Healthcare Training Institute - Quality Education since 1979
CE for Psychologist, Social Worker, Counselor, & MFT!!
The previous section discussed Memories and Expectations.
In this section, we will discuss the Cognitive Behavior Therapy Self-Comparisons Analysis exercise.
Cognitive therapy and Self-Comparisons Analysis are both exciting advances over the older ways of dealing with depression. But, this new theory also shows that there is more to understanding depression than a single magical button. Instead, I've found it is helpful to encourage your clients to do some hard thinking about themselves and their depressive thoughts.
As you know, having clients write down and analyze their depressed thoughts is a very important part of the cure for depression. It is also helpful for your clients to learn more about the nature of depression, to let them know that they are not alone. I've found that Feeling Good, by David Burns, and A New Guide to Rational Living, by Albert Ellis and Robert A. Harper, both inexpensive paperbacks, are particularly valuable for my depressed clients.
Self-Comparisons Analysis teaches clients that negative self-comparisons, together with a sense of helplessness, cause their sadness. Obviously, then, your depressed clients will have to eliminate these negative self-comparisons in order to overcome depression and achieve a normal life. Cognitive therapy allows clients to monitor their thinking in order to prevent the negative self-comparisons from entering and remaining in their minds.
I've found that it is crucial to have depressed clients observe their thoughtswith pencil and paper in hand and write down their thoughts and their analysis. I have my clients ask themselves, "What am I thinking right at this moment that's making me feel so sad?"
Next, I have them record their thoughts in
a table with the following headings:
This table guides your client from the raw, "uninvited thought" which floats into their mind and causes pain, into and through an analysis of that thought which pinpoints the problems and opportunities to intervene and get rid of the painful negative self-comparison that they are making.
Judy, a 26-year-old business woman, used this exercise to analyze her negative self-comparisons. One morning before our session, Judy suddenly realized she was late for an important meeting. The thought then zipped through her mind, "I can never do anything right."
During our session that day, I had Judy write "I can never do anything right"' in her Uninvited Thought column. Next to this thought, in the Casual Event column, Judy wrote "Late for a meeting." The uninvited thought creates pain. Judy also has a hopeless attitude, so this uninvited thought produces sadness. In the next column, Self-Comparison, Judy thought about her uninvited thought. She logically decided that her uninvited thought, "I can never do anything right," translated to the negative self-comparison of, "I do fewer things right than the average person does." We wrote this down under Self-Comparison.
We then moved on to analyzing Judy's negative self-comparison. I had Judy ask herself if her assessment of her situation was actually correct. Under the Analysis column, I had Judy write down the question, "Am I usually late for meetings?" Judy laughed and admitted that she was actually very seldom late. We wrote this in the Response column.
Judy had told herself that she was always late because she has a cognitive-distortion habit common in depressives, generalizing to "always" or "everything" bad from just a single bad instance. Under the Behavior you wish to change column, Judy wrote down, "Inappropriately generalizing from a single instance to my entire life."
Using this CBT exercise, Judy now saw how she had created a painful, negative self-comparison unnecessarily. Judy has a great sense of humor, and after seeing this table, she was able to laugh at how her mind played silly tricks on her - but tricks that made her depressed - because of habits built up through the years.
But let's imagine what would happen if Judy was not so easily convinced that she was playing the self-depressing mind game. In this case, we would need to move on to analyzing the uninvited thought.
In this situation, Judy agreed that her statement, "I never do anything right," implies that others do better than her. Under the Analysis column, I had Judy question this thought and write down, "Do most other people do most things more 'right' that I do?" Judy saw that this is not a correct assessment, and she was not, on average, a poor performer. After this realization, we wrote down in the Behavior you wish to change column, "Biased assessments of what other people are like, making me look bad." After realizing this, Judy saw the irrational pattern of her thoughts and was able to begin to let go of this depressing negative self-comparison habit.
Analyzing either the casual event that triggered the uninvited thought or the uninvited thought itself may be appropriate and effective for a given circumstance with a given client. Sometimes, however, using more than one tactic will increase your effectiveness in combating your client's negative self-comparisons.
In summary, the CBT Self-Comparisons Analysis exercise can be used to help clients see irrational thought patterns and help them let go of their negative self-comparison habit. The next section will discuss how to use role playing.