Cognitive Behaviour Therapy (CBT) and “Thoughts”
We know already that having persistent thoughts – the type of thoughts we call “negative thoughts” – are unhelpful. Having thoughts such as “I can’t cope….” “I hate…” “I’d be ok if it wasn’t for this awful tinnitus” only serve to maintain the monitoring and distress reaction to tinnitus.
When they repeat over and over, it is we who are repeating them. These are thoughts our mind is making. Our mind makes them because we have “trained our brain” to do so through forming and strengthening patterns of neural firings that wire together in the brain to become “habit thoughts”.
These negative thoughts were the reason why CBT seemed to lend itself so well to what was termed the “management of tinnitus” – using primarily the cognitive therapy element of cognitive behaviour therapy to CHANGE the thoughts responsible for perpetuating distress. Surely it must follow, that changing the negative thoughts to more positive thoughts would rid us of the debilitating feelings of fear, anxiety, worry, frustration, anger, to name a few.
Indeed, it did help! Hence when research was carried out, somewhat extensively over several years, changing thoughts (cognitive restructuring) became the evidence-based treatment for tinnitus distress. It was the method used in my clinics – both NHS and private clinics from 2005 until 2018. But during those years, it was always a difficult process for patients to undertake. Those “negative thoughts” were deeply embedded as habit thoughts, and frequently proved extremely stubborn to change.
They were so stubborn and difficult to change, that it made me wonder why “thoughts” were even the target in CBT. After all, we can have thoughts that we don’t react to at all! I can have the thought of being mowed down by a bus, but it doesn’t create “a fear of being mowed down by a bus” in me, causing me to fear buses!
But what if I had been mowed down by a bus before? I’m pretty certain having thoughts about being mowed down by a bus would create fear and anxiety in me!
So, what is the difference? If it was the thought(s) – they would always cause a problem whether I had been mowed down by a bus before or not!
The difference is the meaning that is embedded in the thought(s). Components of "meaning" include implicit memory and are complex.
I explain it to patients like this:
“Think of a thought as a vehicle. Let’s use a train as an example, although you can use any vehicle that comes to mind – a car, a bus, a plane, even a bicycle!
In the train are lots of people travelling, some getting on and off at the different stations. They have bags, suitcases, food, drinks. There are staff (not many these days!) but there is probably a driver, maybe a conductor, maybe someone selling sandwiches and drinks. There’s the electricity (or coal for steam engines) that fuels the train to move, there are the rails along which the train travels, rails that adjust at just the right time depending on where the train is headed – our destination.”
So it isn’t “just a train”. When we think of a thought being a vehicle, look at how much that vehicle is carrying, and what is involved in it doing its job. Everything in the vehicle and everything that enables it to move and do its job is the equivalent to meaning behind the thought. The passengers, and the baggage etc carried by the train.
Baggage is a particularly good word to use here. Look at the “baggage” we all carry around with us. Had I been hit by a bus on a prior occasion, that would have become baggage that I would be carrying around in my consciousness (and subconsciousness). If I was hit by a bus as a child, and I am now an older adult, it is more than likely that the “memory” of being hit by a bus and the fear of it happening again is buried pretty deeply in my subconscious; it is still there though. If I was hit by a bus as an adult, the memory would likely straddle my conscious and subconscious.
We all carry conscious and subconscious information that includes not only objective facts of our experiences, but also subjective feelings, emotions, interpretations, all of which embed as fired and wired together neural pathways throughout our brain and nervous systems throughout our body.
Is it any wonder then that it is SO difficult to “change thoughts” to different thoughts?
It doesn’t even matter that we WANT to change the thoughts. Patients have said countless times: “I’m really trying, but…”
We need to go deeper than the “vehicle”. We need to account for:
- What is our DESTINATION?
- How we can get there (train, car, bus, bicycle)
- The baggage we have with us
- Which baggage we keep
- Which baggage we leave behind
- Do we need new baggage?
When we set out on a journey by train, bus, car, bicycle…. we have a destination in mind. If I am setting out from Birmingham to go to Edinburgh, I can plan my route. With all the tech we have access to nowadays, we don’t even have to work out the route for ourselves, but we do need to know where we are headed.
Destination is a separate topic that deserves its own article when we are talking ‘metaphor’. Suffice to say for now, we’d soon be lost were we headed towards Bristol when the intended destination is Edinburgh!