottlieb, Ph.D.

Copyright © 2010 Andrew Gottlieb, Ph.D. /The Psychology Lounge/TPL Productions


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Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, and other difficulties using evidence-based cognitive behavioral therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.