Excerpted from The Brain Mechanic by Spencer Lord
I'm a lot of things--naturalist, skeptic, "Bright", materialist--an evidence guy. Show me the evidence. And by "evidence," I mean show me the peer-reviewed study--with a decent sample size, double-blind, control group, the whole method.
The area of psychology responsible for seducing the stickler in me is called Cognitive Behavioral Therapy ("CBT"). Just Google it, then spend a half-a-dozen hours reading about its efficacy. CBT is adapted to treat everything--bulimia, drug addiction, anorexia, cigarette smoking, PTSD, depression, anxiety--the list goes on, and the efficacy rates are astonishing.
But what is it?
Simply put, it's "a change in thinking patterns." But what does that mean? Allow me to explain the basic premise through a few simple examples, and a pinch of autobiography. First, a thought exercise: We've all seen hidden camera shows on television. They set up the same gag and run it over and over. Why repeat it? Because every person who walks onto the set reacts differently. They each experience precisely the same set-up, or event, but they all have different emotional responses to that event. You can run the same gag all day and keep laughing because you will keep getting different, interesting, and often funny responses.
Imagine this hypothetical: Choose any one random seat at a table in an upscale restaurant. Every night at 9:00, walk into the restaurant, approach the predetermined chair, and slap its occupant across the face. In a year you will get 365 different reactions. Some people will knock your teeth out before you can escape, others will laugh hysterically, others will shrivel in fear, and others will stare intently at their friends for some kind of explanation. The emotions evoked by the slap will vary widely, as will the responses to it. Just like in the hidden camera show.
This demonstrates the first premise of CBT: Any emotions (although affected by events) do not, and cannot, directly result from them. It often appears that events cause emotions, but every restaurant slap-ee experienced precisely the same event, yet some felt remarkably different emotions following that event. The key to every emotional feeling we've ever had or ever will have is not the actual event; rather it lies between the event and the emotion that follows the event:
Event + ? = Emotion
There is something in between these two that they didn't teach us about in grammar school. In our hypothetical restaurant scenario, why did some people laugh at being slapped by a stranger, why did some feel angry or defensive, while others were afraid? It was the exact same stimulus--why the multitude of responses? The key between the two is: Belief. A CBT equation could be: EV stands for Event; EM stands for Emotion, and B stands for our Beliefs about the EVs that happen in our lives.
EV + B = EM (Events + Beliefs = Emotions)
Everyone on the hidden camera show got the exact same slap across the face (EV), but each had a different belief (B) about the slap, and thus a different emotion (EM) resulted from the exact same slap. This comes from the philosophy of Epictetus, who wrote: "Men are disturbed not by things that happen but by their opinions of things that happen." The wisdom of Epictetus lies at the heart of the CBT. You cannot be disturbed by EVs alone; it's your Bs about EVs that inform your EMs. In a nutshell, it is nearly impossible to change our emotional responses to some kinds of stress (as these are hardwired into the more primitive parts of our brain) and we generally can't control the random and potentially disturbing things (EVs) that happen to us every day. Much of life is beyond our control. Our beliefs determine how we feel about events and things, and here's where the magic happens. Are you ready for this?
You can change your beliefs. Which turns this equation:
EV + B = EM
Into this:
EV + x = EM
There is a variable in the middle--over which you have control. Yes, you can change your beliefs, and CBT teaches you precisely how. I argued too, initially, but one autumn, I personally began to understand the power of this evidence-based psychotherapy.
"The Politician Voice Effect": a political candidate appeared in an election, announcing his intent to run for office. Let's call this candidate Politician X. I disagreed with his party's platform and I didn't want him to win, and every time he came on television I truly detested the very sound of his voice. I became so angry upon hearing it that I would stop whatever I was doing, stand up, find the remote, and mute the television (or throw the remote). I was brand new to the concepts of CBT, and at the mercy of my emotions. I decided to do some experimentation. I told myself, "I cannot change the fact that Politician X is on the air a lot and that I must frequently hear his voice, so I need to find a way to make this situation more tolerable."
