What is cognitive-behavioral therapy and how can it help me?

Simply, cognitive behavioral therapy is combination of cognitive therapy and behavioral therapy.  Cognitions refer to the way we perceive or see things.  Our perceptions are influenced by the core beliefs we have about others, the world and about ourselves.  Aaron Beck, the founder of cognitive-behavioral therapy, identified the triad of depression, which consists of negative thoughts about ourselves, about others and about the world around us.  He identified several thinking errors or cognitive distortions that affect how we feel.  For instance, mind reading is a pattern of thinking in which you believe you know what others are thinking and, in particular, what they are thinking about you.  Catastrophising is a thinking pattern of imagining and believing that the worst possible thing will happen.  If you are prone to depression and/or anxiety, you will quickly be able to identify and relate to several of the thinking errors.  These thinking errors influence how you feel.

The behavioral aspect of CBT is identifying behavioral patterns that result from the way we think and feel, and then deciding how these behavioral patterns are maintaining our emotional suffering.  Sometimes, addressing the thoughts and feelings will alter how we behave and sometimes changing how we behave will modify how we think and feel.  CBT uses a combination of focusing on thoughts and feelings, and using behavioral experiments and exposure.  For instance, if you experience social anxiety, you likely experience thoughts focused on what others are thinking about you and how you are coming across.  You feel self-conscious, awkward and anxious, and the only thing you really want to do is leave the situation.

Using CBT, we would identify your distressing thoughts, the emotions that accompany the thoughts and then look at other possible ways of thinking about the situation.  At some point, you would create a list of social situations that you wish to address and then you would grade the degree of anxiety for each situation from least anxiety provoking to the most anxiety provoking.  You would learn some relaxation and mindfulness exercises to help you manage your anxiety.  In addition to relaxation and mindfulness exercises, other approaches that could be use include evaluating your thoughts, rating your emotions and beliefs, roles plays, imagery/visualization, and learning assertiveness skills.  Ultimately, you would experience the real life situations based on your list and moving from the least anxiety provoking to the most.  It is the facing of our fears that tends to have the most profound and long-lasting effect in reducing anxiety and gaining confidence.

In addition to thoughts, feelings and behaviors, CBT also identifies core beliefs and the assumptions and rules that result from these core beliefs.  Core beliefs, assumptions and rules are intertwined with how you feel and behave.  For instance, if you have a core belief that you are defective you may assume that if people were to really know you, that they would reject you.  As a result, you may have developed certain rules to keep you safe, such as never disclosing certain things about yourself and always being careful about how you behave.  The core belief of defectiveness is likely to be accompanied by feelings of loneliness, isolation, longing and fear.

In contrast, if one of your core beliefs is that you are intelligent, than you may assume that what you have to say is of value and, as a result, you are likely to express your thought and opinions openly.  It is unlikely that you developed rules to keep you safe regarding your intelligence.   Feelings that are likely to accompany this core belief are confidence, pride, self-worth, and contentment.

We are often unaware of the core beliefs, assumptions and rules that influence our feelings and behavior.  By becoming aware of our core beliefs and the assumptions, rules, thoughts, and feelings that are the result of core beliefs, we can begin to develop a different relationship with those core beliefs.  That is, we may not be able to eliminate certain core beliefs, but by becoming aware of our harmful core beliefs, we can at least start to alter the negative impact they have had on our lives.

This is a very basic and simple explanation of CBT.  For a more in depth explanation, please go to the BC Government web page http://www.health.gov.bc.ca/library/publications/year/2007/MHA_CognitiveBehaviouralTherapy.pdf

Self help books with a CBT focus include:
1) When Panic Attacks by Dr. David Burns
2) Feeling Good: The New Mood Therapy by Dr. David Burns
3) Your Depression Map: Find the Source of Your Depression and Chart Your Own Recovery by Dr. Randy Paterson

Other books I recommend are:
1) Your Assertiveness Workbook: How to Express Ideas and Stand Up for Yourself at Work and in Relationships by Dr. Randy Paterson
2) Depressed and Anxious: The Dialectical Behavior Therapy Workbook for Overcoming Depression and Anxiety by Thomas Marra

Disclaimer:  Please note that this blog is only a basic introduction to Cognitive Behavioral Therapy.  The information presented here is not my own.  I have drawn upon a variety of resources.  If you are seeing a health care professional and something within this blog resonates with you, please discuss this with her or him.  If you believe you could benefit from professional support, there are many health care providers that could assist you.  If you are in a state of crisis, please contact your nearest crisis center or go to the emergency room of your nearest hospital. 

 

 

What is the difference between shame and guilt?

January 2012: What is the difference between shame and guilt?  How can I know if I experience too much shame and/or guilt?  If I do, what I can I do about it?

It can be easy to confuse a feeling of shame with guilt and vice versa because they both make us feel bad.  However, where one makes us feel bad about our behavior (i.e. guilt), the other one makes us feel bad about ourselves (i.e. shame).  Both shame and guilt have adaptive qualities, but like any unpleasant emotion, shame and guilt can cause tremendous internal suffering if they dominate our inner experience.

Shame is a feeling that is connected to our sense of worth where guilt is connected to our values and behavior.  When we feel shame, we want to hide.  Our attention is focused internally, our thoughts are self-critical and self-blaming, we feel attacked and/or vulnerable, and we feel propelled to defend ourselves.  As a result, shame has a direct negative impact on our self-esteem and self-worth.  It also interferes with our sense of connection with others.

