Imagine yourself trying on a pair of jeans at a department store. It’s the size you normally wear but they seem a little tighter than you were expecting. You think, “I must have gained weight because I let myself have a cupcake yesterday. I am a disgusting whale with no willpower. I am never going to let myself eat a cupcake again!” If these are the thoughts running through your head and you believe them to be true, you might respond by going on a strict diet, denying yourself cupcakes and other sweets. And if you were feeling really horrible, you might head home from the store and isolate yourself, believing that a “whale” like you shouldn’t be out in public.
Now imagine having a different reaction to the very same situation: “Huh, these jeans are a little tight. I haven’t bought this brand of jeans before, so maybe their sizing is a little different than I’m used to. Plus, I’ve heard that no two pairs of jeans are cut exactly the same so you’ve got the try on multiple pairs to get the right fit.” If this is the tone of your inner monologue, you might then try on a few more pairs of jeans in different sizes until you found ones that felt better. Same situation—very different thought patterns, leading to very different sets of emotionally and behavioral results.
Cognitive Behavioral Therapy, or CBT, is a type of psychological treatment that highlights the relationships between thoughts, feelings, and behaviors. At the Columbia Center for Eating Disorders we offer CBT individually on an outpatient basis and in group format to individuals in our inpatient program. The goal of CBT is to help people re-think their thinking so that they feel better and can make choices in the service of their health (rather than their illness).
How do you know if a thought you’re having is problematic?
If you find that a certain thought comes into your head automatically, and people you trust would disagree with it, then you’re likely onto something. If the thought makes you feel crummy and leads you to act in unhealthy or self-destructive ways, it is definitely a belief that could use some re-tooling. Everyone has thoughts like this. Our triggers are by-and-large unique, though common precipitants for problematic beliefs in those struggling with an eating disorder include comparing one’s body to others or scrutinizing oneself in front of the mirror.
How can you challenge problematic thoughts?
A common way of analyzing and reworking a problematic thought is by looking at the evidence for and against it, as if you were trying your case in a court of law. Thinking of the evidence that supports your thought is usually fairly easy, while thinking of evidence that challenges the thought can be much tougher. Sometimes, enlisting the help of others can make it easier to come up with some of the evidence refuting the troubling belief. Next, review the evidence you’ve developed on both sides to reach a more reasonable conclusion. This conclusion doesn’t need to be the polar opposite of what you were originally thinking; ideally, it moves you towards slightly more balanced ground.
In our earlier example at the department store, one problematic thought might be: “These jeans don’t fit because I ate a cupcake yesterday, so I cannot eat cupcakes anymore.” Reasons this might feel true could be: “I usually wear this size in jeans, and their being too tight is evidence that I’ve gained weight. I ate a cupcake last night, which I don’t typically do.” Evidence against this thought might be: “My other jeans at home still fit, and they are in this same size. One cupcake could not make me gain enough weight to change my pants size.” One possible reasonable conclusion: “These jeans were tight, and while it is possible I’ve gained weight it’s more likely something to do with the jeans I was trying on than me. Eating one cupcake could not make me gain a significant amount of weight.”
What problematic thoughts should you try to tackle first?
If challenging beliefs you feel to be true sounds like a tall order, then break it down even further; think about your problematic thoughts as targets on a dartboard. The thoughts in the center are those that seem the most engrained, feel the most true, and might be the most resistant to change. As you move away from the bullseye, the thoughts are still problematic, but you can in some fashion imagine another way of thinking about them (even if this is acknowledging that you know they are not true for anyone else!). As you continue to work your way further from the center, identify beliefs that feel even less true.
Analyzing and reappraising problematic thoughts is tough work; a good strategy as you are getting started is to practice with the thoughts in the outermost circles. Remember, when you are playing darts, the first goal is to just hit the dartboard (thereby scoring some points!). As you become an experienced thought-analyzer, you can refine your aim and technique, work on the thoughts in the inner circles, and ultimately, tackle the most core beliefs. When you are regularly identifying and challenging your problematic thoughts, and working towards truly believing your balanced conclusion, you will both feel better and engage in healthier behaviors as a result. You will have hit the bullseye.