If you’re self-compassionate, you’ll tend to have higher self-esteem than if you’re endlessly self-critical. And like high self-esteem – self-compassion is associated with significantly less anxiety and depression, as well as more happiness, optimism, and positive emotions. ~David D. Burns
This is the month is all about therapies used to help improve mental health. Of course, I only cover some of the therapies out there because there are so many. Although I am not a counsellor, I worked as client support worker and administrative assistant in a counselling office for ten years. I have enormous respect for counsellors (including coaches and other mental health professionals). I also believe counselling can be an incredible tool for mental health recovery.
I will look at four therapies: Cognitive Behavioural Therapy (CBT), Somatic Therapy, Dialectical Behavioural Therapy, (DBT) and Art Therapy. There is so much information on these therapies so I will stick to explaining what the therapy it, explore some of the research specific to mental illness, talk about my own personal experiences with the therapy, and talk about how art can be used in combination with the therapy.
Cognitive Behavioral Therapy (I’ll use the abbreviation CBT going forward) was founded by a man called Aaron Beck in the 1960s and 1970s. CBT introduces a triangle relationship between thoughts, feelings, and behavior. The premise is if we want to change how we feel and how we behave, the easiest way is to change how we think. Often our thoughts may be inaccurate or distorted and be negatively effecting how we feel and act.
An article, “Cognitive Behavioral Therapy for Anxiety,” clinical psychologist Steven Lucero states that CBT helps individuals identify the links in the chain of thoughts that lead to increased anxiety and depression (Kerslake, 2024). Furthermore, he says that people with anxiety tend to over generalize and assume the worst (Kerslake, 2024).
There was also a 2022 study that found CBT used to with people in psychosis was associated with positive changes in mood, and sleep quality (Agbor et al.). As well, CBT lowered number of hospitalizations and increased the number of voluntary hospitalizations (Agbor et al., 2022).
When I think about using CBT in my own life, I think in four general steps. The first is developing an awareness of thoughts.
There are many ways to become aware of one’s thoughts from meditation to journalling. The importance is to identify thoughts and their impact on your feelings and actions.
The second step is asking whether your thoughts are true. In CBT, cognitive distortions are thoughts that create a negative mood and behaviour but aren’t entirely true (you can read about them below).
The third step would be taking the thoughts that are not true and identifying and challenging cognitive distortions.
Here is a brief description of ten primary cognitive distortions. I’ve used the article, “Ten Cognitive Distortions that cause Negative Thinking” as a guide (Hartney, 2023).
- All-or-nothing thinking ~ this type of thinking sees situations as black or white.
- Overgeneralization ~ this type of thinking takes one bad experience and generalizes that it will happen always.
- Mental Filters ~ only seeing the negative in a situation or relationship.
- Discounting the positive ~ only viewing the situation from a negative perspective and not seeing the positive outcomes.
- Jumping to Conclusions ~ when you assume someone is going to react in a certain way or that someone is thinking something they are not (mind reading). Also, if you think you know what will happen and want to avoid something difficult (fortune telling).
- Magnification ~ magnifying your negative qualities
- Emotional Reasoning ~ you assume your feelings are facts.
- Should statements ~ you either think you should do something, or you think you should be better at something than you are
- Labeling ~ you can label yourself or another person based on one or two behaviours.
- Personalization and Blame ~ blame yourself or another for a situation when there were many factors out of both your control.
Step four of CBT is trying to substitute your thoughts with more realistic beliefs.
One of my critiques with CBT is that we have natural emotional responses to events. Sadness, anger, fear and other emotions are not just negative emotions but healthy ways of expression. Perhaps the goal of CBT is not to get rid of emotions but to identify which thoughts create emotions and behaviours that are problematic in your life.
CBT has also been combined with other therapies, such as mindfulness and art therapy. I came across a wonderful book by Jennifer Guest called, “The CBT Art Workbook for Coping with Anxiety.” It beautifully lays out a process of using CBT with creative activities.
She talks about how anxiety and thinking are connected in two main ways: how threatening we believe a situation is and how confident we feel in our ability to cope with the situation (Guest, 2019). If we view a situation as threatening, even if it isn’t inherently a threat to our life (like public speaking), we have more negative thoughts and more anxiety. If we also feel we don’t have the coping tools we need, our anxiety is even higher, and we may avoid the situation. An art therapist practicing CBT would work with a client to lower perceiving an event as threatening and, at the same time, improving the client’s coping skills, such as deep breathing to help the client face the anxiety-producing situation.
I’m going to talk a little bit about my own experience with my thinking and with CBT. I know as a child, I had anxiety, particularly around social situations and doing well at school.
Anxiety that spiralled out of control was the precursor to my first bipolar episode. I couldn’t stop thinking about stressful and scary things and this created enormous anxiety. Everything felt like a threat in my life. I didn’t have awareness of my thoughts contributing to my anxiety or any resources to work with them. It wasn’t until 2018, three years later, that I came across Feeling Good: The New Mood Therapy by David D. Burns. I followed my thoughts for a day, and I was blown away by how many worries and negative beliefs I had. That was the first time I had some insight that perhaps some of my thinking couldn’t be trusted as a accurate reflection of my experience or sense of self.
I would say I tried to make some small changes to my inner dialogue, but negative anxious thinking is a habitual pattern which we slip back into. I tried meditation and reading about mindfulness and self-compassion to shift critical thoughts.
