Highlights from Jonathan Otto's interview with Krystin Henley, for the Depression & Anxiety Series. Krystin, a psychologist, discusses cognitive behavioural therapy (CBT) as an effective treatment for anxiety and depression.
Krystin: My husband and I have two children, 3.5 and 2, and so CBT has come more alive in my life, trying to figure out, although I know they don’t have the cognitive capacity to understand some of these abstract ideas, I’m working creating a little library of children’s picture books so I can start to introduced some of these concepts and I’ve been particularly more interested in prevention, even though I love intervention and Doctor Nedley’s program has been one of the most fulfilling jobs that I have personally had because of the holistic approach. And so as we help clients with the intervention piece, I’m also thinking in the back of my mind, how can we prevent this? We need to start teaching children about some of these major concepts and how it impacts their life.
Jonathan: Wonderful. So you believe that pictorial aids could be really helpful for children? Have you seen it work for your children?
Krystin: Personally, I have in our home and professionally, too, when I was practicing, I would use some tools. You wanna start very simple with children, so you’re focusing on more emotions and teaching them how to be aware of their emotions and warning signs, what happens in their body, the physiological symptoms that they could feel when you’re talking about feelings and what not.
Jonathan: Excellent. Now you mentioned the value of being in a holistic context and how that’s been rewarding to you as a practitioner and this is very interesting ‘cause I’d be curious to see, when you do cognitive behavioral therapy in isolation where you know for a fact that this person is doing everything else in their life, identical to how they were doing it before which led to their depression, and now the only thing that they’re doing is cognitive behavioral therapy, they haven’t changed their diet, they haven’t included or changed anything when it came to exercise, their hydration, their exposure to spiritual things. They haven’t done any of these things. What do you find is their result [inaudible ] those that do do these other holistic areas of health?
Krystin: Well, I’ve never been involved with research in outpatient setting but it is discouraging, especially now being involved with Doctor Nedley’s residential program, it is discouraging to know that you can’t control some of those aspects, or at least you can’t force people to ... I mean, you can educate them but it’s really on them whether or not they’re gonna be enhancing their frontal lobe with those lifestyle changes that they would make. So you know, you do your best with the CBT piece while knowing it may not have the same effect or at least the speed of it, yeah, the speed of recovery won’t have the same implications.
Jonathan: I could imagine, I could imagine because they’re not [inaudible ] their mind and so for example if somebody’s Vitamin D level is the Vitamin D level of a corpse, which can happen, people can have their Vitamin D level that low, they could do [inaudible ] therapy in the wild and they would still not feel happy because their body was designed to feel happy when it has the supply it needs.
Krystin: Right. Well, and when you talk with participants who have gone through the program, most all of them talk about coming here and experiencing this fog, that they feel they’re in this fog and they can’t quite get out of it. But then maybe by day five or seven, this fog starts lifting and CBT concepts are starting to make sense to them. And then at that point, we really are able to see major changes in the therapy room. You know, we don’t have to point things out as much to them about their distortions, they’re calling themselves out when they’re experiencing a distortion and some of their core misbeliefs.
Jonathan: Do you notice the difference? Can you tangibly see the difference?
Krystin: I can see a difference. And then of course, they confirm that, they express that, “Yeah, I’m feeling a lot better, this is making sense.” It’s still challenging and I think that’s why some clinicians struggle with CBT because it takes work and there are other treatment modalities out there that seem to have a quicker fix but I think there’s beauty in challenging ourselves and really working hard at something. And because nobody is immune to, even being trained in CBT, nobody is immune to distorted thoughts and those core, core beliefs that can really creep up on you in moments where you might feel a little insecure about something that’s going on in you’re life or whatnot.
Jonathan: Can you help me identify some distorted thoughts?
Krystin: Yeah, so ... you mean, like list them?
Jonathan: Well, I would ... one, I would like you to list them and two, I’d like you to help me to find some distorted thoughts right now.
