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The role of thoughts in mental health

The term ‘cognitive’ relates to thinking and perception, two processes by which individuals interpret their experiences and form ideas about themselves and the world around them . Thoughts are formed by words and images, and their content varies according to a person’s past and present experiences.

Thoughts which contribute to the maintenance of mental health problems share two common characteristics: 1they contain some form of inaccuracy or distortion; 2they form a significant part of a person’s reality and they feed into the symptoms, distress and disability associated with the problem. The difference between ‘normal’ thoughts and those associated with mental health problems is not so much in their content as it is in the degree of conviction and significance that a person may attach to them.

Such thoughts are considered under four groups below: •Negative automatic thoughts and intrusive thoughts: They trigger distressing feelings (fear, worry, anxiety or low mood) and the person feels that he or she has no control over their occurrence. •Overvalued ideas and delusions: They appear to digress from ideas that are acceptable or common within a person’s environment and the person has a strong conviction in them. •Catastrophic beliefs and feared consequences: They are ideas that something awful may happen if a person does not carry out certain behaviours, or does not avoid certain situations. •Assumptions, core beliefs, personal rules and schemas: These are beliefs which have been developed through life experiences and shape or influence a person’s views and actions in response to a critical incident. Given that thoughts are the result of information processing in relation to past and present experiences, misinterpretations or unhelpful ideas are the result of information processing errors, as outlined below: •Catastrophizing: expecting the worst to happen and overestimating the probability of it happening. •Emotional reasoning: using feelings to guide our judgement and confusing how things feel with how things really are. •Dichotomous thinking: thinking in absolute terms, all-or-nothing, black-or-white, not considering the middle ground. •Arbitrary inference: jumping to conclusions, making judgements without evidence, believing that we know what others are thinking, predicting the future. •Generalizing: making sweeping statements based on single incidents, overestimating the importance of isolated events. •Personalizing: assuming that one has responsibility over everything, blaming ourselves over things that we have little control or influence on. •Selective focus and filtering: Focusing on the negative and discounting the positive, looking for evidence to back up our ideas and disregarding evidence which challenges them, selecting fragments of evidence without considering the whole picture. •Fixed rules: using commands rather than wishes and options as the driving force for our behaviours, such as ‘I should’ and ‘I must’, rather than ‘I would like to’ or ‘I would prefer it’. The key aspects of the cognitive model for mental health problems is that our thoughts shape the way we behave and feel (both emotionally and physically) and that in turn our behaviours and feelings may confirm or disconfirm these thoughts, thereby creating a cycle of interlinked thoughts, behaviours and feelings

Cognitive therapy aims to produce change in a problem through a process called cognitive restructuring or reattribution (that is, reducing a person’s belief in their misinterpretations and unhelpful ideas by reinforcing a person’s belief in alternative interpretations and more constructive ideas). The description of cognitive techniques in three groups for the purpose of this chapter is to aid clarity, however, in clinical practice cognitive restructuring involves all three groups in a continuous process. Cognitive restructuring is not simply about positive thinking but about expanding our thinking repertoire so that it includes other options in the way we view ourselves and others, the world around us, our life and future. Furthermore, cognitive restructuring is not so much about challenging inaccurate, distorted or unhelpful beliefs as it is about reinforcing alternatives ones. The reason for this is twofold. Firstly, someone may feel stupid or dejected if a long-held belief which had shaped a person’s feelings and behaviours is crashed without an alternative being offered. Secondly, trying to challenge and undermine a person’s beliefs may appear threatening and patronizing compared to suggesting and testing alternatives which may be more acceptable and unassuming.

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