Using Mindfulness and Cognitive Therapy for Treating Self-Doubts

To the outside world, you are successful, attractive or popular. You have a good marriage, your kids are doing well, or you get good reviews at work. But you feel like a worthless fraud on the inside. How could your own perception be so disparate from reality?

“Most people are struggling with difficult thoughts and feelings. But the show we put on for others says ‘I’ve got it handled,'” says Steven C. Hayes, a professor of psychology at University of Nevada-Reno. In reality, however, “there’s a big difference between what’s on the outside and what’s on the inside.”

Cognitive-behavioral therapy aims to help patients identify and dismantle their self doubts in several ways. Identifying the underlying cognitive distortion that may often be unconscious to the person is key. Most people make the mistake of utilizing one or more of several common cognitive distortions in appraising their life situations. Once these distortions are understood and made conscious, labeling the situation and thought error is often a big relief, besides extremely valuable (e.g., “I get all A’s and B’s in my accounting class, but I worry or dream I’m going to fail the class. What catastrophization! How ridiculous.”)

The next step is dismantling, which requires action steps learned with a cognitive therapist. These steps include utilizing the Socratic method (“What is the likelihood that your distortion is real? If so, what will happen next? What is the worst thing that will happen? What else can I do about when I have this thought?”) until the distortion becomes clear to the conscious mind, and renders itself faulty, exaggerated, or better yet, replaced.

Now, a third-wave of cognitive-behavioral therapy movement centers on mindfulness—paying attention to the present moment. One way I have found it useful to apply with clients is to help them imagine their thoughts as fluid, just passing through their minds, rather than sticking or having legitimate power or meaning (like “passing clouds.”) This technique can diffuse their emotional power (“Here’s that old ‘stupid’ feeling again. You know, this happens every time I compare myself to George in my class. But wait, my grades are good! I am sure mean to myself. I’m just going to let that thought pass and take a deep breath. Then, I’m going to get back to studying, or take a break. Or I could remind myself/focus upon when I did well on my tests or reports.”)

Here’s an example summary of how to address the thoughts of being a fraud:

Worried about being a fraud: Resolve to try to remember that you are valuable or capable, and have come by successes honestly.

Deny: Remember past decent exam scores and/or praise from a teacher/colleague.

Accept: Understand that everyone feels this way from time to time and ask yourself if worrying is worth it.

“Part of what mindfulness does is get to you to recognize that these critical thoughts are really stories you have created about yourself. They are not necessarily true, but they can have self-fulfilling consequences,” says Zindel V. Segal, a professor of psychiatry at the University of Toronto who devised Mindfulness-Based Cognitive Therapy to help depressed patients. “If you can get some distance from them, you can see that there are choices about how to respond.”

Mindfulness also involves paying attention to your breathing and other physical sensations while observing your thoughts so you have a tapestry of information to consider, says Dr. Segal. In fact, neuro-imaging studies have shown that when people consider problems mindfully, they use additional brain circuits beyond those that simply involve problem-solving. Randomized-controlled trials within the past ten years have shown extremely effective responses for people using the techniques for treating depression, anxiety, and even the personality disorders. I use many of these techniques also for addressing cravings for alcohol or drugs, or for addressing fears about change while undertaking sobriety.

My colleague Marsha Linehan, Ph.D., a professor of psychology at the University of Washington, summed up nicely the negative power behind such cognitive distortions: “It’s the nonjudgmental part that trips most people up,” says Dr. Linehan. “Most of us think that if we are judgmental enough, things will change. But judgment makes it harder to change.” She adds: “What happens in mindfulness over the long haul is that you finally accept that you’ve seen this soap opera before and you can turn off the TV.”


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