Krystin: In you? Okay. See, my accent just came, in you. Okay. Well, there are 10 of them. I can try and-
Jonathan: Oh yeah, let’s go textbook first, let’s have a look at-
Krystin: Well, typically, you’ll see, what’s common’s all or nothing thinking which is this black and white type of thinking, you’ll hear a lot of always, never, a lot of absolute language, I’m never gonna get better, things are always gonna be this way. That’s a typical and common distortion. And then there is disqualifying the positive. So that one, you might actually recognize that there’s some value for example somebody might compliment you and say, “Oh, I thought ... you’re looking so nice today,” and while you recognize the importance or that comment as a compliment, you struggle with accepting it and so you might say, “Oh, she just said that to me ‘cause she feels sorry for me ‘cause she knows I’ve been struggling with depression,” so that’s another one.
Krystin: A big one is a negative mental filter. And people kind of describe this one as if you’re wearing some glasses or something and you can’t see the positive, all you can see is the negative around you. There’s actually a great children’s book that I use for that one called Alexander and the Very Horrible, Terrible, Not So Very Good Day or something. I can’t quote that name for sure.
Jonathan: Yeah, yeah, and the child in that book, he’s dramatizing everything that’s happened.
Krystin: Right, catastrophizing everything that’s happening to him and even fantasizing, “Well, maybe this wouldn’t happen in Australia,” actually in the book. But he’s so focused about all the things that are happening to him throughout his day that are not going right and it spirals down into this vortex in which he can’t get out and that’s a common distortion and then there’s shoulds and musts. That’s also absolute type of language where we have these demands and expectations that we put on other people. “Oh, if he’s my friends, he should really do that for me,” and to combat that, we have to switch it and say, “Well, he’s my friends and I would prefer, I would like him to treat me that way. But I can’t demand or expect that I’m gonna be treated that way.
Jonathan: I’ve heard that referred to as shoulding on people or shoulding on yourself, which is a kind of colloquial crass way to ... But it’s a good way to remember it. But yeah, continue. That’s really interesting because I think that you’re getting into the fact that we’re happiest when we’re not trying to control others and their reactions and a lot of the things that we’re hoping for are manifestations of love and they can’t be commanded and so this helps open that up and so then when we see somebody do something nice for us, we’re not feeling like entitled to that action. We’re just grateful for it. Is that correct?
Krystin: Yeah, yeah. I think so and one thing too that people get really confused about when they’re learning about CBT is we make sure people understand that we don’t try and just have you think positive thoughts about yourself all the time. Sometimes, there are thoughts that we have that are very difficult to accept and they are true. But they might not necessarily be helpful for us to dwell on that thought and so for a child who may have a learning disability who could be struggling in school and realizing, “I can’t keep up with my peers. I can’t read as fast as them.” So in that case, you’re not just gonna say, “What are you talking about? You’re such a good reader.” You might have to help the child realize, “I do work at a slower pace.” But then they don’t stop there with the thought. It’s, “This is hard. This is challenging and I don’t like feeling left behind compared to my peers. But I can handle it. I can try and do my best and I don’t have to feel like a failure because of that.”
Jonathan: That’s amazing and interesting enough, my wife actually went through that and she went to the same school as you did, [Lo Melina ] and even in college, she had to get given admission to have a longer time because of a learning difficulty that she had and it’s clinical, right? But once she was given that, she aced her class and so a redefinition for her when she obviously, as you could imagine, felt always like she was behind, she was last, she was somebody that was like, “Oh, you’re continually a disappointment,” because Alexa had thought she was a total disappointment and thought that she was slacking off and that’s the opposite of who my wife is and so understanding the uniqueness in that certain ... and challenge her. I’m really fast. She’s really slow. she’s really thorough. I’m not. Right? Do you see that? Right? So she has a uniqueness in that, which is beautiful and so I think that redefining, seeing the strength in the weakness, would that be a concept that would be congruent?
Krystin: Yeah, yeah and we have to be careful to not just think thoughts or feed thoughts to people that will inflate their pride or inflate their self esteem. Self esteem is thinking highly of oneself. We’re constantly trying to help people understand that instead of focusing on self esteem, we want to focus on self worth and that is recognizing the value that I have the innate value and of course, your spiritual belief system is going to tie into that, if that fits for you. But the fact that God fearfully and wonderfully made you and you have this worth within you, but you also [inaudible ] that in other people and that’s a crucial piece I think a lot of the distortions that people struggle with.
