Cognitive Behavioral Therapy
Dr. Dixon Mitchell
One of the core dimensions of Cognitive Behavioral Therapy (CBT) is observing andhelping patients become more aware of their automatic thoughts and the relationship automatic thoughts have to core beliefs, moods and daily behaviors we all exhibit. Dr. Aaron T. Beck, one of the founders of CBT, made an important discovery as a practicing analyst in the early 1960s. He noticed that an important key to understanding individuals in therapy was to pay attention to quick thoughts, which go through the patients’ mind, particularly in times of mood shifts or distress. He could uncover keys to conceptualizing patients by observing what he called “hot thoughts” – which are automatic, spontaneous thoughts, which just pop into our head. We are not deliberately trying to think about them, that’s why they’re called “automatic.” Most of the time, they are real quick and we’re much more aware of the emotion e.g., sadness – than we are of the thoughts. Often the thoughts are distorted in some way, but we react as if they are true (Beck, 1995).
Some time ago, I saw a 25 year old female who was accompanied by her father, who drove approximately 100 miles to bring her to therapy from a small town north of Birmingham. She had just finished her master’s degree and was deeply depressed. She reported feeling lonely, isolated, and spent most of her time with her parents, although she wanted to date and develop new interests and friends. She told me one of her best friends, whom she grew up with, had moved to Birmingham to take a teaching job. When I asked the patient why she did not drive to Birmingham to visit with her friend, she replied “That’s out of my league.” With astonishment, I asked her to tell me more about her automatic thought “that’s out of my league”. She related that both of her parents were professional teachers and both had sensory handicaps; her mother was blind and her father was deaf. She was socialized to get a good education, but stayed close to home, where the parents could protect her and provide the security they wanted her to have.
Apparently, the daughter obeyed the parents, and never ventured far from home, attending a small college 15 miles from her hometown and living at home while attaining her master’s degree. Additional counseling sessions revealed the patient was avoidant, and suffered from a dependent personality disorder and was depressed because many of her friends had left her hometown to pursue career opportunities and other role relationships of adulthood. Actually, the automatic thought “that’s out of my league” through the downward arrow technique, led the patient to understand her erroneous core schema of incompetence and the major thrust of therapy-reframing her beliefs about herself, other people and the future.
As therapists, we can all become more aware of “blocks” to our growth and self-development by checking out our own automatic thoughts when we are challenged, anxious, sad or angry. To reality check our own automatic thoughts can help us begin to be aware of our patients’ automatic thoughts and how it may contribute to all of us getting stuck at times. Thanks for taking the time to read my reflections on cognitive behavioral therapy. More to come…
Dr. Dixon Mitchell is a licensed psychologist and United Methodist minister, who practices in Mountain Brook, Alabama. Dixon is minister of counseling at Canterbury United Methodist Church. He established Alabama Center for Cognitive Therapy and has been the executive director since 1993. He spends most of his time in individual, couple and family therapy, seeing patients throughout Alabama. He comes to Pine Grove the 3rd Tuesday of each month to teach and instruct Pine Grove therapists, who wish to become certified cognitive therapists, through the Academy of Cognitive Therapy. Dr. Mitchell is a founding fellow of the Academy of Cognitive Therapy.
Pine Grove Behavioral Health and Addiction Services is an extension of Forrest General Hospital, located in Hattiesburg, Mississippi. Pine Grove’s world renowned programs focus on treating gender specific chemical addiction including a specialized track for co-occurring eating disorders. Additionally, Pine Grove offers a focused substance abuse healing program for adults age 55 and over. Other Pine Grove specialty programs include a dedicated professional’s treatment curriculum and a comprehensive evaluation center. Pine Grove also features a program for patients with sexual and intimacy disorder issues. Pine Grove was established in 1984 and has provided nationally and internationally recognized health care for over 30 years.
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