I had a psychiatrist in my late 20s who was a real believer in Eckart Tolle and his book The Power of Now. We would have conversations about how his principles of being present impacted mental health. During that time, I spent a lot of time just drawing myself back to the present. I felt a sense of positive control not believing in all my thoughts. I felt more at peace. However, there are limits when your doctor focuses exclusively on one approach to healing mental illness. CBT couldn’t heal my trauma.
One of CBT’s limitations is that it doesn’t heal deep-long standing trauma. CBT is a top-down therapy and doesn’t work with the body and the trauma stored there. A CBT therapist doesn’t look at the past with the client.
I have used CBT principles a lot when focusing anxious situations. I have worked to challenge thoughts that perceive everyday events as threats so that I can face fears. In an article called, “The Talking Therapy that Works,” one of the questions that a CBT therapist asks is: What is the worst thing that could possibly happen? (Albert, 2024).
I have used this question on myself many times, specifically when attending large gatherings, and public speaking. These situations still make me anxious but its if I can challenge my thinking and use my breathe to regulate, I can face these things.
When I feel like I am in a bad mood or triggered by something, I often bring it to my journal. I can explore how I am feeling, see if it is connected to what is really happening or something in the past. I engage in some CBT practices of looking for distorted thoughts and an awareness of how they might be impacting my life.
As I mentioned before in posts, I completed at CBT for Insomnia (CBT-I), an evidence-based program for getting better sleep. It was very helpful to challenge beliefs about sleep and insomnia to reduce some anxiety around sleep.
When I was working on my art therapy practitioner course, I did a unit on CBT and art therapy. One art directive used to combine both therapies is doodling. Doodling allows a person to access deeper thoughts and feelings. The Art Therapy Sourcebook says that “A nonverbal form of communication such as art can be a window to feelings and thoughts that might not be accessible through language” (Malchiodi, 2007, p. 12).
Once these thoughts and feelings are known, a practitioner can work with cognitive distortions through a CBT process. The visual aspect of art therapy and the step-by-step approach of CBT are a good combination for challenging cognitive distortions and self-limiting beliefs.
Okay, are you ready to dive into making some art?🎨
Therapeutic Arts Activity
Using doodling to uncover deeper thoughts surrounding a current issue.
Instructions
Set aside two to five minutes. Pick a theme in your life where you have some negativity around. Using felt pens and a piece of paper, start doodling spontaneous drawings without censoring anything.
After this activity, take your journal and answer the following questions:
- What specific negative thoughts or beliefs came to the surface when reflecting on your doodling?
- Did any of the shapes, lines or colours represent a particular emotion, thought, or belief? In other words, were there any symbols that brought you deeper insight into how you feel about the problem?
- Could you find any cognitive distortions? For each belief or thought, can you ask yourself if it is true?
- Can you find more realistic thoughts or self-beliefs to substitute?
Materials Needed
- Computer paper
- Markers
- Journal
- Pen
Once you’ve completed this activity, here are some questions as guidelines for your personal explorations:
1. Set aside some time where you become aware of your thoughts. Can you see how your thoughts affect your mood and your actions?
2. Have you had any individual or group therapy with CBT? What was your experience?
3. Out of the ten cognitive distortions, which ones do you struggle with the most?
4. Is there any take aways from this blog post that might help you for your mental health?
With last post still on my mind, I reflected in this activity on my negative body image as a self-limiting belief. The starry sky, the curvy goddess form and the ocean help me to transcend body self-consciousness into being in my body. I realize when I am in nature and by the ocean, I feel a joy in my body. Nothing changes in terms of my body size but everything changes about how I embody my body. This doodling reminded me about this. Doodling gets me past my inner critic and allows line and colour to be free which echos the experience I feel when I am at the ocean. I hope you enjoyed this practice. ❤️❤️❤️ With care and kindness, Meegan
In the spirit of creating a community of reflection and art making, your comments are welcome. If you choose to leave a comment, it is important to know I respect your privacy. Your information will not be given, lent, rented, or sold to anyone. However, when making a comment on the site, your IP address and browser user will be collected. Please see full Privacy details on my Privacy Policy Page Privacy Policy. If you are having a mental health emergency, please take care of yourself, and call 911 or take yourself to emergency at your closest hospital.
Sources:
Agbor C, Kaur G, Soomro FM, Eche VC, Urhi A, Ayisire OE, Kilanko A, Babalola F, Eze-Njoku C, Adaralegbe NJ, Aladum B, Oyeleye-Adegbite O, Anugwom GO. The Role of Cognitive Behavioral Therapy in the Management of Psychosis. Cureus. 2022 Sep 7;14(9):e28884. doi: 10.7759/cureus.28884. PMID: 36225466; PMCID: PMC9541382.
Edoardo, Al. (2024). The Talk Therapy That Works.The Anti-Anxiety Handbook magazine. Future PLC Quay House: Bath, England.
Guest, Jennifer. (2019). The CBT Art Workbook for Coping. Jessica Kingsley Publishers: London, UK.
Hartney, E. (2023). 10 Cognitive Distortions that can cause negative thinking. https://www.verywellmind.com/ten-cognitive-distortions-identified-in-cbt-22412.
Kerslake, R. (2024). Everything You Need to Know About Cognitive Behavioral Therapy for Anxiety. https://www.healthline.com/health/anxiety/cbt-for-anxiety#cbt-for-anxiety
Malchiodi, Cathy A. (2019). The Art Therapy Sourcebook. McGraw-Hill: New York.
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