When we feel guilt, on the other hand, we are motivated to make amends or apologize.  We feel bad about what we did (or did not do), but we do not feel bad about who we are as a person.  Guilt shifts our focus externally (i.e. toward the person or persons we have hurt), motivates us to acknowledge the harm we have caused and to repair this harm. Guilt is connected to our values and morals, and holds us accountable to these values and morals.  We feel relief from guilt when amends has been made.  Another way of viewing the experience of shame versus guilt is that shame is about self-critical blaming (which is destructive) and guilt is about taking responsibility.

It is a fine distinction between shame and guilt, and it is easy to see why shame and guilt can be experienced simultaneously, which can also make it difficult for us to know what we are feeling.   This is especially so if we experience excessive shame because excessive shame can make us prone to experience excessive guilt.

The action tendency of shame and guilt are different, and when experienced simultaneously can become confusing.  However, it is possible to become aware of the distinction, understand the reason or reasons why one is feeling shame and/or guilt, and begin the process of using these emotions to clarify one’s boundaries, values and beliefs.  Becoming aware of our feelings of shame and/or guilt, and working with these feelings instead of trying to avoid them can keep them from becoming destructive.

Although the feelings of shame and guilt have adaptive qualities, both can cause much suffering if experienced excessively.  When this occurs, we are more prone to a variety of psychological and emotional problems including substance abuse, eating disorders, interpersonal violence, depression and anxiety, and workaholism.  People who experience excessive shame are likely to experience some of the following:
1.  Fear of vulnerability and of being oneself
2.  Fear of intimacy and a tendency to avoid commitment in relationship
3.  Perpetual thoughts of being worthless and unlovable, and believing that no matter  what one does, it will not make a difference
4.  Feelings of defensiveness when given even minor negative feedback (making a           mistake can be devastating because it is difficult to separate the mistake from who  one is as a person.  That is, one does not make a mistake, one is a mistake)
5.  Tendency to blame others
6.  Debilitating guilt and, as result, one is constantly apologizing (the guilt and apologizing is because excessive shame is related to the destruction of boundaries.  In turn, the destruction of these boundaries makes it difficult for us to know what is our responsibility and what is not.  When we experience excessive shame, we assume too much responsibility for the behavior and/or feelings of those around us)
7.  Feelings of being an outsider
8.  Projection of one’s beliefs about oneself onto others.  This means that you assume another person has the same negative feelings and thoughts about you as you do about yourself.
9.  Feelings of defectiveness
10. Feeling controlled from the outside and from the inside in the form of one’s internal self-critic

These are just some of the experiences excessive shame can cause. That being said, what can we do if we feel debilitating shame and guilt?

If you believe you are experiencing excessive shame and guilt, it is important to name it, experience it and inspect it.   Shame does not want to be exposed.  That is, shame tells us that, “no one must know or find out”.  As a result, an important step to overcoming shame is exposing it by sharing what we feel ashamed about with someone we trust.  Someone who we believe will not judge us or blame us, but will be supportive and understanding.

Since excessive shame is maintained by an internal self-critical voice that is often the result of past maltreatment or learning, it is often helpful to identify the content of this internal self-critic so this content can be examined and challenged.  Connecting this internal self-critic to past maltreatment or learning can help one to understand why one has developed such a harsh inner self-critic and begin to develop compassion towards oneself.

Finally, naming, experiencing and inspecting the feelings that accompany the content of the inner self-critic can increase our connection to ourselves.  Feelings are informative and naming, experiencing and inspecting our primary feelings is really just a way of honoring and connecting with oneself.  Instead of expending mental energy avoiding or fighting against our unpleasant thoughts and feelings, identifying and being with these feelings can ultimately free us to be more ourselves.

Here is an exercise to help become more consciously aware of the feeling of shame and the thoughts that accompany this feeling.  This exercise is from Emotion-Focused Therapy (Leslie Greenberg):

Think of a situation when you felt worthless or deeply ashamed.
What happened that led you to feel this way?  Identify the feeling
in your body.  Now, shift your attention to the negative voice in your
head.  What do you believe about yourself?  What do you believe
others think and feel about you?  Write this down.  Identify what
was done to you that made you feel this way.  Now, find a part of
yourself to fight back against the shaming.  Imagine yourself back
in the situation.  If the situation was when you were a child, imagine
the situation with you as an adult standing up for your child self and
have your adult self provide your child self with what you needed in
that situation (e.g. support, protection or comfort).

To reiterate, shame and guilt are feelings that are unpleasant, but they also keep our behavior in check.  However, when shame and guilt become excessive, they then become destructive.  Excessive shame and guilt adversely affects our self-esteem, our self-confidence, our self-worth, and our relationships with others.  Excessive shame and guilt also adversely affects our spirituality.  There are various ways to address excessive shame and guilt.  Some books that directly deal with shame and/or guilt are:

1) Shame & Guilt: Masters of Disguise by Jane Middleton-Moz
2) Healing the Shame That Binds You by John Bradshaw

I also recommend the books:

1) Reinventing Your Life by Jeffery E. Young and Janet S. Klosko (the defectiveness schema is the result of excessive shame)
2) Emotional Alchemy: How the Mind Can Heal the Heart by Tara Bennett-Goleman

Disclaimer:  Please note that this blog is only an introduction to the feelings of shame and guilt.  The information presented here is not my own.  I have drawn upon a variety of resources.  If you are seeing a health care professional and something within this blog resonates with you, please discuss this with her or him.  If you believe you could benefit from professional support, there are many health care providers that could assist you.  If you are in a state of crisis, please contact your nearest crisis center or go to the emergency room of your nearest hospital.