Krystin: Then they can also find that they struggle with certain core beliefs too, which Dr. Ellis, who’s another founding father of CBT has talked about the 11 common misbeliefs as well and that those core beliefs, those deep seeded, rigid foundational beliefs that we have about ourself that we may struggle with then drives our distortions and gives us these automatic thought that then impact how we feel and how we behave in society and in our culture.
Krystin: All or nothing. I did disqualifying the positive and negative mental filter. Shoulds and musts. We have name calling. Name calling’s another one. That’s just making judgements on either yourself or other people. Pretty harsh labels too, whether or not you have enough facts or evidence to create a label for somebody. But you might even have a little bit of evidence and then you judge them harshly for something and then another cognitive distortion is magnification, minimization. So Dr. [Nedley ] actually calls this one majoring in minors and minoring in majors. So magnification, you tend to blow something small, you blow it up, make a big deal about it, whether it’s a mistake that you’ve made or a blemish that you have on your face. People tend to also blow something up in other people. If another person makes a mistake, then they’re berating them for that and so you can see how distortions also mix a lot of the time because as you magnify a mistake that somebody else has made, you also are name calling and then you might throw in a should and must as well. “You shouldn’t treat me that way.”
Krystin: So typically, when we relate to people, several distortions might be working together. Another cognitive distortion is, well, assuming the facts and there’s two subtypes. There’s mind reading. So we assume that we know what the other person is thinking when we really don’t know for sure. No matter how well you know somebody, you can’t assume what they’re thinking and then fortune telling. So you may not necessarily know what will come to be in the future. But you get yourself worked up over the possibility of something going wrong and people with this distortion tend to struggle with it. The tricky thing about automatic thoughts is it’s not necessarily words or a full sentence. It’s often not a full sentence. Sometimes, it could be an image that comes up in your mind.
Krystin: So if somebody is fortune telling about a test, they might see themselves getting the test back and they have the F and they haven’t even taken the test yet or some parents get worried about their children who might be on a vacation or on a mission trip and they have these images that pop up in their mind, these horrific things that could be happening to their child and so people often struggle with that one as well.
Jonathan: I can imagine that could come up in relationship too when it comes to jealousy and things like that, right?
Krystin: Oh yeah. For sure, yeah. That would fall into that category.
Jonathan: Like imagining things about our spouse or our partner that is not true, guess, speculative.
Jonathan: Often, I would imagine a lot of things are based on people’s trauma or something else that’s happened that causes the thought patterns to run that way, not necessarily realities. Is that true?
Krystin: Right. Yeah. Definitely and so that’s why in the depression and anxiety recovery program, we don’t just stop at the distortions. We have to dive a bit deeper with participants and help them identify their core [inaudible ] beliefs that could be rocking their world, essentially. So for example, somebody who has been molested or who has had some sort of trauma or abuse in their past, they typically struggle with a misbelief that relates back to their self worth. So not being good enough and often, you’ll also see that they don’t feel like God cares for them, has rejected them for some reason because of the guilt and the shame that they feel and they feel disgusting and based on how people have treated them, that could be reaffirming that core belief that they have about themselves, which is a really tough place to be in and so as therapists, we want people to see the truth and to really recognize that. Another cognitive distortion is emotional reasoning and so sometimes, we assume that our emotions are facts and so while we’re feeling a certain way, it doesn’t necessarily say that that’s what we are.
Krystin: So though I feel ugly, it doesn’t mean I am ugly and so we have to also work with participants to come out of that as well.
Jonathan: Okay, because I like identifying some of these examples because I think it allows people to put themselves in and almost have this done live time for them. Okay, so what about me. I’m a career driven kind of man, husband. What are some of the things somebody in my kind of position or situation life would kind of come to you for and I mean, it’s such a generalization. But we could role play in another way. But let’s list out, for example, three or four different kinds of realities so people can get an idea of what this could look like.
Krystin: As a CBT therapist, first of all, if you’re a true CBT therapist, you don’t pretend to be the expert. So I would want to get to know your story first and see just what you’ve gone through and then I would maybe show you a list of cognitive distortions and have you show me which ones you think you struggle with and then we would work on those and see, well, is it really true and even if there is some element of truth in the negative thought, then we work at finding, well, is it helpful because in the case of somebody who struggles with a learning disability, then it is true that they’ll be slower. But it’s not helpful to dwell on that and you need to work at finding a more soothing thought in that case.