I reminded myself that this candidate's voice was not the real cause of my emotion--it couldn't cause my emotion. Only my beliefs about his voice were causing me to feel angry. In other words, hello, I was making myself angry about this politician. I knew my EMs were caused by my Bs, and I had to change them, but how? What exercise could I use to change my beliefs about his voice?
First, what were my beliefs about his voice? Because of his popularity, I believed he was responsible for his party's surge in the polls. I believed that the more he talked with that annoying voice the higher he and his party would climb in the polls, and I didn't want them to climb; therefore, I believed that his voice had a causal relationship to my unhappiness. How in the world could I change that belief, especially when I felt so sure it was true? I assumed that if I was right there was no reason to change my belief because my belief must be right too! "There's no reason for me to change my belief if I'm right!" I kept saying to myself. "I'm right! I'm right!"
How utterly wrong I was. There was a reason to change my beliefs, and it was a very good reason: I wanted to get some emotional relief, and let go of the anger I was feeling. But, was there a way to change my belief to a different belief that wasn't a wrong belief? My imagination went wild. How was it possible to change a belief, especially one that I felt sure was "right?" Is there a different belief that's also right? Or at the very least isn't wrong? Under what hypothetical circumstance would hearing this politician's voice result in a neutral or even positive emotion? I imagined this fictional scenario:
The phone rings, and I answer and hear: "I work for XYZ TV, as an assistant on the producer of the Saturday Night Variety show. We know you've done a lot of stage work, and you have a good ear. We would like to pay you $100,000 to consult with us on how best to impersonate Politician X in some of our skits. We really think you could help us a great deal. We know you oppose X's campaign, and your skillful mimicry of the candidate's mannerisms and vocal idiosyncrasies could do a lot to make him a laughing-stock and boost his opponent's campaign, so you'd be supporting your own political agenda, while making money and working with some big names in entertainment. Would you please consider our offer? We will send you a retainer and about twenty hours of video."
Whoa. The second I started imagining this Alternate Positive Scenario, in which I would be paid handsomely to study the politician's distinctive voice, and in which that very same voice would ultimately bring him down in the polls, rather than up, I started listening more carefully. It was like magic: My anger melted away. I actually sat there, transfixed by the candidate's voice, without any negative EMs, contemplating what it would be like if I had to study his voice for money. I replaced my original B about his voice with a new B, based on a fictional, but possible scenario. I started listening to his vowels and consonants, and imagining the comedy skits surging in popularity on the internet as the voting public mocked his voice and his political platform.
Bang. I cured my anger. I kid you not. I physically felt the tension in my chest unwind and sink back out through the back of my spine. I literally cured my anger. Now I can watch the politician for hours without a strong emotional response. It didn't matter how ludicrous this alternate scenario was. It's simply an exercise--that clearly demonstrates that there are other possible, rational responses to the same stimulus. That first definition "a change in thinking patterns" makes more sense now. It means changing your beliefs, and there are countless techniques people can use to achieve this. "But that 'alternate positive scenario' is absurd!" you say. Of course it is, but so are pull-ups. You don't do pull-ups to get anywhere, you do them to strengthen your arms. The 'alternate positive scenario' is simply an exercise that teaches people there are other ways of looking at the world (beliefs) that result in other emotions.
So, the "decent sample size, double-blind, control group" power of Cognitive Behavioral Therapy lies in its ability to change people's patterns of thinking by changing the deepest and most important aspect of their thinking processes--their Belief Systems. CBT teaches people how to eliminate dangerous and destructive negative emotions (rage, grief, depression, panic), and replace them with healthy emotions. The premise is simple: There are rational beliefs and irrational beliefs, and we can choose. CBT is the most powerful evidence-based psychotherapy available to modern psychologists.
And this is just the tip of the iceberg. It is now being used to treat pain, and even stop seizures. To read about the rest of my journey, and learn more--get your copy of "The Brain Mechanic," the layperson's guide to Cognitive Behavioral Therapy now.