Changing the Patient’s Mind

Changing the Patient’s Mind
The goal of cognitive therapy is to assist the patient to evaluate his or her
thought processes carefully, to identify cognitive errors, and to substitute
more adaptive, realistic cognitions. This goal is accomplished by therapists
helping patients to see their thinking about themselves (or their situation)
as similar to the activity of a scientist—that they are engaged in the activity of
developing hypotheses (or theories) about their world. Like a scientist, the
patient needs to “test” his or her theory carefully. Thus, patients who have
concluded that they are “worthless” people would be encouraged to test
their “theories” rigorously to determine if this is indeed accurate. Further,
in the event that the theories are not accurate, patients would be encouraged
to change their theories to make them more consistent with reality
(what they find in their experience).
A slightly different intervention developed by Beck and his colleagues is
to help the patient identify common cognitive distortions. Beck originally
identified four cognitive distortions frequently found in emotional disorders:
arbitrary inference, selective abstraction, overgeneralization, and magnification
or minimization. These were later expanded to ten or more by
Beck’s colleagues and students.
Arbitrary inference is defined as the process of drawing a conclusion from a situation, event, or experience when there is no evidence to support
the conclusion or when the conclusion is contrary to the evidence. For example,
a depressed patient on a shopping trip had the thought, “The salesclerk
thinks I am a nobody.” The patient then felt sad. On being questioned
by the psychologist, the patient realized that there was no factual basis for
this thought.
Selective abstraction refers to the process of focusing on a detail taken
out of context, ignoring other, more salient features of the situation, and
conceptualizing the whole experience on the basis of this element. For example,
a patient was praised by friends about the patient’s child-care activities.
Through an oversight, however, the patient failed to have her child vaccinated
during the appropriate week. Her immediate thought was “I am a
failure as a mother.” This idea became paramount despite all the other evidence
of her competence.
Overgeneralization refers to patients’ patterns of drawing a general conclusion
about their ability, their performance, or their worth on the basis of
a single incident. For example, a student regards his poor performance on
the first examination of the semester as final proof that he “will never make
it in college.” Magnification and minimization refer to gross errors in evaluation.
For example, a person, believing that he has completely ruined his
car (magnification) when he sees that there is a slight scratch on the rear
fender, regards himself as “good for nothing.” In contrast, minimization refers
to minimizing one’s achievements, protesting that these achievements
do not mean anything. For example, a highly successful businesswoman
who was depressed concluded that her many prior successes “were nothing.
. . simply luck.” Using the cognitive distortions, people are taught to examine
their thoughts, to identify any distortions, and then to modify their
thoughts in order to eliminate the distortions.