When I told one of them about my panic attack, she mentioned cognitive behavioral therapy, or C.B.T.—a rational kind of therapy, she explained, that focussed on influencing your emotions by inspecting and adjusting your thought patterns. (View Highlight)
This was an old and familiar notion (we are disturbed “not by things, but by the views we take of things,” the Greek philosopher Epictetus wrote), but C.B.T. systematized it through exercises designed to identify problematic emotions and trace them back to the thoughts that had authored them. (View Highlight)
They all reflect the so-called cognitive revolution—a shift, which began in psychology during the mid-twentieth century, toward a more information-based view of the mind. Freudian thinkers had pictured our minds as hydraulic machines, with pressures rising against resistances and psychic forces that might get bottled up. The cognitive model, by contrast, imagined something more like a computer. Bad information, if it were stored in a crucial place, could cause system-wide problems; irrational or inaccurate thought patterns could shape feelings or behaviors in counterproductive ways, and vice versa. Coders get at a similar idea when they say, “Garbage in, garbage out. (View Highlight)
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Ellis, who earned a Ph.D. in psychology in 1947, trained as a psychoanalyst but grew frustrated with the tradition’s approach to therapy, which he felt emphasized dwelling on one’s feelings and ultimately subordinated patients to their pasts. The “rational therapy” for which he became known in the sixties proposed that individuals had the power to reshape themselves willfully and deliberately, not by reinterpreting their life stories but by directly analyzing and modifying their own beliefs and behaviors. (View Highlight)
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Ellis showed his patients how to avoid “catastrophic thinking,” and guided them toward “unconditional acceptance” of themselves—a rational position in which you acknowledge your weaknesses as well as your strengths. (View Highlight)
He switched from searching for repressed memories to identifying automatic thoughts (View Highlight)
In C.T., patient and therapist joined in a kind of “collaborative empiricism,” examining thoughts together and investigating whether they were accurate and helpful. C.T. combined with elements from behavioral approaches, such as face-your-fear “exposure” therapy, to create C.B.T. (View Highlight)
Ellen Kanner, a clinical psychologist who trained in the nineteen-seventies and has been in practice in New York since 1982, watched the rise of C.B.T. in her clinic. “I’ve seen psychology evolve from very Freudian, when I first did my training,” she told me. Cognitive behavioral therapy had an advantage, she recalled, because therapists and researchers liked its organized approach: exercises, worksheets, and even the flow of a therapy session were standardized. “You could more easily codify it and put it in a study with a control, and see whether it was effective,” she recalled (View Highlight)
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The idea that we can challenge and adjust our automatic thoughts “makes us feel like we’re in control,” Brewer went on, but constantly wrestling with our thinking can itself become a bad mental habit: if you feel anxious, the best approach might not be to interrogate your anxious feelings or mount a rational counterattack, but simply to notice the anxiety and then let it pass. “It’ll go away on its own,” Brewer said. “If you push it away, or engage with it, or tussle with it, it’ll grow.” Brewer has explained his mindfulness-inflected theory of personal change, which has its roots in what he calls Buddhist psychology, in books such as “Unwinding Anxiety,” from 2021. “With mindfulness, it’s about changing the relationship to cognition,” he said. “The thought is already there. It’s not something we have a lot of control over. It’s going to come up. But you can observe it, and, by observing it, you can change your relationship to it.” (View Highlight)
We’ve been trained, as part of our culture, and as part of C.B.T., to think, I have to work to change myself.” This attitude, he continued, could be counterproductive. “People get in their own way. They say, ‘I’m not working hard enough. I don’t have enough will power.’ But curiosity and kindness don’t take work. They take practice and recognition.” (View Highlight)
Sometimes there’s an unconscious process that has to be addressed when there’s resistance to conscious interventions. If your mother told you that you were ‘worthless,’ or you had parents who were narcissistic or alcoholic or who didn’t build you up, then we have to go back and talk about your history. That’s more of a psychodynamic approach.” (View Highlight)
although the cognitive side of the therapy remains fundamental, the Beck Institute now incorporates mindfulness, “compassion-based therapy,” and techniques from other evidence-based therapies. “You have to change your ideas both at the intellectual level and emotionally, at the gut level,” she told me. She asked me to imagine a patient who had experienced trauma at the hands of a parent with alcoholism. “It’s not the events themselves—it’s the conclusions they reach, such as ‘I’m unlovable, I’m worthless,’ ” she said. “We first help someone understand why these things happened on an intellectual basis. ‘These things happened because my mother was often drunk, not because I was a bad kid.’ Sometimes those realizations will filter down to the emotional level. But sometimes they’ll say, ‘I still feel like I’m a bad person.’ In which case what they’re saying is that the intellectual techniques were necessary but not sufficient.” (View Highlight)
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A typical therapist might employ C.B.T. as one of many techniques, using a particular exercise when she believes it will help a particular patient. Beck thinks that C.B.T.’s rational approach is most effective when the therapy is “delivered in the context of a warm, compassionate therapeutic relationship,” and that C.B.T. “must be adapted for each individual client. It isn’t one size fits all.” (View Highlight)
C.B.T. does contain a theory of change—and it’s not entirely convincing. If people could change just because rational thinking told them to, we wouldn’t live in such a crazy world (View Highlight)